Hypervascular splenic lesions are findings that enhance more or similarly to the background splenic parenchyma on late arterial phase, on contrast-enhanced CT or MRI.
splenic hemangioma 2
most common primary benign neoplasm of the spleen
second most com...
Hypervascular pancreatic lesions are findings that enhance more or similarly to the background pancreatic parenchyma in the late arterial phase, on contrast-enhanced CT or MRI.
intrapancreatic accessory spleen: should not be overdiagnosed as a malignant tumor
The presence of gas in the pancreatic gland and/or the pancreatic ducts is an uncommon finding.
Causes of gas in the pancreatic ducts
altered function and/or anatomy of the sphincter of Oddi: causes duodenal-pancreatic duct reflux
patulous pancreatic duct opening 2
Differential diagnoses of cirrhotic liver nodules include regenerative liver nodules, dysplastic liver nodules, and hepatocellular carcinoma (HCC), all represent a spectrum of diseases ranging from non-neoplastic reparative process (regenerative) to nuclear atypia (dysplastic) to typical neoplas...
Mass-forming chronic pancreatitis occurs in around 30% of cases of chronic pancreatitis, where a mass or a focal enlargement of the pancreas is usually seen on imaging. In many instances, it poses a challenge as the epidemiology and imaging appearances overlap those of pancreatic adenocarcinoma....
A duodenal stricture refers to a segment of narrowing involving the duodenum. They can occur from a range of benign infective - inflammatory to malignant etiology. They can contribute to gastric outlet obstruction.
Disconnected pancreatic duct syndrome, also referred only as disconnected pancreatic duct, refers to the symptoms and complications due to the complete discontinuity of the main pancreatic duct between segments of viable secreting pancreatic tissue and the duodenum, usually seen as a sequela of ...
Retrorectal developmental cysts are rare and mostly congenital benign lesions found in the retrorectal space:
spectrum of cystic teratomas
retrorectal epidermoid cyst
retrorectal dermoid cyst
retrorectal teratoid cyst
duplication cyst of the rectum
tailgut duplication cyst
Hepatosplenomegaly is simply the simultaneous presence of a pathologically-enlarged liver (hepatomegaly) and spleen (splenomegaly).
Many infections can produce a mild concurrent enlargement of the liver and spleen. This list is by no means exhaustive.
Bowel wall thickening is a useful finding on imaging studies and has a number of different causes.
The reason for bowel wall thickening depends on the underlying etiology but includes submucosal edema, hemorrhage, and neoplastic infiltration.
In describing bow...
Intestinal failure is when a patient's native bowel is unable to digest and absorb the food, electrolytes, and fluids needed for normal growth and development.
This often includes intractable diarrhea, weight loss, dehydration, electrolyte imbalance, and malnutrition.
Diffuse colonic nodularity on barium enema or CT colonography has a range of possible etiologies:
lymphoid hyperplasia (tend to be small and discrete)
lymphoma (tend to be larger nodules and confluent)
urticaria (closely spaced polygonal lesions, history is often helpful)
Megaesophagus or diffuse esophageal dilatation can be caused by a variety of conditions.
Some of the more common causes are given below 1-3:
malignant stricture, e.g. esophageal cancer, ca...
Spontaneous splenic rupture (SSR) (also known as atraumatic splenic rupture) is rare, especially when compared to traumatic splenic rupture.
The pathogenesis of atraumatic splenic rupture is not well understood. Splenomegaly is present in almost all patients (~95%), although the rup...
Malignant esophageal neoplasms are much more common than benign esophageal neoplasms, especially if the patient is symptomatic.
esophageal carcinoma (90%)
esophageal squamous cell carcinoma (SCC)
esophageal spindle cell carcinoma
Non-neoplastic solid lesions of the pancreas are conditions which may mimic pancreatic neoplasms on imaging. They include:
intrapancreatic accessory spleen
peripancreatic lymph node
Granular mucosal pattern of the esophagus represents very fine nodularity of the esophageal mucosal surface. This finding is non-specific and may represent:
reflux esophagitis (most common)
superficial spreading esophageal carcinom...
Enteritis (plural: enteritides) refers to inflammation of the small bowel. When associated with inflammation of the stomach, the term gastroenteritis is used which is usually caused by infection.
Pancreatic atrophy is non-specific and is common in elderly patients, although in younger patients it can be a hallmark of pathology. Most commonly it is associated with aging, obesity and end-stage chronic pancreatitis.
It occurs principally with fatty replacement of the pancreas (pancreatic ...
