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CT Duodenum,.pptx
- 17. Lecco’s Theory and Baldwin’s Theory
- 62. in the setting of unexplained pneumobilia with or without an inflamed gallbladder and in the absence of a gallstone ileus, a close look at the bowel is recommended to assess for a cholecystoenteric fistula
Editor's Notes
- S: suprarenal (adrenal) gland A: aorta/IVC D: duodenum (second and third part) P: pancreas (except tail) U: ureters C: colon (ascending and descending) K: kidneys E: (o)esophagus R: rectum
- 1st part is smooth no circular folds, moveable and show peptic ulcers
- (a) first segment of the duodenum (dashed outline in a–d) and the gallbladder (white arrow) and IVC (green arrow). (b) second segment of the duodenum and the liver (*), common bile duct (orange), portal vein (red), and pan. duct (purple). (c) the third segment of the duodenum and the SMA (blue) and aorta (yellow). (d) the fourth segment of the duodenum and the duodenojejunal junction (green) and aorta(yellow)
- Both foregut and midgut vascular supply
- . (C) Axial contrast-enhanced computed tomography (CECT) with oral water demonstrates the relationship of D2 and D3(*) with pancreas and superior mesenteric artery (SMA: dotted arrow) and superior mesenteric vein (solid arrow) medially. (D) Sagittal CECT with oral water demonstrates the relation of left renal vein (dotted arrow) and third part of duodenum (arrowhead) at the angle of aorta and SMA (solid arrow).
- Large duodenal diverticulum in a 77-yearold man. CT scan obtained with oral and intravenous contrast material shows two “duodenal lumina.” The true lumen is lateral to the diverticulum (straight arrow). The diverticulum contains an air-fluid level and causes medial displacement of the pancreatic head (curved arrow). Duodenal diverticula are common findings on abdominal CT scans.
- CT scan shows the small bowel in the right side of the abdomen and the colon in the left side. The duodenum does not cross the midline between the superior mesenteric artery and the aorta. The superior mesenteric artery is to the right of the superior mesenteric vein (arrow) rather than in its typical location to the left
- a) Diagram illustrates Lecco's theory of the development of annular pancreas, in which the left ventral bud regresses and the right ventral bud adheres to the duodenal wall and becomes stretched and elongated with rotation. (b) Diagram illustrates Baldwin's theory of the development of annular pancreas, in which the left ventral bud persists and migrates around the duodenum in opposite directions to fuse with the dorsal pancreatic bud.
- INCOMPLETE COMPLETE
- COLON 1ST AND ILEUM 2ND Sagittal reconstructed contrast-enhanced CT image (a) shows a submucosal lesion (arrow) in duodenal bulb with negative Hounsfield values (-94
- CT demonstrating a mass in the duodenum (red arrow highlighting lesion) A hamartoma is a local malformation made up of an abnormal mixture of cells and tissue.
- a) Image from a contrast-enhanced barium study shows a pedunculated polyp (arrow) in the lumen of the descending duodenum. (b) Axial CT image shows the head of a pedunculated polyp (arrow) partially occupying the lumen of the descending duodenum.
- shows a well-defined homogeneous duodenal mass (arrows), with a subtle enhancement after intravenous administration of iodinated contrast material.
- a periampullary tumor. Coronal CT image shows severe dilation of the common bile duct (asterisk) and pancreatic duct (short arrow) secondary to an ulcerated duodenal mass (arrows). . Axial cECT image ,a heterogeneous exophytic endoluminal mass , third part of the duodenum (arrows); homogeneous mass 2ND portion of the duodenum, ?duodenal adenocarcinoma (white arrow); liver metastases are also seen
- Duodenal gastrointestinal stromal tumors (GISTs) in two different patients. Axial contrast-enhanced CT images show two enhancing lesions (arrows) arising from the third portion of the duodenum (a) and the inferior duodenal flexure (b). Also note the central areas of low attenuation, suggesting necrosis
- e (a) shows an enhancing mass (white arrow) arising from the second portion of the duodenum, associated with a large exophytic component with cystic and necrotic areas inside. Liver metastases are present (black arrow). Upper endoscopy (b) shows a soft, irregular mass protruding from the duodenum wall. The histopathological diagnosis was compatible with a malignant duodenal GIST
- Axial contrast-enhanced CT image (a) shows a very hypervascular soft-tissue mass (arrows) concentrated in the third portion of the duodenum. Arteriogram
- Abdominal cramping and explosive, frequent diarrhea. Fatty poops that smell bad. Edema or swelling of your feet and legs. This can be a symptom of heart failure. Wheezing and shortness of breath. Some people might lose interest in sex or have erectile dysfunction. Jaundice, which is when your skin and whites of your eyes turn yellow. Dizziness or feeling faint. This can be a sign of low blood pressure. Feeling like your heart is racing.
