gastrointestinal tract radiology revision notes
based on previous year questions
image based questions
for last minute revision
short notes
pg preparation notes on gastrointestinal tract
11. DES vs nut cracker esophagus
TONY SCARIA 2010 KMC
12. Nut cracker esophagus
• peristaltic sequence is normal and
• peristaltic amplitude and duration is increased in distal esophageal
body
• Rx
• Treatment should be aimed at GERD as it is unclear that chest pain in
nutcracker eso is due to acid reflux or intraluminal hypertension
TONY SCARIA 2010 KMC
14. rat tail appearance
• Barium swallow in the image shows the
typical rat tail appearance which is seen in
carcinoma of esophagus. The malignancy has
an asymmetric contour with abrupt proximal
borders of narrowed distal segment giving rat
tail appearance.
• Chest radiographs may show adenopathy, a
widened mediastinum, pulmonary or bony
metastases, or signs of tracheo-esophageal
fistula such as pneumonia
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18. Achalasia cardia
• in achalasia myenteric plexus is deficient at LES release of NO and
VIP is defective
• PRESSURE AT DISTAL END INCREASED WITH NO PERISTALSIS
• HYPERTENSIVE LES/ INCREASED LES RESTING TONE is primary pathology in
ACHALASIA . it is bcoz of dysfunction of inhibitory neurons releasing NO and
VIP so that acetylcholine releasing excitatory vagal fibres take upper hand
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38. Posterior cricoid web
• Plummer Wilson syndrome
• Predisposes to hypopharyngeal SCC
• More common in women
• Dysphagia
• Iron deficiency anemia
• Weight loss
• esophageal webs
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45. • a. Elongation and narrowing of pyloric canal (2–4 cm length)
• b. Passing of small barium streak through pyloric canal seen as a string of barium known
as string sign.
• c. Crowding of muscle folds in pyloric canal known as double/triple track sign.
• d. Transient triangular tent-like cleft/niche in mid portion of pyloric canal with apex
pointing inferiorly;
• e. Outpouching along lesser curvature due to disruption of antral peristalsis, known
aspyloric teat/teat sign.
• f. Mass impression upon antrum with streak of barium pointing toward pyloric channel,
known as beak sign/antral beaking.
• g. Indentation of the base of duodenal bulb known as umbrella/kirkling/ mushroom sign.
• h. Gastric hyperperistaltic waves known as caterpillar sign.
• i.Gastric distension with fluid.
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52. • Ultrasound (investigation of choice)
• Criteria for diagnosis include
• 1. An elongated pyloric channel (longer than 16 mm),
• 2. An enlarged pyloric diameter (greater than 14 mm),
• 3. A thickened muscle wall (greater than 4 mm).
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56. • HYPERTROPHIC PYLORIC STENOSIS
• Pyloric stenosis is the most common surgical disorder producing emesis in
infancy.
• It results from hypertrophy of the circular and longitudinal muscularis of the
pylorus and the distal antrum of the stomach with progressive narrowing of
the pyloric canal.
• hypocloremic, hypokalemic metabolic alkalosis
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57. HPS is a/w erythromycin intake in neonatal
period
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60. USG shows target sign in Hypertrophic pyloric
stenosis
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61. • IMAGING STUDIES
• A positive upper GI series can include the following diagnostic signs:
• 1. Outlining of the narrow pyloric channel by a single “string sign” or “double
track” owing to folds of mucosa
• 2. A pyloric “beak” where the pyloric entrance from the antrum occurs
• 3. The “shoulder” sign, in which the pyloric mass bulges into the antrum
• 4. Complete obstruction of the pylorus.
