Gastric Volvulus
Most common type; “upside-down stomach” Occurs in setting of large paraesophageal hernia Stomach rotates upward, with greater curvature lying above lesser curve • Mesenteroaxial volvulus: Rotation of stomach about its short…
Opportunistic Intestinal Infections
Favors distal small bowel (SB) and colon Mucosal hyper- or hypoenhancement; submucosal edema Infiltration of mesenteric fat Lymphadenopathy is very uncommon • Mycobacterial Mycobacterium avium-intracellulare (MAI): Thickened SB folds with relatively…
Acalculous Cholecystitis
Findings identical to calculous cholecystitis (except gallstones) Thickening of gallbladder wall > 3 mm Positive sonographic Murphy sign – May be absent or impossible to elicit in critically ill patients at…
Primary Sclerosing Cholangitis
Pruned appearance of biliary tree develops over time • CT/MR Thickening and hyperenhancement of bile duct wall suggests active inflammation Visualization of greater than expected number of peripheral ducts on MRCP…
Portal Vein Occlusion
Color Doppler US initially: Highly accurate and cost effective CT or MR: Complete evaluation and to search for cause TOP DIFFERENTIAL DIAGNOSES • Streaming artifact • Extrinsic compression • Budd-Chiari syndrome PATHOLOGY • Most…
Epithelioid Hemangioendothelioma
Enhancing (hyperemic) peripheral inner rim (increased vascularity) Nonenhancing peripheral outer rim or “halo” (avascular rim) Delayed or nonenhancing central part of tumor (myxoid and hyalinized stroma) • Imaging protocol: Multiphasic CT…
Sickle Cell Anemia
Splenic autoinfarction: Absent or small calcified spleen Massive splenic infarction: Rare complication defined as when > 50% of spleen is infarcted Splenic sequestration: Massive splenomegaly Splenic abscess: Usually due to…
Celiac-Sprue Disease
Mucosal hyperenhancement accompanies active ulceration Reversal of jejunoileal fold patterns (atrophied jejunal, thickened ileal) Submucosal edema, fat, or gas Small bowel intussusception Eccentric soft tissue density mass in bowel wall…
Peripheral (Intrahepatic) Cholangiocarcinoma
Most common type of CCA Well circumscribed, large, with lobulated margins Multicentricity, especially around main tumor • Periductal-infiltrating CCA Grows along bile ducts and is elongated, spiculated, or branch-like • Progressive, gradual,…
Emphysematous Cholecystitis
Best modality for identifying intramural/intraluminal gallbladder (GB) gas (100% sensitive) Gas within pericholecystic abscess or free intraperitoneal air may be present with perforation Other CT findings similar to uncomplicated cholecystitis…
