The A to Z ofAbdominal masses:

specific appearances

Dr. Shalini GovilRadiology Department

CMC, Vellore

The A to Z ofAbdominal masses:

specific appearances

Dr. Shalini GovilRadiology Department

CMC, Vellore

AchalasiaDilated oesophagus

Food debrisTapered GEJ

Adrenal myelolipoma

Fat on US / CT&

Soft tissue (myeloid)

Bilateral multi-nodular low density adrenal massesDD: granuloma / metastases

Adult polycystic kidney disease

B/L enlarged kidneysNumerous cysts

No normal parenchymaSOL effect on calyces

Broadening of infundibuli

Angiomyolipoma-flow aneurysm-

Appendicular abscess

>6 mm diam = appendicitisRIF collection+/- appendix

Collection should lead to caecalpole

>6 mm diam = appendicitisRIF collection+/- appendix

Collection should lead to caecalpole

Appendicular cystadenocarcinoma

Widened low density lumen in RIFLeads to caecal pole

Bracket ca++/- pseudomyxoma

Bezoar

Soft tissue density and mottled airNegative cast of lumen

Bile duct stones

Radio opaque Radio lucent

Bladder leiomyoma

Obtuse angle withlumen

HomogeneousSolid

Muscle densitySmooth

Oval

Choledochal cyst

Fusiform biliary dilatationNormal calibre peripheral ductsIntrahepatic stones on US / MR

Abnormal PBJ

Crohn’s disease

Gradation of severity – skip lesionsAsymmetry – anti-mesenteric sacculations

Mesenteric longitudinal ulcers“Creeping fat” – “Comb” sign

Inter loop fistulae

Coccoon

Colonic lipoma

“cottage loaf appearance” -Liver herniation through a rent in the

diaphragm.

Cushing’s syndrome

Bilateral diffuse adrenal enlargementIncreased RP and IP fatMultiple rib fractures

Exuberant callus

Diverticulosis

Blind pouches containing debrisNo mucosal folds

Mushroom configuration

Diverticular abscess

“Saw tooth” sigmoid colon - LIFAir and contrast within collectionIntramural tracking of contrast

Duodenal carcinoid

EnhancingVascular

Intramural / luminalEnhancing duodenal / pancreatic mass: remember

neuroendocrine!

(Para) duodenal hernia

EnhancingVascular

Intramural / luminalEnhancing duodenal / pancreatic mass: remember

neuroendocrine!

Duplication cyst

Gut signatureEnhancing mucosal folds

Blind

DUPLEX KIDNEY

2 URETERS2 MOIETIES

Gangrene bowel

Air in mucosal foldsDependent air

Circumferential airAir in mesenteric veins / portal veinCheck splanchnic arteries and veins!

