CT Abdomen Case based presentation dr.damodhar, drdamodhar, sugery, ct scan

1. CASE BASED
PRESENTATION

2. HOW TO READ CT ABDOMEN

3. Case I
 28 year-old male with abdominal pain

6. Focal nodular hyperplasia
 Focal nodular hyperplasia (FNH) is a benign tumor-like mass of the liver,
second only to haemangiomas in frequency
 FNH is most frequently found in young to middle aged adults, with a strong
female predilection. 10 - 20% occur in men
 CT
- On non contrast scanning the lesion is usually hypo- or isodense, but may
appear hyperdense if the rest of the liver is fatty. A hypodense central scar
can be seen in up to 60% of lesions over 3 cm in size .
- FNH demonstrates bright arterial contrast enhancement except for the
central scar which remains hypodense .
- In the portal venous phase the lesion becomes iso dense to liver.
- The scar demonstrates enhancement on delayed scans in up to 80% of
cases

7. CASE II
 History
young-age female patient with abdominal pain

10. Superior mesenteric artery syndrome
 Compression of 3rd portion of duodenum between the aorta and superior
mesenteric artery (SMA)
 Females more affected than males
 Most often in older children, adolescents
 Some doubt the true existence of the syndrome
 Pathophysiology
 Narrowing of angle between SMA and aorta
 SMA usually forms an angle of 45 degrees with the aorta

11.  Clinical findings
 Epigastric pain ,Nausea and Repetitive vomiting
 Abdominal cramping
 Typically findings are worst in supine position and may be relived by changing
to the prone or left lateral decubitus positions
 Imaging findings
 Usually requires upper GI or CT of abdomen for diagnosis
 Megaduodenum
 Pronounced dilatation of 1st and 2nd portion of duodenum and frequently stomach
 Best seen in supine position
 Compression of duodenum between aorta and SMA

12. CASE III
 History
A middle-aged female presents with abdominal pain and swelling

15. Omental and peritoneal calcified metastatic disease from
bilateral ovarian serous cystadenocarcinomas. Left
hydronephrosis indicates distal ureteric encasement
 Omental Cake
An omental cake refers to infiltration of the omental fat by material of soft-tissue density. The
most common causes are metastases from ovary, stomach or colon.
Tuberculous peritonitis may also give this appearance.

16. CASE IV
 42 year-old female with abdominal pain

21. Ulcerative colitis with colonic mass

22. CASE V
 Diabetic patient with right iliac fossa pain

24. Emphysematous cholecysitis
 Occurs more often in men
 As opposed to gallbladder disease in general which occurs more often in
women
 Mostly elderly patients (>60) with diabetes
 Gas may occur in the wall and/or the lumen
 May spread to pericholecystic tissue
 Rarely, gas may escape into the bile ducts

25.  CT findings of (non-complicated) cholecystitis
 Most common is gallbladder wall thickening >3mm, and
 Cholelithiasis
 Increased density of bile (>20 H)
 Loss of clear definition of gallbladder wall
 Pericholecystic fluid such as a halo of edema

26. Case VI
 History
60-year old male with non-specific pain

30. Mesenteric lipodystrophy ( stage II
sclerosing mesentritis )
 Sclerosing mesentritis is a rare idiopathic disorder characterised by chronic non-specific inflammation
involving the adipose tissue of the bowel mesentery
 The disease is said to pass through 3 stages, although some authors believe these to be separate
entities :
1- mesenteric panniculitis: inflammatory reaction
2-mesenteric lipodystrophy: degeneration of mesenteric fat
3- retractile mesenteritis: fibrosis, which may be associated with distortion or lymphatic obstruction
 CT
- CT features are somewhat dependent on the main tissue component and include a well-demarcated
or ill-defined mesenteric mass like lesion with misty attenuation, soft-tissue attenuation, or both.
- The mesentery demonstrates positive mass effect and may have a ground glass opacity. Typically the
traversing mesenteric vessels and soft tissue nodules have a spared fat halo (this has sometimes been
referred to as the fat ring sign) . Its orientation is aligned with the root of the jejunal mesentery. Punctate /
coarse calcifications as well as small lymph nodes (usually <5 mm) may be present within the region