Gastrointestinal imaging : cases PDF
Preview Gastrointestinal imaging : cases
GASTROINTESTINAL IMAGING CASES Stephan W. Anderson, MD Jorge A. Soto, MD Associate Professor of Radiology Professor of Radiology Boston University School of Medicine Boston University School of Medicine Section Chief, Abdominal Imaging, Department of Radiology Vice Chairman, Department of Radiology Boston Medical Center Boston Medical Center Boston, Massachusetts Boston, Massachusetts Christine Menias, MD Professor of Radiology Mallinckrodt Institute of Radiology Washington University St. Louis, Missouri New York Chicago San Francisco Lisbon London Madrid Mexico City New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2013 by McGraw-Hill Education, LLC. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 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Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. To my wife and sons. Stephan W. Anderson, MD I would like to thank all of the Mallinckrodt family of residents, fellows, and faculty who have and continue to teach me. It’s been a great privilege. The contributions to the “Cooky Jar” all these years is the reason that this review can be made. Christine Menias, MD I dedicate this book to my parents, wife, and children. Jorge A. Soto, MD CONTENTS Contributors xi Case 1–30: Peliosis Hepatis 104 Preface xiii Case 1–31: Passive Hepatic Congestion 106 Case 1–32: Hepatic Infarction 109 Chapter 1: Liver 1 Chapter 2: Gallbladder and Biliary System 113 Case 1–1: Cavernous Hemangioma 4 Case 2–1: Ascending Cholangitis 116 Case 1–2: Hepatic Adenoma 7 Case 2–2: AIDS Cholangiopathy 119 Case 1–3: Focal Nodular Hyperplasia 11 Case 2–3: Acute Cholecystitis 123 Case 1–4: Simple Hepatic Cyst 14 Case 2–4: Acalculous Cholecystitis 126 Case 1–5: Hepatic Angiomyolipoma 17 Case 2–5: Complicated Cholecystitis 129 Case 1–6: Dysplastic Nodule 20 Case 2–6: Recurrent Pyogenic Cholangitis 132 Case 1–7: Biliary Hamartomas 22 Case 2–7: Porcelain Gallbladder 135 Case 1–8: Biliary Cystadenoma/Cystadenocarcinoma 25 Case 2–8: Primary Sclerosing Cholangitis 139 Case 1–9: Hepatic Epithelioid Hemangioendothelioma 27 Case 2–9: Adenomyomatosis 142 Case 1–10: Peribiliary Cysts 30 Case 2–10: Ampullary Stenosis 145 Case 1–11: Hepatocellular Carcinoma 34 Case 2–11: Biliary Dyskinesia 148 Case 1–12: Fibrolamellar Hepatocellular Carcinoma 39 Case 2–12: Choledocholithiasis 152 Case 1–13: Hepatic Metastases 42 Case 2–13: Mirizzi Syndrome 156 Case 1–14: Intrahepatic (Peripheral) Case 2–14: Choledochal Cyst 162 Cholangiocarcinoma 47 Case 2–15: Caroli Disease 165 Case 1–15: Pyogenic Hepatic Abscess 52 Case 2–16: Cholangiocarcinoma 170 Case 1–16: Hydatid Cyst (Echinococcosis) 56 Case 2–17: Gallbladder Carcinoma 175 Case 1–17: Amebic Liver Abscess 59 Case 2–18: Ampullary Carcinoma 178 Case 1–18: Fitz-Hugh-Curtis Syndrome Case 2–19: Gallbladder Polyps 181 (Perihepatitis) 62 Case 1–19: Hepatosplenic Candidiasis 65 Chapter 3: Pancreas 185 Case 3–1: Pancreatic Adenocarcinoma 188 Case 1–20: Acute Hepatitis 68 Case 3–2: Mucinous Cystic Neoplasms 194 Case 1–21: Hepatic Infl ammatory Pseudotumor 71 Case 3–3: Serous Cystadenoma 197 Case 1–22: Hepatic Schistosomiasis 74 Case 3–4: Solid and Papillary Case 1–23: Cirrhosis 78 Epithelial Neoplasm 200 Case 1–24: Pseudocirrhosis 84 Case 3–5: Intraductal Papillary Case 1–25: Hepatic Steatosis 86 Mucinous Neoplasm 203 Case 1–26: Hemochromatosis 91 Case 3–6: Pancreatic Endocrine Tumor 206 Case 1–27: Hepatosplenic Sarcoidosis 94 Case 3–7: Metastases to the Pancreas 209 Case 1–28: Portal Vein Thrombosis and Case 3–8: Pancreas Divisum 214 Cavernous Transformation 98 Case 3–9: Annular Pancreas 216 Case 1–29: Budd-Chiari Syndrome 101 vii Case 3–10: Acute Pancreatitis 220 Case 5–17: Esophageal Scleroderma 329 Case 3–11: Emphysematous Pancreatitis 225 Case 5–18: Esophageal Varices 331 