Alexandria Radiology » GI & GU

GI & GU Case 21

anne — Thu, 08 Apr 2010 12:08:00 +0000

Benign entity secondary to obliteration of efferent ductules resulting in cystic appearance usually near the mediastinum. Most frequently found in patients of 50 year old or older and is often bilateral. Extratesticular lesions are typically more common than intratesticular ones. About 95 percent of intratesticular lesions are malignant. Recognition of benign lesions is important to avoid unnecessary surgery.

Benign lesions include intratesticular simple cysts, tubular ectasia, epidermoid cyst, tunica albuginea cyst, intratesticular varicocele, abscess, and hemorrhage. Benign lesions include intratesticular simple cysts, tubular ectasia, epidermoid cyst, tunica albuginea cyst, intratesticular varicocele, abscess, and hemorrhage.

GI & GU Case 20

anne — Wed, 30 Dec 2009 14:27:36 +0000

Gonadal vein thrombosis (GVT) is mostly observed in females. It can occur at any age but is classically found in the post partum period. In about 90 percent of the cases, it occurs on the right side. It is potentially fatal if it extends into the IVC and renal veins resulting in pulmonary embolism. GVT can clinically mimic other pathologies such as pyelonephritis and cholecystitis.

On CT the involved vein is enlarged with a central low attenuation area consistent with thrombus. US frequently is limited because of overlying bowel gas. Mild perivascular stranding may be encountered. Anticoagulant and intravenous (IV) antibiotic therapy is the treatment of choice.

GI & GU Case 19

anne — Mon, 13 Jul 2009 18:17:35 +0000

Adenomyosis is a benign disease of the uterus characterized by ectopic endometrial glands and stroma within the myometrium. It can be diffuse or focal. Adenomyosis occurs mainly in premenopausal women, particularly those who are multiparous. Pelvic ultrasound is commonly used as the initial imaging modality for patients with clinically suspected adenomyosis. The reported sensitivity and specificity of TAS are 32.5–63% and 95–97%, respectively. Typical appearances of adenomyosis at TVS include poorly marginated hypoechoic and heterogeneous areas within the myometrium, myometrial cysts, and a globular or enlarged uterus.

Magnetic resonance (MR) imaging is a highly accurate noninvasive modality for diagnosis. The diagnosis is typically made on high resolution T2WI. Adenomyosis appears as either diffuse or focal thickening of the junctional zone forming an ill-defined area of low signal intensity, occasionally with embedded bright foci on T2-WI corresponding to islands of ectopic endometrial tissue and cystic dilatation of glands. It has been proposed that a junctional zone thickness greater than 12 mm should further optimize the diagnostic accuracy of MR imaging.

GI & GU Case 18

anne — Mon, 13 Jul 2009 18:15:17 +0000

Fournier gangrene is a rapidly progressing necrotizing fasciitis involving the perineal, perianal, or genital regions and constitutes a true surgical emergency with a potentially high mortality rate. CT not only helps evaluate the perineal structures that can become involved by Fournier gangrene, but also helps assess the retroperitoneum, to which the disease can spread. Findings at CT include asymmetric fascial thickening, subcutaneous emphysema, fluid collections, and abscess formation. Subcutaneous emphysema is the hallmark of Fournier gangrene but is not seen in all cases. The administration of broad-spectrum antibiotics and aggressive surgical débridement of the nonviable tissue are both essential for successful treatment. An awareness of the CT features of Fournier gangrene is imperative for prompt diagnosis and effective treatment planning.

GI & GU Case 17

anne — Mon, 13 Jul 2009 18:13:19 +0000

Focal nodular hyperplasia (FNH) is the second most common benign liver tumor after hemangioma. FNH is classified into two types: classic (80% of cases) and nonclassic (20%). Magnetic resonance (MR) imaging has higher sensitivity and specificity for FNH than does ultrasonography or computed tomography (70%) and (98%) respectively.

About 1/3 of these lesions are isointense to liver parenchyma on both T1 and T2WI. Approximately 2/3 are slightly bright on T2 WI and slightly dark on T1WI. A central scar is present in approximately 65% of the cases and contains malformed vascular structures. Although not specific to FNH, the scar tend to be hypointense on T1 and hyperintense on T2 , that is in distinction to the scar seen with fobrolamellar carcinoma which tend to be hypointense on both T1 and T2 WI.