Vertical-banded gastroplasty (VBG) is an older, purely restrictive procedure used to treat morbid obesity.
It involves creating a small gastric pouch, based on the lesser curvature of the stomach (which is thicker and less resistant to stretching than the greater curvature), by using...
Barium meal has been frequently used to differentiate malignant and benign gastric ulcers:
Features suggesting benign gastric ulcer
outpouching of ulcer crater beyond the gastric contour (exoluminal)
smooth rounded and deep ulcer crater
smooth ulcer mound
smooth gastric folds that reach the...
Right iliac fossa mass is a common clinical presentation and has a range of differentials that need to be excluded. Radiology plays an important role in this differentiation.
Subdiaphragmatic free gas is one of the ways of detecting presence of free intraperitoneal gas (i.e. pneumoperitoneum). It is the presence of free, extraluminal gas in the anterior subhepatic space.
Subdiaphragmatic free gas is well appreciated as the g...
A gasless abdomen refers to a paucity of gas on abdominal radiography, and the specific cause can usually be identified when the patient's history is known. Common causes include:
small bowel obstruction
Widening of the presacral space is one of the diagnostic indicators of the diseases involving pelvic pathology and rectal involvement. It is ideally measured on barium studies at the level of S3/4 disc level on lateral radiographs and the normal value of the presacral space is <15 mm in adults....
There are many complications that can occur following gastric banding. It is helpful to divide these into early and late post-surgical complications.
Although the exact mode of presentation can vary depending on the underlying complication common modes of presentation tha...
Gastrointestinal manifestations of AIDS are protean and can be broadly divided into opportunistic infections and tumors:
herpes simplex virus (HSV)
primary infection with HIV
The apple core sign, also known as the napkin ring sign (bowel), is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma.
The appearance of the apple-core lesion of the colon also can be caused by other diseas...
Gastric outlet obstruction is a syndrome resulting from mechanical obstruction of stomach emptying.
Gastric outlet obstruction can be due to malignant or benign causes.
adenocarcinoma (second most common 4)
lymphoma (less common than other malignancies as...
Hemoperitoneum (plural: haemoperitoneums) is the presence of blood within the peritoneal cavity.
penetrating or non-penetrating abdominal trauma (often with associated organ injury) 1
ruptured ectopic pregnancy
ovarian cyst rupture
aneurysm or pseudoaneurysm rupture
Splenic calcifications can occur in various shapes and forms and can occur from a myriad of etiological factors.
The usual calcification observed in radiographs are the multiple, miliary form presenting numerous small rounded densities averaging from three to five millimeters in diameter where ...
The differential diagnosis for a terminal ileitis is quite extensive, and includes:
inflammatory bowel disease
Crohn disease (most common)
backwash ileitis due to ulcerative colitis
Pancreatic calcifications can arise from many etiologies.
Punctate intraductal calcifications
alcoholic pancreatitis (20-40%) 2
intraductal, numerous, small, irregular
preponderant cause of diffuse pancreatic intraductal calcification
gallstone pancreatitis (2%) 2
Periampullary tumors are those that arise within 2 cm of the ampulla of Vater in the duodenum.
Tumors that fall under this group include four main types of tumors 1,4 that will be approached in their specific articles:
pancreatic head/uncinate process tumors: includes pancreatic ductal adenoca...
Pancreatitis (plural: pancreatitides) refers to inflammation involving the pancreas.
It has various forms which can be classified in many, many ways according to time of onset, etiological agent or associated pathology.
interstitial edematous pancreatitis
Intra-abdominal calcification in a neonate can be caused by a number of pathologies that cause calcification within the peritoneal space or within organs.
The commonest cause is meconium peritonitis which is the result of aseptic peritonitis secondary ...
Medical devices in the abdomen and pelvis are important to be recognized, just like medical devices of the chest. We often ignore these devices, considering them to be incidental and non-pathological, however it is essential to be aware of potential complications.
Cystic retroperitoneal lesions can carry a relatively broad differential, which includes:
retroperitoneal lymphatic malformation
retroperitoneal mucinous cystadenoma
retroperitoneal cystic teratoma
retroperitoenal cystic mesothelioma
pseudomyxoma retroperitonei with cystic change
Bulging duodenal papilla is a conical or cylindrical protuberance at the medial aspect of the descending or horizontal duodenum at the site of the sphincter of Oddi. It is a finding on small bowel follow-though (and endoscopy) and has a relatively long differential. On cross-sectional imaging, ...
The small intestine is rarely the site of malignant tumors, although it accounts for ~75% of the entire length of the GI tract and more than 90% of the mucosal surface. Approximately 40 different histologic tumor types have been described.
