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3. Case 1
 H/O: A 45year Patient with history of ovarian
mass .

5. messenteric /peritoneal soft tissue masses, massive ascites, desmoplastic
reaction (causes omental caking and tethering or mass effect of bowel)

6.  DDX:1 Pseudomyxoma peritonei (ruptured
mucocele or mucinous tumor [ovary,
appendix, pancreas])
2, messenteric tumors (desmoids, carcinoid,
lymphoma, mesothelioma),
3, endometriosis
,4, mesenteric fibrosis (TB peritonitis,
radiation, postsurgical adhesions, retractile
messenteritis

7. Peritoneal Carcinomatosis
 Intrabdominal spread of malignant tumors. Common
in ovarian, gastric, and colon cancer.
 Radiologic:

8. Case No.2
 A 50 years patient present changed bowel
habits and mass abdomen.

10. Synchronous Adenocarcinom
 DDX Colonic Narrowing
Tumor /Trauma- adenocarcinom, carcinoid, serosal
mets, endometriosis, caustic and cathartic agents,
adhesions
Infection/ Inflammatory- diverticulitis, Tuberculosis,
XRT
Congenital- IBD
Metabolic- amyloidosis, pelvic lipomatosis
Vascular- ischemia
Most common GI tract cancer, 2nd most common
cancer
Risk factors: personal history or family history of
colon/ endometrial/ breast cancer, IBD, Polyposes,
Environmental, ureterosigmoidoscopy

11.  Screening: age > 50 annual fecal occult blood test
and q2-3y sigmoidoscopy/ BE
Duke Classification: A insitu, B local extension, C
lymph nodes, D distant mets
Remember DDX coned cecum: infection (TB, CMV,
Actinomyces, Blasto, Typhoid, Yersinia, Amebiasis),
inflammation (IBD, appendicitis, typhlitis,
diverticulitis), tumor (carcinoma, met)
Duke DDX Extrinsic Colonic Masses
Neoplastic- peritoneal carcinomatosis, peritoneal
mets, pseudomyxoma, endometrioma
Nonneoplastic- appendicitis, mucocele, cholecystitis,
pancreatitis, PID

16. Pneumatosis Cystoides Intestinalis

18.  Causes: ischemia
Mucosal disruption-trauma
Infection/ inflamm (IBD, TB, divertic)
Obstruction (pyloric stenosis, Hirshsp)
Increased permeability- steroids, xrt, chemo
Pulmonary disease – COPD, CF, asthma,
chest trauma, increased intrathoracic
pressure

19.  Correlate with patient history and associated
radiologic findings
 ischemia – portal venous air,
pneumoperitoneum, vascular disruption,
bowel wall edema, “picket fencing” of SB on
barium study with separation of loops and
narrowing, a dynamic ileus, mesenteric
standing, clot of engorgement of mesenteric
vessels, abnormal bowel wall enhancement
pattern, ascites

20.  Duke DDX Multiple Colonic Filling Defects
 Multiple adenomas
 Polyposis
 Multiple adenocarcinomas
 Mets
 Lymphoma
 IBD
 Pneumatosis
 Lymphoid hyperplasia
 Infectious Colitis- Amebiasis, Schistosomiasis

21. Case 3
 H/O: Diarrhea and weight loss.

23. Whipple’s Disease
Diffuse Small Bowel Fold Thickening Whipple’s Disease.
 Bacterial infection causes diffuse SB fold thickening/ separation
of loops and low density adenopathy. Can also involve stomach.
 DDX diffuse SB fold thickening
Tumor/ Trauma- lymphoma, hemorrhage, ischemia
Infection/ infiltrative- Whipple’s, Giardia, Mycobacteria, Eos
gastroenteritis, lymphangiectasia, Strongyloides
Congenital- Crohn’s (always add TB)
Metabolic- menetrier’s, ZE, hypoalbuminemia
Vascular- lymphangiectasia
Other- Mastocytosis