Coeliac artery thrombosis

GB carcinoma

GB fossa massIf confined to lumen – mucosa will not be

discernible.Sludge ball: no enhancement; may have moved since

US; turn patient; mucosa seen

Gallbladder carcinomaEnhancing GB Wall

thickeningExtension intoliver

Enhancing GB wallnodular

thickening

Ascites

Porcelain gallbladder

GIST / Leiomyosarcoma

EnhancingVascular

Intramural / luminalExophytic component

EnhancingVascular

Intramural / luminalExophytic component

GIST - stomach

EnhancingVascular

Intramural / luminalExophytic component

GIST – cystic type

Mesenteric cysts:Duplication

Cystic tumoursBCT

Omphalo-mesentericLymphatic

Haemangioma – para vertebral

Soft tissue densityPhleboliths

Mild enhancementWell defined

Bright on T2 MRI

Haemangiomaliver

Hepatic FNH

Hepaticadenoma

HCC

Hepatoblastoma

METASTASIS

Hydatid cysts liver

Daughtercysts

calcification

Hydatid cyst liverbiliary communication

Amoebic abscess Pyogenic abscess

Hepatic Abscesses

Hiatus hernia

Widens oesophageal hiatusGE junction sited above

ligamentum venosumGastric rugae seen above hiatus

Widens oesophageal hiatusGE junction sited above

ligamentum venosumGastric rugae seen above hiatus

Intussusception

Crescent of mesenteric fatLead point 75% adults

Coiled springTarget / Bull’s eyeHayfork / trident

Insulinoma

Jejunal thickening

PerforationCollection

Air fluid level

>3 mmDD: Lymphoma / TB / Crohn’s/ Carcinoma /

ischemia / necrotising infection

Krukenberg lesions

BilateralSolid, fairly homogeneous

OvalWell-defined

Soft tissue density

Leiomyoma - oesophagus

Obtuse angle with lumenHomogeneous

SolidMuscle density

Smooth

Leiomyoma - ileum

Obtuse angle with lumenHomogeneous

SolidMuscle density

SmoothOval

Lintus plastica

Rigid small capacity stomachThick wall

Intact mucosaPrimary / secondary

Omental cake & ascites can be seen in both

Liposarcoma

Fat and soft tissue density nodulesInsinuating

Encases and separates vesselsSOL effect on adjacent organs

Mg always a possibility

Lymphoma

Splenomegaly & splenic lesionsHomogeneous solid nodes

DD: TB

Lymphoma / TB

Mesenteric lymphomaSANDWICH SIGN… seen in

– – vessels and fat sandwiched by adenopathy

Mesenteric carcinoidMesenteric carcinoid

•Desmoplastic process ortethering process

•DD: radiation fibrosis,adhesions

Mesenteric carcinoidMesenteric carcinoid

•Desmoplastic process ortethering process

•DD: radiation fibrosis,adhesions

Anterior sacral meningocoele

sacral defect

mass

Neuroblastoma

Midline and para vertberal solidEncases major vessels

Ca+Extends into spinal canal

Displaces bowel anteriorly, kidneyslaterally

Midline and para vertberal solidEncases major vessels

Ca+Extends into spinal canal

Displaces bowel anteriorly, kidneyslaterally

Omental cake

OVARIAN CARCINOMAULTRASOUND

Serous cystadenoma Serous cystadenocarcinoma

OVARIAN TUMOURS

Mucinous cystadenoma

Mucinous cystadenocarcinoma

OVARIAN CARCINOMACT

OVARIAN CARCINOMAperitoneal metastases

PANCREATITIS - ACUTE NECROTISING

Low density areas lackingenhancement

Extra-pancreatic fat necrosis –mottled / bubbly soft tissueVessels seen “skeletonized”Thickening of Gerota’s and

lateroconal fascia

Pancreatic abscess

Air within necrosis / collectionRemember fistula – check contiguous

bowelFever, raised WBC count, toxic

CHRONICPANCREATITIS

Pancreatic carcinoma

Soft tissue densityInfiltrates & encases RP structures

Loss of peri vascular fat sleeveDisruption of ca+

Pancreatic cystadenocarcinoma

Solid, enhancing with central irregular low densityThick irregular septae

Well definedMay be exophytic

Extends up to splenic vesselsDD: Gastric stromal tumour

Traumatic pancreatic transection

Portal and splenic vein thrombosis

Pelvic lipomatosis

Excess fat around the rectum, bladder,ureters

Mass effect on rectal lumen, uterus / bladder

Peritoneal metastasesCa colon

Perinephric abscess

Perinephric hematoma

Pheochromocytoma

PNET

Pseudomyxoma peritonei

PUJ obstruction

RCC

Rectal haemangioma

Renal AVM

Renal trauma

RETROPERITONEAL FIBROSIS

Mantle / plaques of peri-aortic softtissue density

Elevated duodenumEncases aorta and origins

Compresses IVCCollaterals

Medial ureteric deviation

Pseudo-RPF

(Cystic) Teratoma

Rokitansky nodule

Teratomafat-fluid level

(Immature) Teratoma

Tubo-ovarian abscess

Tuberous sclerosis

TCC KIDNEY

CORONAL MPR

TCC BLADDER WITH INVOLVEMENTOF RIGHT DISTAL URETER

Uterine fibroid

Uterine: CERVICAL CARCINOMA

Vaginal extensionVaginal extension

Myometrial extension

Uterine: ENDOMETRIAL CARCINOMAUterine: ENDOMETRIAL CARCINOMA

Vascular: aorto-arteritis

Vascular: aortic aneurysm

*Contrast =aorta

*Unopacified =thrombus

*Perianeurysmalfibrosis

*Subacute leak– soft tissue

density

*Contrast =aorta

*Unopacified =thrombus

*Perianeurysmalfibrosis

*Subacute leak– soft tissue

density

Vascular: Pseudo aneurysm ofSplenic artery

contrastfilled

aneurysmlumen

contrastfilled

aneurysmlumen

thrombus

Vascular: Intra-renal pseudoaneurysm

Vascular: IVC leiomyosarcoma

Vascular: SMA SYNDROME

Beaking of 3rd part of duodenumbetween SMA and aorta

Dilated duodenum and stomachDebris in stomach

Normal duodenal wallNo RP pathology

VHL

Wilm’s tumour