TONY SCARIA 2010 KMC
72. Benign ulcer Malignanat ulcer
• 95 % • 5%
• Distal stomach & lesser curvature • Fundus & proximal part of greater curvature
• Margins are smooth & rounded
• Not elevated / heaped up / beaded
• Irregular
• Heaped up & beaded
• Radiating folds smooth & symmetrical & reach
up to edge of ulcer
• Distorted folds that donot reach up to edge
• Hampton’s line lucent line at orifice of ulcer Carman meniscus sign large flat based ulcer with
heaped up edges that fold inward to tarp a lens
shaped barium collection
TONY SCARIA 2010 KMC
75. Carman meniscus sign in malignant gastric
ulcer
• A large flat based ulcer with
heaped up edges that fold
inwards to trap a lens shaped
barium collection that is convex
towards lumen
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76. Trifoliate dudodenum d/t secondary duodenal
diverticula which occurs as a result of peptic ulcer
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97. • First part of duodenum triangular cap
• Jejunum is feathery
• Valvulae conniventus
• Distinguish small bowel from large intestine
• Featureless distal ileum
• Decreased valvulae conniventis
• Large intestine
• Haustartions present in colon
• valve of houston in rectum
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103. Small bowel Large bowel
• Valvulae conniventes feathery appearance in
jejunum
• Featureless ileum
• Central in location
• Haustrations + in large intestine
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109. Single bubble sign
• Obstrn proximal to pylorus
• In pyloric stenosis
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110. Small bowel obstruction
• String of bead sign
• Step ladder sign
• Concretina effect (herring bone pattern)
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111. String of beads
• When the small bowel is filled with a large amount of fluid, a row of
small gas bubbles may be trapped between the valvulae conniventes.
The row of gas bubbles is called the “string of beads” or “string of
pearls” sign and is seen on the decubitus or upright view of the
abdomen
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121. Ileal atresia
• Multiple air level in plain x ray
• Microcolon on barium enema
• Obstruction in barium meal
• Apple peel appearance
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122. Meconeum ileus
Abdominal X ray • Dilated loops of SI
• Absence of air fluid levels d/t thick & viscous
enteric contents
• soap bubble appearance
• Entrapment of small bubbles of gas in thick viscous
meconium ground glass appearance
Contrast enema study • Microcolon (d/t disuse)
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127. Radiological signs in intussusception
Plain film • Target sign soft tissue lucency with concentric
area of lucency d/t mesenteric fat
• Meniscus sign crescent of gas shadow with in
colonic lumen that outlines apex of intussusception
Barium enema • Claw sign rounded apex of intussusception that
protrudes into contrast column
• Coiled spring sign edematous mucosal folds of
returning limb of intussusceptum outlined by
contrast material
USG • Target sign
• Bull’s eye sign
• Pseudokidney sign
• Doughnut sign
CT scan • IOC
• Target sign may be seenTONY SCARIA 2010 KMC
136. Radiological findings
Plain x ray • Large inverted U shaped loop of massively
distended sigmoid colon coffee bean sign or
bend inner tube
• Absent haustra
• Apex of loop reaching left diaphragm
Gastrograffin enema • Narrowing at site of volvulus bird of prey sign
or ace of spades sign
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144. Whirl pool sign
Bowel rotates around its mesentry with mesenteric vessels creating whorls
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145. Gallstone ileus
• Riglers triad
• Incomplete or complete small bowel
obstruction
• Gas within GB (pneumobilia)
• Ectopic gall stone
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147. RADIOLOGICAL SIGNS OF CROHNS DISEASE
• Apthous ulcer earliest
• Central flecks of barium surrounded by halo
• Rose thorn appearance
• String sign of kantor
• creeping fat on CT scan
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148. Aphthous ulcer earliest feature of crohns
disease
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154. String sign of kantor CROHNS DISEASE
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155. Radiological features of UC
• Earliest change is fine mucosal granularity
• Deep ulceration appear as ‘ collar-button’ ulcers.
• Loss of haustration in long standing disease colon become
shortened and narrowed.
• Polyp can be seen which may be due to post inflammatory polyp,
pseudopolyp, adenomatous polyps or carcinoma.
• Loss of haustral folds lead pipe or pipe stem colon
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202. Splenic rupture on xray
• Obliteration of splenic outline
• Loss of psoas outline
• Elevation of left hemidiaphragm
• Fracture of lower ribs on left side indendation of gastric outline
• IOC blunt trauma abdomen in CECT
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