FNH demonstrates intense homogeneous enhancement during the arterial phase of gadolinium-enhanced imaging and enhancement of the central scar during later phases. The functional reticuloendothelial and hepatocellular features of FNH can be well demonstrated by scintigraphy. Approximately half of all cases of FNH demonstrate uptake of Tc-99m-labeled sulfur colloid.

GI & GU Case 16

anne — Mon, 13 Jul 2009 18:11:22 +0000

Epiploic appendages are peritoneal outpouchings that arise from the serosal surface of the colon and contain adipose tissue and vessels. Patients with epiploic appendagitis (EA) most commonly present with localized abdominal pain, more commonly on the left. The average patient is about 40 years old. Symptoms can often mimic acute appendicitis, diverticulitis, or cholecystitis. Initial labs are usually normal. The most common CT appearance is an oval lesion less than 5 cm in diameter fat attenuation abutting the anterior colonic wall.

The clinical management of acute appendagitis includes conservative treatment with pain medication. It is important to be aware of the evolutionary follow-up CT findings of acute appendagitis because these findings may persist for several months and mimic the diagnosis of acute epiploic appendagitis in the absence of a prior comparison study or suggestive clinical history.

GI & GU Case 15

anne — Mon, 13 Jul 2009 18:00:42 +0000

Meckel’s diverticulum is a congenital sacculation of the distal ileum occurring in 2 to 3 percent of people. It is usually located within 100 cm of the ileocecal valve and often contains heterotopic gastric tissue, pancreatic tissue, or both. Only about 2 percent of people with Meckel’s diverticulum develop complications. Although diverticula are equally common among males and females, males are 2 to 3 times more likely to have complications such as bleeding, perforation and obstruction. Tc-99m pertechnetate scintigraphy has an overall specificity and sensitivity of 90 percent for establishing the diagnosis.

GI & GU Case 14

anne — Mon, 13 Jul 2009 17:58:01 +0000

Emphysematous cholecystitis (EC) is a life-threatening complication of acute cholecystitis characterized by early gangrene and perforation of the gallbladder with a mortality rate of approximately 15 percent. It is the result of bacterial invasion of the gallbladder wall by gas-forming bacteria. The most common micro-organisms implicated are Clostridium species. E coli is also encountered. Vascular compromise of the cystic artery may also play a role in the etiology. EC occurs more often in elderly men.

GI & GU Case 13

anne — Mon, 13 Jul 2009 17:55:36 +0000

Didelphic uterus results from complete nonfusion of both müllerian ducts. Two separate uterine bodies with two cervices are present. A longitudinal or transverse vaginal septum may also be encountered. Associated renal anomalies which typically are ipsilateral can be associated and include renal agenesis, ectopic kidney, cystic dysplasia, and duplicated collecting system. The likelihood of having a successful pregnancy with a uterus didelphys is approximately 60 percent. Surgical correction of a uterus didelphys is rarely indicated, but pregnant women should be closely monitored for proper cervical function.

MRI is the most sensitive imaging modality for these congenital anomalies – particularly in cases of non-communicating horn which will not be depicted by conventional hysterosalpingogram.

GI & GU Case 12

anne — Mon, 13 Jul 2009 17:46:41 +0000

Adrenal carcinoma (AC) are rare, highly malignant tumors with a poor prognosis.

20% non functioning. 50% hyperfunctioning.
Size usually >5 cm
Frequently heterogenous with irregular margins
Occasionally calcified
Tendency to IVC invasion
Metastases to regional nodes, kidneys, liver, lung, bone, brain
Mets are the only reliable sign of malignancy.
Large size and calcifications are suggestive of it.

MRI shows heterogenous hyperintense lesion with heterogenous enhancement. According to early studies, high glucose uptake on FDG-PET scans suggests malignancy.

With regard to CT and adrenal masses, unenhanced density values of >10 HU are characteristic of adenomas with a high lipid content and this threshold has a sensitivity of 71% and a specificity of 98% in diagnosing such lesions. Adrenal lesions with a density of >10 HU in an unenhanced CT scan or an enhancement washout of <50% and a delayed attenuation of >35 HU are suspicious for malignancy.