GIT and Hepatobiliary radiology mocks

Candidal esophagitis

Pneumoperitoneum

Pseudomembranous colitis

Varicoid CA

Gastric volvulus

benign gastric ulcer with smooth folds

Malignant gastric ulcer..carman meniscus sign

Esphageal malignant stricture

Duodenal stenosis pic A and duodenal atresia pic B

Crohns..irregular stricture ascending colon..on ct thick walled gut with fat halo sign.

schatzi ring and achalasia

Gallstone ileus..riglers triad with pneumobilia

pancreatic ,liver trauma grading

Lymphangioma

Claw sign and soft tissue mass right paravertebral region..intususception

MIBG scan..left adrenal mass

Liver MRI protocol

• Examination of the liver with MRI requires numerous sequences and imaging at multiple times after the administration of gadolinium. Many variations exist, but a typical protocol would include:

• Pre-contrast

• T2• T2 fat sat• T1 weighted gradient echo in and out of phase• T1 2D or 3D gradient echo equences (e.g. VIBE)• Post-contrast

• T1 2D or 3D gradient echo equences (e.g. VIBE) at• arterial phase: 20-25 seconds• portal venous phase: 60-70 seconds• equilibrium phase: 3-5 minutes• hepatobiliary delayed phase: 10-30 minutes with and without fat sat• later delayed phase: 1 hour +/- 3 hours in some institutions

celiac angiogram

Gut malrotation with volvulus

Zenker diverticulum

killian jamieson diverticulum

Antral narrowing,,CA

MRCP..signal voids in gallbladder and distal CBD .pt presented with intermittent obstructive jaudice

Riglers triad ..gallstone ileus

Achalasia..smooth tapered narrowing of GEJ with proximal dilatation.bird beak appearance.

Emphysematous pancreatitis

Emphysematous pancreatitis pic from net

Triangular cord sign..biliary atresia

Budd chiari..hepatomegaly,heterogenous enhancement ,hepatic veins not enhanced,

Caroli disease..mutiple hypodense cystic lesions in right lobe liver with splenomegaly and multiple cysts in kidneys.

Triphasic CT,,typical hemangioma centripetal fill in.

Cecal volvulus..dilated gut loop with haustral pattern seen.

irregular mucosa and stricture narrowing ascending colon.,shortening of colon and terminal ileum pushed up..its Ileocecal TB .DD is crohns,CA

Double duct sign..CBD and pancreatic duct both dilated ..DD is pancreatic CA,ampullary CA and stone at distal ampulla

Narrowing at confluence of hepatic ducts and proximal CBD..klatskin tumor..DD is enlarged lymph nodes..Here GB is not seen bcz its full of sludge..ovoid dark area

Necrotizing enterocolitis..air in bowel wall

Ahaustral dilated gut loop ..sigmoid volvulus..next barium enema will show bird of prey sign

Gallstone,mild ascites and pneumoperitoneum shown by arrow

ERCP..image after endoscpe removed..Multiple filling defects and multiple areas of narrowing.

• what is the difference between infective cirrhosis and the cirrhosis due to PSC??

• The end result of PSC is cirrhosis which is usually characterised by a markedly distorted biliary tract with atrophy of the entire liver with the exception of the caudate lobe which is hypertrophied in almost all cases (68-98%) Atrophy involving the left lobe is a feature which somewhat distinguishes it from cirrhosis from other causes, in which the left lobe is usually hypertrophied

Right lateral decubitus film..descending and sigmoid colon smooth ahaustral.. IBD

Thickened gastric walls with transpyloric spread and no perigastric involvement..lymphoma..Difference between lymphoma and CA?

Gastric lymphoma vs adenocarcinoma• 1)Preservation of the perigastric fat planes at CT is more likely to

be seen in lymphoma than in adenocarcinoma, particularly in the presence of a bulky tumor

• 2)the stomach remains pliable even with extensive lymphomatous infiltration, and the lumen is preserved, making gastric outlet obstruction a rather uncommon feature However, non-Hodgkin gastric lymphoma should be recognized as another cause of linitis plastica, an appearance that results from dense infiltrates of lymphomatous tissue in the gastric wall without associated fibrosis .