Case 3–12: Chronic Pancreatitis 228 Case 5–19: Dysphagia Lusoria 333 Case 3–13: Autoimmune Pancreatitis 231 Case 5–20: Feline Esophagus 335 Case 3–14: Groove Pancreatitis 234 Case 5–21: Esophageal Web 337 Case 5–22: Schatzki Ring 339 Chapter 4: Spleen 237 Case 5–23: Caustic Ingestion 341 Case 4–1: Splenic Cyst 240 Case 4–2: Splenic Hemangioma 243 Chapter 6: Gastroduodenal 345 Case 4–3: Splenic Lymphangioma 246 Case 6–1: Gastric Carcinoma 348 Case 4–4: Splenic Hamartoma 249 Case 6–2: Linitis Plastica 350 Case 4–5: Splenic Angiosarcoma 252 Case 6–3: Gastrointestinal Stromal Tumor 352 Case 4–6: Splenic Metastases 255 Case 6–4: Gastric Lymphoma 355 Case 4–7: Splenic Granulomatous Disease 258 Case 6–5: Gastric Polyps 359 Case 4–8: Splenic Abscess 261 Case 6–6: Peptic Ulcer 362 Case 4–9: Splenic Hydatid Cyst 264 Case 6–7: Zollinger-Ellison Syndrome 364 Case 4–10: Splenic Fungal Infection 267 Case 6–8: Crohn Disease of the Stomach 367 Case 4–11: Splenic Sequestration 270 Case 6–9: Gastritis 369 Case 4–12: Splenic Infarction 273 Case 6–10: Gastric Diverticulum 372 Case 4–13: Splenic Torsion 276 Case 6–11: Duodenal Diverticulum 374 Case 4–14: Splenosis 279 Case 6–12: Ménétrier Disease 377 Case 6–13: Bezoar 379 Chapter 5: Esophagus 283 Case 6–14: Gastric Volvulus 381 Case 5–1: Drug-Induced Esophagitis 286 Case 6–15: Bouveret Syndrome 384 Case 5–2: Radiation Esophagitis 288 Case 6–16: Hiatal Hernia 386 Case 5–3: Refl ux Esophagitis 290 Case 6–17: Gastric Outlet Obstruction 388 Case 5–4: Viral Esophagitis 292 Case 5–5: Candida Esophagitis 295 Chapter 7: Small Bowel 391 Case 5–6: Zenker Diverticulum 300 Case 7–1: Small Bowel Polyposis 394 Case 5–7: Traction Diverticulum 303 Case 7–2: Small Bowel Carcinoma 397 Case 5–8: Pulsion Diverticula 305 Case 7–3: Small Bowel Carcinoid 400 Case 5–9: Pseudodiverticulosis 307 Case 7–4: Small Bowel Lymphoma 403 Case 5–10: Killian-Jamieson Diverticulum 309 Case 7–5: Small Bowel Diverticulitis 408 Case 5–11: Fibrovascular Polyp 312 Case 7–6: Meckel Diverticulitis 412 Case 5–12: Esophageal Leiomyoma 314 Case 7–7: Infectious Enteritis 415 Case 5–13: Esophageal Carcinoma 316 Case 7–8: Foreign Body 418 Case 5–14: Boerhaave Syndrome 322 Case 7–9: Radiation Enteritis 422 Case 5–15: Esophageal Foreign Body Case 7–10: Crohn Disease 424 (Food Impaction) 324 Case 7–11: Celiac Disease 428 Case 5–16: Achalasia 327 Case 7–12: Whipple Disease 431 viii Case 7–13: Mastocytosis 433 Case 8–17: Familial Colonic Polyposis 514 Case 7–14: Scleroderma 435 Case 8–18: Colon Carcinoma 516 Case 7–15: Small Bowel Ischemia 438 Case 8–19: Rectal Carcinoma 519 Case 7–16: Pneumatosis Intestinalis 442 Chapter 9: Omentum, Mesentry, Abdominal Case 7–17: Vasculitis of Small Bowel 445 Wall, and Peritoneum 523 Case 7–18: Small Bowel Obstruction 450 Case 9–1: Omental Infarction 526 Case 7–19: Gallstone Ileus 454 Case 9–2: Mesenteric Panniculitis 529 Case 7–20: Intussusception 457 Case 9–3: Desmoid Tumor 532 Case 9–4: Mesenteric Cyst 535 Chapter 8: Colorectal 461 Case 9–5: Malignant Peritoneal Mesothelioma 537 Case 8–1: Acute Diverticulitis 464 Case 9–6: Pseudomyxoma Peritonei 540 Case 8–2: Epiploic Appendagitis 467 Case 9–7: Inguinal Hernia 544 Case 8–3: Acute Appendicitis 469 Case 9–8: Spigelian Hernia 546 Case 8–4: Cecal Volvulus 473 Case 9–9: Femoral Hernia 549 Case 8–5: Typhlitis 476 Case 9–10: Obturator Hernia 552 Case 8–6: Toxic Megacolon 479 Case 9–11: Amyand Hernia 554 Case 8–7: Ogilvie Syndrome 481 Case 9–12: Visceral Artery Aneurysm 558 Case 8–8: Crohn Disease 483 Case 9–13: Splenic Vein Thrombosis 561 Case 8–9: Ulcerative Colitis 487 Case 9–14: Portal Vein Thrombosis 563 Case 8–10: Infectious Colitis 490 Case 9–15: Gastroduodenal Artery Case 8–11: Perirectal Fistula 493 Pseudoaneurysm 566 Case 8–12: Sigmoid Volvulus 498 Case 9–16: Splenic Artery Pseudoaneurysm 568 Case 8–13: Intussusception 501 Case 