TEST UR RADIODIAGNOSTIC SKILLS

1. SPOTTERS-KEYS
DR. ANISH CHOUDHARY, JR 3
30.05.16

2. 1.

3. 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!

4. 2.

5. 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

6. 3.

7. Long esophageal stricture
 Findings:
 long segment of esophageal narrowing
 loss of normal mucosal pattern
 ddx:
 Long-term nasogastric intubation
 radiation

8. 4.

9. Achalasia
 Findings:
 tight stenosis of the distal
gastroesophageal junction
= “bird’s beak” appearance
 dilated proximal esophagus
 ddx:
 pseudoachalasia
 Malignant stricture
 Benign stricture
 Chagas disease

10. 5.

11. Pancreatitis
 Findings:
 diffuse narrowing of the
duodenum
 splaying of the “C-loop
 loss of normal mucosal
pattern
 ddx:
 large tumor
 pseudocyst
 hemorrhage

12. 6.

13. 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!

14. 7.

15. Ascariasis
 Findings:
 serpentine intraluminal
foreign bodies = ascaris
worms
 thin ribbon of contrast =
barium WITHIN worm GI
tract
 ddx:
 NONE!
 This is an Aunt Minnie!

16. 8.

17. 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

18. 9.

19. Boerhaave’s syndrome
 Findings:
 focal horizontal contrast extravasation in
the posterior distal esophagus
 surrounding abnormal posterior mucosa
 ddx:
 Iatrogenic
 Tumor

20. 10.

21. 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

22. 11.

23. 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!

24. 12.

25. 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

26. 13.

27. 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!

28. 14.

29. Caroli’s disease
 Findings:
 percutaneous cholangiogram shows
marked dilated and beaded appearance
of the intrahepatic biliary system
 ddx:
 NONE!
 This is an Aunt Minnie!

30. 15.

31. Cholangiocarcinoma
 Findings:
 percutaneous cholangiogram shows
smooth narrowing of the biliary duct
confluence and proximal common
hepatic duct
 ddx:
 NONE!
 This is an Aunt Minnie!

32. 16.

33. 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!

34. 17.

35. 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

36. 18.

37. 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”)

38. 19.

39. 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)

40. 20.

41. 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

42. 21.

43. Heterotopic gastric mucosa
of 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)

44. 22.

45. 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

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

47. 23. CT Hypotension Complex
Shock Bowel

48. 23.

49. 24.

50. 24. HISTOPLASMOSIS

51. 25. 81 YEAR OLD WITH HISTORY OF NON VEG DIET.

52. 25. Foreign Body (Chicken
Bone) Perforation of Bowel

53. 25. Foreign Body (Chicken
Bone) Perforation of Bowel

54. THANK YOU