GITImagingPracticeQuizesMZeba

Pancreatic Injury 🌀Anatomical Context: ➖Proximal pancreas: Right of SMV-portal vein axis. ➖Distal pancreas: Left of SMV-portal vein axis. ➖Superficial: Injury superficial to the duct. ➖Deep: Injury down to/including the duct. 🌀Key Notes: ➖Low-grade injuries (Grades I-II): Do not involve the duct. ➖High-grade injuries (Grades III-V): Involve the duct. ➖Multiple injuries advance grade up to Grade 3. MZeba (Source: Radiopedia)

Krukenberg Tumor (Carcinoma Mucocellulare) 🌀A metastatic "signet ring" cell tumor to the ovary. 🌀From primary tumors: ➖Stomach ➖colon, ➖breast, ➖lung, ➖the opposite ovary. 🌀Imaging Characteristics: ➖USG: Bilateral, often solid ovarian masses with possible cystic areas. ➖CT/MRI: Typically reveals bilateral ovarian enlargement with mixed solid-cystic lesions. The solid components may show heterogeneous enhancement. ➖PET/CT: May help identify primary sites and other metastases. MZeba (Source: Radiopedia)

GB Polyps: European Guidelines (2022) 🌔Polyp ≥10 mm: Cholecystectomy recommended if no other cause for symptoms. 🌔Polyp <10 mm: ➖Symptomatic: Cholecystectomy if no alternative cause. ➖Asymptomatic: ⚡Risk factors for malignancy: ➖6-9 mm: Cholecystectomy recommended. ➖≤5 mm: Follow-up ultrasound at 6 months, 1 year, and 2 years. ⚡No risk factors: ➖6-9 mm: Follow-up ultrasound. ➖≤5 mm: No follow-up needed. Risk factors: 1⃣Age >60, 2⃣primary sclerosing cholangitis, 3⃣Asian ethnicity, 4⃣sessile polyps, 5⃣focal wall thickening >4 mm. 6⃣Growth ≥2 mm in 2 years: Reassess with risk factors. MZeba (Source: Radiopedia)

Gallbladder Polyps 🌔Raised lesions on the gallbladder mucosa, mostly benign. 🌔USG is preferred; polyps appear as non-shadowing, immobile growths. 🌔Key Associations ➖Peutz-Jeghers syndrome ➖Familial adenomatous polyposis. 🌖Radiographic Indicators: ➖Size: Neoplastic polyps >18 mm; non-neoplastic <7.5 mm. ➖Cholesterol polyps: Usually <10 mm, single vessel, echogenic. ➖Larger polyps: Hypoechoic, possibly pedunculated, may show comet-tail artifact. 🌖High-Resolution USG: Helps distinguish neoplastic polyps if >1 cm, lobulated, with branching vessels. 🌖CT: Limited for small polyps; enhancement signals malignancy risk. MZeba (Radiopedia)

Gallbladder Adenocarcinoma: 🌀Morphologies: ➖Intraluminal mass ➖Diffuse wall thickening ➖Mass replacing gallbladder (most common) ➖Gallstones: Present in 60%-90%. 🌀USG ➖Irregular mass with low echogenicity. ➖Hyperechoic foci with shadowing (gallstones/calcifications). 🌀CT ➖Phases: Arterial (20-30s), Venous (50-60s). ➖Hypodense, irregular peripheral enhancement. ➖Large heterogeneous mass with possible necrosis/gallstones. ➖Advanced Features: Biliary dilatation, invasion, lymphadenopathy, metastasis. 🌀MRI ➖Best for staging; detects liver invasion, metastasis. ➖High sensitivity for hepatic (100%) and lymph node invasion (92%). (Source: Radiopedia) MZeba

Epiploic Appendagitis: 🌀Rare, self-limiting ischemic/inflammatory condition of the appendices epiploicae, often mistaken for diverticulitis or appendicitis. Caused by torsion or venous thrombosis, leading to ischemia and necrosis. 🌀Common Sites: ➖Rectosigmoid (57%) ➖Ileocaecal region (26%) ➖Ascending colon (9%) 🌀USG: Non-compressible, hyperechoic mass with a subtle hypoechoic rim, 2-4 cm. 🌀CT: ➖Fat-density ovoid mass (1.5-3.5 cm) adjacent to colon. ➖Hyperattenuating ring sign. ➖Central hyperdense dot (thrombosed pedicle). ➖Surrounding inflammatory fat stranding. 🌀MRI: High signal mass with inflammatory changes, vivid rim enhancement on T1 C+. 🌀DD: ➖Acute appendicitis (if right-sided) ➖diverticulitis ➖mesenteric panniculitis ➖omental infarction ➖omental neoplasms (e.g., liposarcoma). (Source: Radiopedia) MZeba