24.  Duke DDX Thickened Regular Folds
Herorrhage- ischemia, bleeding diathesis, trauma
Edema- hypoproteinemia, CHF, venous or lymphatic
obstruction, lymphangiectasia, ZE, radiation enteritis
Duke DDX Thickened Irregular Folds
Inflammatory- Crohn, infection (Giardia, Strongyloides,
Whipple’s), amyloid, mastocytosis, EG
Neoplastic- lymphoma
Duke DDX Thickened Nodular Folds/ Mucosa
Infection- Giardia, MAI, Cryptosporidias, Whipple’s
Infiltrative- amyloid, lymphangiectasia, lymphoid hyperplasia,
lymphoma
(Giardiasis): Irregular fold thickening proximal SB
(Hypoalbuminemia): Generalized and regular pattern
(Lymphoma): Separation of loops and irregular fold thickening,
can also be nodular, constricting aneurysmally dilated-
Lymphoma can look like anything
(Amyloidosis): Diffuse, irregular, can also be nodular

29. “Picket fencing” pattern of fold
thickening in ischemia
 Causes of ischemia- hypovolemia,
vasoconstriction, atherosclerosis and low flow
state, arterial or venous flow occlusion,
vascular strangulation from obstruction,
vasculitis, abdominal inflammation, cytotoxic
drugs, xrt (>4500 rads)

31. Case 4
 19 yo man with incidental finding on CT.

34.  Urachal Adenocarcinoma

35. Urachal Adenocarcinoma
 Urachal carcinoma is a rare tumor (0.4% of bladder
cancers, 40% of bladder adenocarcinomas).
Adenocarcinoma comprises 90% of Urachal
carcinomas. Other 10% can be SCC, TCC, or
Sarcoma.
 Tumors usually located anterior and superior to dome
of bladder in midline (90%).
 In contradistinction to bladder tumors, calcifications
occur in 70%.
 70% occur before the age of 20.
 Prognosis is poor.

36. Case 5
 Newborn with incidental finding on US.
4 mm lesion in abdominal wall adjacent to
dome of the bladder.

38.  4 mm lesion in abdominal wall adjacent to
dome of the bladder

39. Urachal Cyst
 Urachas: the umbilical attachment of the
bladder. It is a fibrous band extending from
the dome of the bladder to umbilicus,
remnant of the allantosis and cloaca.
 The Urachas usually atrophies (umbilical
ligament) as the bladder descends into the
pelvis. Persistent canalization of the urachus
may lead to urine flow from the bladder to the
umbilicus.

40.  Different types of patency:
 Patent Urachas: entirely patent, an open,
direct connection from the umbilicus to the
bladder
 Urachal Sinus: end of urachus involving
umbilicus patent
 Urachal Diverticulum: end involving bladder
patent
 Urachal Cyst: central portion is canalized

45. Case 6
 H/O: Difficult & Pain full micturation

47.  Cystitis

48.  Inflammatory process of the bladder
 Can be caused by infection (most common),
radiation, medications (such as
Cyclophasphamide). Eosinophilic cystitis also
possible.
 Radiographic features: Mucosal thickening,
reduced bladder capacity, standing of
perivesical fat


49.  Bacterial Cystitis:
 Acute:
 Pathogens in Bacterial cystitis: E. Coli
>Staphylococcus > Streptoccus >
Pseudomonas
 Predisposing factors: Instrumentation,
trauma, bladder outlet obstruction, neurogenic
bladder, calculus, tumor

50.  Chronic Cystitis: results from repeated bacterial
infections due to such causes as reflux, diverticulum,
bladder outlet obstruction
 Emphysematous Cystitis: results from infection
(most commonly E. coli.) that causes gas within the
bladder and bladder wall
 Predisposing diseases: Diabetes mellitus, long-
standing urinary obstructio
 Tuberculosis: chronic interstitial cystitis that usually
ends in fibrosis. Typically coexists with renal TB

51.  Schistosomiasis:
 Caused by S. haematobium. Infected humans
excrete eggs in urinary tract; eggs become trapped in
mucosa causing severe granulomatous reaction
 Radiographic features: extensive calcifications in
bladder wall and ureter (hallmark), inflammatory
pseudopolyps, ureteral strictures, SCC
 Other types of Cystitis: Radiation cystitis,
Eosinophilic cystitis, Interstitial cystitis

52. Another example (this form
cyclophosphamide)

54. Another example (hemorrhagic
cystitis)

56. Case 7
 H/O: Infertility for last 04 years with lower
abdomen pain.

58. Another Patient

59.  Salpingitis Isthimica Nodosa

60.  Salpingitis Isthimica Nodosa (SIN)
 Radiographic findings: diverticula-like
outpouchings from the fallopian tubes
 The cause of SIN is unknown but there is
usually a history of PID
 It is associated with infertility and ectopic
pregnancy