9–17: Aortoenteric Fistula 571 Case 8–14: Appendiceal Mucocele 504 Case 8–15: Pneumatosis Cystoides Coli 506 Index 575 Case 8–16: Iischemic Colitis 510 ix CONTRIBUTORS Rahul Arya, MD Steven Kussman, MD Department of Radiology Department of Radiology Boston University Medical Center Boston University Medical Center Boston, Massachusetts Boston, Massachusetts Tharakeswara Kumar Bathala, MD Vijay Ramalingam, MD Department of Radiology Department of Radiology University of Texas MD Boston University Medical Center Anderson Cancer Center Houston, Texas Boston, Massachusetts German Castrillon, MD Emilio Sanin, MD Staff Radiologist Staff Radiologist Universidad de Antioquia Hospital Pablo Tobon Uribe Medellin, Colombia Medellin, Colombia David Hindson, MD Jennifer Uyeda, MD Department of Radiology Department of Radiology Boston University Medical Center Boston University Medical Center Boston, Massachusetts Boston, Massachusetts xi PREFACE While many radiologists attain a fair degree of comfort condition at hand. Subsequently, the Findings section pres- with gastrointestinal (GI) imaging, this book aims both to ents a brief overview of the salient points of the imaging fea- reinforce the more common knowledge and expand the tures of the case. The Differential Diagnosis lists other condi- breadth of familiarity of radiologists with GI pathologies and tions which may be entertained given a similarity in clinical disease entities. This includes the presentation of clini- presentation or imaging features. The Comments section pro- cally relevant subtleties and nuances of common condi- vides a detailed description of each case, including pertinent tions, increasing the added values of the radiologists in background information, clinical presentation, pathophysiol- these common GI diagnoses. In addition, we present the ogy, and imaging fi ndings on modalities typically employed less common GI conditions and diseases which, while not in a particular case. Finally, the Pearls section lists several encountered on a daily basis, may have signifi cant clinical salient take-home points for each case, from the clinical impact in a given patient’s care. presentation to the imaging fi ndings. Ultrasound, computed This book, entitled Gastrointestinal Imaging Cases aims to tomography (CT), and magnetic resonance imaging (MRI) familiarize the reader with a wide range of entities encoun- are the predominant modalities employed throughout this tered in GI image practice. Included herein are diseases and text, a refl ection of appropriate clinical practice. In addition, conditions ranging from those which are commonly encoun- where relevant, plain radiography, fl uoroscopy, and positron tered to those which, while less common, remain clinically emission tomography (PET) are presented. relevant. Importantly, common variants and benign condi- This book is intended to be a good resource for the prac- tions are presented to allow the reader to confi dently detect ticing radiologist but is also felt to be highly appropriate for malignant and other life-threatening conditions. Naturally, the radiologist in training, from those interested in more the images provided are paramount to gaining a complete advanced training in GI imaging to those in dedicated GI understanding of the various imaging presentations of a par- imaging fellowships. The intent of this work is not to provide ticular condition, along with useful imaging features which an encyclopedic presentation of all aspects of GI imaging, allow for confi dent diagnoses. In addition, included in the but to present those conditions which are felt to be relevant body of each case, a Presentationsection highlights com- in the clinical practice of GI radiology. mon or classic clinical signs and symptoms related to the xiii
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