Omental Infarct: 🌀USG: 🐚Focal area of increased echogenicity in the omental fat. 🌀CT Scan: 🐚Focal area of fat stranding. 🐚Hyperdense peripheral halo. 🐚Encapsulated fatty lesion. 🐚Swirling of omental vessels may indicate omental torsion. 🌀DD: ➖Epiploic Appendagitis: Smaller fat stranding area; hyperdense central dot (thrombosed vessel). ➖Acute Appendicitis ➖Diverticulitis ➖Mesenteric Panniculitis: Differentiates by presence of a bowel loop at the end of the mesentery. ➖Liposarcoma: May resemble omental infarction but with thick enhancing septa. Source: Radiopedia MZeba

Duodenitis 🌀Inflammation of the duodenum. 🌀Causes: 1. Infective: ➖Helicobacter pylori ➖Giardiasis ➖Tropical sprue 2. Non-Infective: ➖Pancreatitis (most common) ➖Cholecystitis ➖Crohn’s Disease ➖Duodenal ulcers ➖AIDS ➖Post-radiation therapy ➖NSAIDs ➖Alcohol ➖Diverticulitis ➖Gastric hypersecretion ➖Zollinger-Ellison syndrome 🌀Radiographic Features: 1. Thickening of folds, nodules or nodular folds, erosions. 2. Deformity of the duodenal bulb. 🌀Differential Diagnosis: Brunner gland hyperplasia. (Source: Radiopedia) MZeba

Traction esophageal diverticulum: 🌀 A true esophageal diverticulum (i.e. includes all layers of the esophageal wall) 🌀 Occurs secondary to external pulling/traction forces on the esophageal wall. 🌀 Etiology ➖ Pulmonary/mediastinal scarring or fibrosis ➖ Inflammatory processes in the mediastinum: e.g. tuberculous adenitis 🌀 Radiographic features Unlike rounded pulsion diverticula (e.g. Zenker or Killian-Jamieson diverticula), a traction diverticulum is triangular or polygonal in shape, and broad-mouthed. (Radiopedia) MZeba

IPMNs enhance on ERCP due to: 1. Mucin Secretion: Mucin is enhanced with contrast. 2. Ductal Dilatation: Ducts dilated with mucin become more visible. 3. Contrast Uptake: Mucinous material absorbs contrast, enhancing visibility. 4. Papillary Projections: Papillary structures may become more pronounced with contrast. (Reference: Kozaka, K., & Hara, A. (2017). "Imaging features of intraductal papillary mucinous neoplasm of the pancreas: A review." World Journal of Gastroenterology, 23(23), 4157-4170. )

Celiac Disease/sprue ⚀ Proximal SB: Duodenum & Jejunum ⚁ Jejunal & Ileal fold reversal ⚂ Villous atrophy, loss of jejunal fold, hypersecretion➡️ barium flocculation. ⚃ Moulage sign ⚄ CT: ↗️ Dilated fluid filled bowel ↗️ Flocculation, layering ↗️ Mesenteric LN ↗️ Engorged Mesenteric vessel comb sign ⚅ Complications ☈ T-lymphoma ☈ Intussusception ☈ Pneumatosis Intestinalis ☈ Splenic atrophy ☈ Risk of thromboembolism ☈ CMLNS MZeba

Imaging of Solid Pseudopapillary Neoplasm (SPEN): 🌀Appearance: Well-defined mass with solid & cystic components. 🌀Capsule: Thick, well-defined capsule, ⬇️ 🌀Location: Pancreatic tail>>anywhere in the pancreas. 🌀Enhancement: Solid parts ➕ cystic areas less. 🌀Internal Features: May show internal hemorrhage or calcifications. MZeba

Appendicular Mass on Barium Enema: --- Non-specific signs. --- Non-filling of the appendix --- Submucosal mass lesion at the caecal pole. --- Extraluminal compression of the caecum. (Radiopedia)