In this article, an overview will be given of the most...
Diaphragmatic rupture often results from blunt abdominal trauma. The mechanism of injury is typically a motor-vehicle collision.
Given that the most common mechanism is motor vehicle collisions, it is perhaps unsurprising that young men are most frequently affected. The estimated ...
HIV-associated neoplasms are numerous and can be broadly divided into two groups:
associated but not AIDS defining malignancies
The development of these malignancies in HIV affected individuals generally implies progression to AIDS 4:
There are a number of splenic lesions and anomalies:
hypervascular splenic lesions
Benign mass lesions
The double bubble sign is seen in infants and represents dilatation of the proximal duodenum and stomach. It is seen in both radiographs and ultrasound, and can be identified antenatally 2.
Causes include 1,2:
Dysphagia refers to subjective awareness of difficulty or obstruction during swallowing. It is a relatively common and increasingly prevalent clinical problem. Odynophagia is the term for painful swallowing.
Fluoroscopy is the mainstay of imaging assessment but manometry can help evaluate the e...
Causes of calcifications in the lower abdomen and pelvis include:
seminal vesicle and ductus deferens calcification
dropped stones ...
Linitis plastica is a descriptive term usually referring to the appearance of the stomach, although the rectum can also be described this way. The appearance is said to be reminiscent of an old leather water-bottle.
The underlying cause is usually a scirrhous adenocarcinoma with diff...
Diffuse small bowel disease may be caused by a number of conditions may be generalized multisystem disorders or conditions that effect the bowel in a global fashion:
Intra-abdominal calcification is common and the causes may be classified into four broad groups based on morphology:
These are discrete precipitates in a vessel or organ. They are sharp in outline but the density and shape vary but in some cases, they may be virtually pathognomonic...
Splenomegaly refers to enlargement of the spleen. The upper limit of the normal adult splenic length is traditionally cited at 12 cm, but lengths upwards of 14 cm can be seen in normal, taller males 7.
Massive splenomegaly is variably defined, including when the spleen is 5 standar...
Lower gastrointestinal bleeding usually occurs distal to the ligament of Treitz, and has a wide differential diagnosis:
An upper gastrointestinal bleed usually refers to bleeding proximal to the ligament of Treitz.
Splenic epithelial cysts, also known as splenic epidermoid cysts or primary splenic cysts, are unilocular fluid lesions with thin and smooth walls and no enhancement. They represent ~20% of cysts found in the spleen, and are usually an innocuous incidental imaging finding.
Note that most (~80%)...
The differential diagnosis of small bowel fold thickening is broad. Diffuse fold thickening may be "regular and smooth" or "irregular and nodular".
Regular, smooth generalized thickening
congestive cardiac failure (CCF)
Peritoneal calcification is seen in a limited number of conditions that result in calcification of peritoneal structures. Therefore, the differential diagnosis is small:
psammoma bodies in malignancy (most frequently cystadenocarcinoma of the ovary): fine sand-like calcification
There are numerous primary pancreatic neoplasms, in part due to the mixed endocrine and exocrine components.
Classification based on function
exocrine: ~99% of all primary pancreatic neoplasms
pancreatic ductal adenocarcinoma ~90-95%
intraductal papillary muc...
Omental cake refers to infiltration of the omental fat by material of soft-tissue density. The appearances refer to the contiguous omental mass simulating the top of a cake. Masses on the peritoneal surfaces and malignant ascites may also be present.
The most common cause is metasta...
Nodular filling defects due to mucosal lesions in the duodenum are due to a number of processes. For a differential list which includes non-mucosal lesions see duodenal filling defects.
The differential diagnosis for mucosal lesions includes:
heterotopic gastric mucosa
Discrete colonic ulcerations are nonspecific findings, and can be due to:
Cystic or necrotic appearing lymph nodes can be caused by a number of infectious, inflammatory or malignant conditions:
squamous cell carcinoma metastases
plasmacytoid T-cell leukemia
acute myeloid leukemia
herpes simplex lymphadenit...
The differential for cystic lesions of the pancreas includes:
intraductal papillary mucinous neoplasm (IPMN)
serous cystadenoma uncommonly uni/macrolocular
simple pancreatic cyst
cystic neuroendocrine tumor of the pancreas
diffuse pancreatic cysts
Colonic strictures can be long (>10 cm) or short.
scirrhous colorectal carcinoma (apple core sign)
post surgical (anastamotic stricture)
scirrhous colorectal carcinoma
inflammatory bowel disease