SPOTTERS-KEYSDR. ANISH CHOUDHARY, JR 3

30.05.16

1.

Zenker’s diverticulum

Findings:

Focal contrast collection along the posterior lateral proximal esophagus connecting by a thin neck

Found at the cricopharyngeus, the Killian’s dehiscence

ddx:

NONE!

This is an Aunt Minnie!

2.

Gastric carcinoma

Findings:

Large mass projecting into the fundus with a large central ulcer

loss of normal folds and wall contour

ddx:

leiomyosarcoma

lymphoma

metastasis

3.

Long esophageal stricture

Findings:

long segment of esophageal narrowing

loss of normal mucosal pattern

ddx:

Long-term nasogastric intubation

radiation

4.

Achalasia

Findings:

tight stenosis of the distal gastroesophageal junction = “bird’s beak” appearance

dilated proximal esophagus

ddx:

pseudoachalasia

Malignant stricture

Benign stricture

Chagas disease

5.

Pancreatitis

Findings:

diffuse narrowing of the duodenum

splaying of the “C-loop

loss of normal mucosal pattern

ddx:

large tumor

pseudocyst

hemorrhage

6.

Area gastrica

Findings:

Fine linear polygonal pattern of the gastric body seen on a double contrast study

This is a normal fold pattern

ddx:

NONE!

This is an Aunt Minnie!

7.

Ascariasis

Findings:

serpentine intraluminal foreign bodies = ascaris worms

thin ribbon of contrast = barium WITHIN worm GI tract

ddx:

NONE!

This is an Aunt Minnie!

8.

Barrett’s esophagus

Findings:

Segmental narrowing of the distal esophagus with smooth tapering margins, ulcerations, and loss of normal mucosal pattern

ddx:

GERD

radiation

malignancy

9.

Boerhaave’s syndrome

Findings:

focal horizontal contrast extravasation in the posterior distal esophagus

surrounding abnormal posterior mucosa

ddx:

Iatrogenic

Tumor

10.

Brunner’s gland hyperplasia

Findings:

multiple smooth and round filling defects up to 1cm involving the bulb and descending duodenum

due to increased acidity in the duodenal bulb

ddx:

Hyperplastic polyps

Familial polyposis syndromes

11.

Bezoar

Findings:

mass-like gastric luminal filling defect composed of undigested or partially digested food

may cause obstruction

ddx:

NONE!

This is an Aunt Minnie!

12.

Pseudomembranous colitis

Findings:

numerous thickened folds of the transverse and descending colon

sloughed mucosa or debris within the lumen

ddx:

Ischemic colitis

Ulcerative colitis

Crohn’s disease

Infectious colitis

13.

Candida esophagitis

Findings:

numerous plaque-like filling defects of the distal esophagus

no erosions or narrowing seen

may appear worse with disease severity

ddx:

NONE!

This is an Aunt Minnie!

14.

Caroli’s disease

Findings:

percutaneous cholangiogram shows marked dilated and beaded appearance of the intrahepatic biliary system

ddx:

NONE!

This is an Aunt Minnie!

15.

Cholangiocarcinoma

Findings:

percutaneous cholangiogram shows smooth narrowing of the biliary duct confluence and proximal common hepatic duct

ddx:

NONE!

This is an Aunt Minnie!

16.

Lye stricture & colonic interposition

Findings:

Long segmental distal esophageal narrowing

Anteriorly located bowel loop connecting mouth of stomach = interposed colonic loop

ddx:

NONE!

This is an Aunt Minnie!

17.

Apthous ulcers

Findings:

Numerous shallow mucosal defects with a surrounding mound of edema = “bull’s eye” or “target” lesions

do NOT penetrate beyond the muscularis mucosa

ddx:

Crohn’s disease

Infectious colitides

18.

Inflammatory polyps

Findings:

islands of normal or edematous mucosa seen during active inflammation

they protrude into the lumen because the surrounding mucosa is sloughed or deeply ulcerated

ddx:

ulcerative colitis

Infectious colitis

Crohn’s disease (“cobblestone pattern”)

19.

Crohn’s disease

Findings:

multiple loops of small bowel show segmental narrowing, loss of normal mucosal pattern (cobblestone), and fistula formation

striking involvement of the terminal ileum

ddx:

lymphoma

Tuberculosis

Yersinia (TI only)

20.

Duodenal adenocarcinoma

Findings:

eccentric sessile lesion with an irregular, ulcerated surface along the lateral wall of the descending duodenum

ddx:

sessile polyp

leiomyoma / leiomyosarcoma

metastasis

21.

Heterotopic gastric mucosaof the duodenal bulb

Findings:

numerous, slightly elevated lesions measuring a few millimeters clustered in a small segment of the duodenal bulb

may have angulated or plaque-like margins

occur in up to 20% of pts.

no clinical significance

ddx:

benign lymphoid hyperplasia (if 1-2mm smooth filling defects)

22.

Erosive gastritis

Findings:

numerous 3-4mm shallow mucosal defects with a surrounding mound of edema = “bull’s eye” or “target”

do NOT penetrate beyond the muscularis mucosa

ddx:

Idiopathic (50%)

NSAIDs (greater curve)

Crohn’s disease (apthous ulcers)

Alcohol ingestion

23. A 35 yo in a motor vehicle accident with severe injuries.

23. CT Hypotension ComplexShock Bowel

23.

24.

24. HISTOPLASMOSIS

25. 81 YEAR OLD WITH HISTORY OF NON VEG DIET.

25. Foreign Body (Chicken

Bone) Perforation of Bowel

25. Foreign Body (Chicken

Bone) Perforation of Bowel

THANK YOU