GITImagingPracticeQuizesMZeba pinned «GIT SBA Quizzes by MZeba --- Liver 1. http://t.me/QuizBot?start=GC4MAiiE 2. http://t.me/QuizBot?start=vC5mEro9 3. http://t.me/QuizBot?start=lzLdkF0o --- Pancreas 1. http://t.me/QuizBot?start=fO7KKUaX 2. http://t.me/QuizBot?start=KGoKvBQ8 --- Biliary Tract…»

GIT SBA Quizzes by MZeba --- Liver 1. http://t.me/QuizBot?start=GC4MAiiE 2. http://t.me/QuizBot?start=vC5mEro9 3. http://t.me/QuizBot?start=lzLdkF0o --- Pancreas 1. http://t.me/QuizBot?start=fO7KKUaX 2. http://t.me/QuizBot?start=KGoKvBQ8 --- Biliary Tract 1. http://t.me/QuizBot?start=cdvropq5 2. http://t.me/QuizBot?start=PRP1Ma1a --- Spleen 1. http://t.me/QuizBot?start=ImELmqnC 2. http://t.me/QuizBot?start=OVmIYAs2 --- Small Bowel http://t.me/QuizBot?start=5sXwmjRf --- Colon http://t.me/QuizBot?start=5sXwmjRf --- Mesentery/Retroperitoneum 1. http://t.me/QuizBot?start=sxlgyJGv 2. http://t.me/QuizBot?start=L9p4efiA --- Esophagus & Stomach 1. http://t.me/QuizBot?start=cq0sS1RC 2. http://t.me/QuizBot?start=tEEI82Sq 3. http://t.me/QuizBot?start=BxLeFG4S --- Review Quizzes 1. http://t.me/QuizBot?start=pejP3AaT 2. http://t.me/QuizBot?start=L11rz1DI 3. http://t.me/QuizBot?start=BNi1Bpvc 4. http://t.me/QuizBot?start=OKaWnBs0 5. http://t.me/QuizBot?start=U4fCQu8r MZeba

Imaging worrisome features of IPMN that may guide further surgical intervention: 1. Main duct IPMN -- Main pancreatic duct over 5 mm -- Presence of contrast-enhancing components 2. Branch duct IPMN -- Main pancreatic duct over 5 mm -- Cyst diameter ≥3 cm -- Presence of a contrast-enhancing mural nodule ≥5 mm 16 -- Presence of solid mass -- Thickened and enhancing cyst wall -- Growth rate ≥5 mm/year (Radiopedia)

Liver Mets 🌾Hypervascular:RTMCs R:RCC T:ThyroidCa M:Melanoma C:Carcinid/ChorioCa S:Sarcoma 🌾Calcified:COP Colon Ovary Pancread 🌾Frequency:Colon>Pancreas>🫁>Stomach>liver>breast>esophagus>kidney

Biliary Stricture morphology: A. Benign features include: - Smooth - Tapered margins B. Malignant features include: -- Irregular -- Shouldered margins -- Thickened (>1.5 mm) and enhancing (on arterial and or portal venous phase) duct walls. (Radiopedia)

CT can predict perforation with high specificity (95%) in patients with known appendicitis when certain findings are present: 1. Focal defect in the enhancing appendiceal wall (most sensitive finding) 2. Appendicular abscess (most specific finding) 3. Extraluminal gas (contained locules or free intraperitoneal gas) 4. Extraluminal appendicolith 5. Extraluminal leak of enteric contrast. (Radiopedia)

POLYPOSIS SYNDROMES FAP 🔺AD 🔺Premalignant polyps colon>SB 🔺Prophylactic colectomy ⚀Gardener:Desmoid,Osteoma,Papillary Thyroid ca,Epidermoid DOP Garden ⚁Fundic gland polyposis synd:hyperplastic gastric polyps ⚂Turcots:CNS tumors (gliomas&medulo) HNPPCC/LYNCH 🔺AD 🔺Adenomatous polyps 🔺Other cancer:Endometrial, Stomach&SB, Liver& billiary 🔼Urothelial Tumors PEUTZ JEGHERS 🔺AD 🔺Hamartomatous pedunculated polyps SB 🔺Skin:perioral mucocutaneous pigm 🔺Gynecological ➕gastric,duodenal&colonic malig COWDEN 🔺AD 🔺Hamartomatous polyps:skin➕ext mucous membrane➕GIT 🔺⬆Risk of thyroid Ca,skin,oral,breast and uterine malignancy. CRONKHITE-CANADA 🔺Non-inherited, non AD 🔺Hamartomatous polyps thruout GIT 🔺Abnormal skin pigmentation, alopecia and onychodystrophy💅