• 3) Although transpyloric spread is more common in gastric lymphoma than in carcinoma,

• 4)Adenopathy is seen with both adenocarcinoma and lymphoma, but if it extends below the renal hila or the lymph nodes are bulky, lymphoma is more likely

• Complications such as obstruction, perforation, or fistulization can occur as a result of the disease itself or of treatment and can be detected with CT and barium studies.

Intussusception due to polyp..gut in gut appearance

Hirschprung disease.

• What is difference between technique of barium enema done if hirschprung is suspected?

• we dont inflate baloon bcz it obscures view and go for lateral view

Enlarged pancreatic soft tissue shadow with diffuse calcifications...alcoholic pancreatitis bcz in other chronic pancreatitis size of pancreas is reduced.In cystic fibrosis this also can happen

Spot film barium follow thru ..small bowel outlined by contrast normally upto cecum..ascending,transverse,descending and sigmoid colon not outlined by contrast but rectum is outlined..Fistula between cecum and rectum

Irregular stricture narrowing of terminal ileum,cecum and ascending colon,contracted,distorted cecum,ulcers,pseudopolyps...TB bcz the lesion is continuous not skip lesions. The gap between diseased gut and normal that is marked by arrow is due to thickness of gut loop.

Like previous image gap between gut loops due to wall thickening..but see here due to wall thickness lumen is not narrowed and there are few ulcers on outer margin shown by arrow.DD is lymphoma,crohns ...TB didnt appear like this it gives luminal narrowing early

Barium enema,,contrast outpouching from transverse colon to sigmoid..rectum spared..IBD more in favour of crohns .

Round Filling defect in 1st part duodenum (gallstone eroded in it) causing gastric outlet obstruction.NG passed.

ERCP..choledochal cyst type 1..next can do cross sectional images bcz these pts are at risk of cholangiocarcinoma..

MRCp..dilated pancreatic duct and its side branches..DD ampullary CA,chronic pancreatitis.

Mid part of CBD not seen..GB also not seen ..no history of surgery,its gallbladder CA infiltrated CBD

Cutoff at level of confluence of hepatic ducts and proximal CBD..Klatskin tumor.. Further cross scetional imaging..If u do PTC in this patient what will u do different?left side PTC to relieve pts symptoms

Post cholecystectomy jaundice..leakage of bile two pools.

Pancreatic divisum..pancreatic duct dilated and joins above its normal position in minor papilla...complication is pancreatitis.

Giant hemangioma with peripheral nodular enhancement..complication is kasaback meritt syndrome.Giant hemangiomas not resected they are embolized.

lesion enhancing on arterial phase with delayed enhancement of scar FNH ..its not FLC bcz that wash out on portovenous phase but see its hyperdense on delayed phase.

Celiac angiogram..see tumor blush in rt lobe..Most common treatment of HCC in pakistan is trans arterial catheter embolization TACE..but only selective branch which supply tumor is embolized otherwise hepatic ischemia will result if main hepatic artery embolized.

Multiple hypodense lesions liver and peripancreatic lymphadenopathy..lymphoma

MR pelvis and perineum axial ..T1post contrast and T2w..left ischiorectal abscess and prostatic abscess.

Cavernous transformation of portal vein..dilated tortous vessels at porta hepatis and splenomegaly.

Pancreatic mass with fat stranding,SMA encased..

MRI liver standard sequences..1st row. from left 1 is T2W see renal pelvis fluid and csf giving high signals..second image is T2 fatsat see fat supressed but fluid high..Third image is T1 out of phase imaging see chemical shift artifact..ow first image is T1 inphase bcs fluid and fat both dark..second image is post contrast T1 arterial phase fat supressed image and last is portovenous phase