- Desmoplastic reaction: this is incited by local serotonin release ▸ it can cause a radiating ‘stellate’ pattern of linear strands into the surrounding fat ▸ it may encase the mesenteric vessels with resultant c
- Axial ceCT image (a) reveals a well-defined, enhancing, exophytic mass arising from the descending duodenum (arrow). Axial excretory-phase contrast-enhanced CT image (b) demonstrates washout in the same mass (a radiating bands emanating from the second duodenal portion due to desmoplastic reaction (arrows). A periduodenal hypervascular adenopathy (arrowhead) is
- Spot radiograph from an upper gastrointestinal study shows an intrinsic duodenal mass with mucosal destruction and polypoidal filling defects (arrowheads). (b)
- ) Contrast-enhanced CT scan shows circumferential thickening of the duodenum with stranding in the adjacent mesentery and loss of fat plane with likely invasion into the head of the pancreas (P), a suspicion that was confirmed at histologic analysis
- There is an infiltrative, circumferential, and intermediate attenuation mass involving the second and third portions of the duodenum. The patient was administered oral contrast, this mass is not obstructing the gastroduodenal outflow. There is a smaller soft tissue mass which extends from the duodenal mass into the right mid abdominal mesentery. There is obstruction of the common bile duct by the duodenal mass, with dilation of the gallbladder. No adenopathy or disease elsewhere in the abdomen or pelvis is present.
- rrows) in a patient with a subungual melanoma (hematogenous or peritoneal spread). Curvedcoronal reconstructed ceCT image (b) shows a hypervascular duodenal implant (white arrows) and liver metastases (black arrows) in a patient with lung cancer (asterisk). Curved-coronal reconstructed contrast-enhanced CT image shows pancreatic tumor (asterisk) progression within duodenum (arrows).
- Axial ceCT image shows outpouching in the duodenum, filled with contrast material (arrow). (a) Axial intravenous ceCT image of the abdomen obtained in the arterial phase shows contrast material extravasation (arrow) into the second segment of the duodenum. (b) ceCT image of the abdomen obtained in the portal venous phase shows an increase in extravasation (arrow), indicating active hemorrhage. (
- (a) Coronal CT image shows small foci of extraluminal gas (arrow) adjacent to the second segment of the duodenum. (b) Axial CT image shows extraluminal extravasation of oral contrast material (arrow) adjacent to the second segment of the duodenum.
- (a) Duodenitis in shows diffuse wall thickening of the duodenum with periduodenal fat stranding (arrow). (b, c) Groove pancreatitis with epigastric pain and elevated lipase levels. Axial (b) and coronal (c) CT images show a bulky pancreatic head (*), with peripancreatic stranding and fluid (arrows in b). Note the thickening of the second segment of the duodenum, with periduodenal stranding and trace fluid.
- (a) Axial shows a 3-cm gallstone (arrow) in the first segment of the duodenum, with a choledochoduodenal fistula (arrowhead). (b) Coronal CT image shows pneumobilia (arrow) and extensive periduodenal stranding (arrowhead)
- Axial CT angiogram shows diffuse wall thickening of the duodenum with hyperattenuation, likely a duodenal hematoma (white arrow) with adjacent hemoperitoneum (*). Note the devascularization of the left kidney owing to injury to the left renal artery (black arrow). CT angiograms of the abdomen show a high-attenuation collection centered in the second and third segments of the duodenum, consistent with hematoma Deceleration injury. Axial (a) coronal (b) CT images show foci of extraluminal gas (arrow), with wall thickening of the second segment of the duodenum (arrowhead)
- (a) Axial CT angiogram in the arterial phase shows extensive periaortic stranding and soft-tissue thickening (white arrow), with a small focus of intravenous contrast material in the third segment of the duodenum (yellow arrow). (b, c) Coronal CT angiograms obtained in the arterial phase show periaortic stranding and soft-tissue thickening (arrow in b) and a small amount of contrast material in the duodenum (arrow in c). The constellation of findings is consistent for ADF
- Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal
- Axial contrast-enhanced CT image shows significant decrease in the distance between the aorta and the SMA (aortomesenteric distance), measuring 4 mm (arrow). (b) Sagittal contrast-enhanced CT image shows a decrease in the angle between the aorta and the SMA (aortomesenteric angle) (circle) to 12