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The A to Z ofAbdominal masses:
specific appearances
Dr. Shalini GovilRadiology Department
CMC, Vellore
The A to Z ofAbdominal masses:
specific appearances
Dr. Shalini GovilRadiology Department
CMC, Vellore
AchalasiaDilated oesophagus
Food debrisTapered GEJ
Adrenal myelolipoma
Fat on US / CT&
Soft tissue (myeloid)
Bilateral multi-nodular low density adrenal massesDD: granuloma / metastases
Adult polycystic kidney disease
B/L enlarged kidneysNumerous cysts
No normal parenchymaSOL effect on calyces
Broadening of infundibuli
Angiomyolipoma-flow aneurysm-
Appendicular abscess
>6 mm diam = appendicitisRIF collection+/- appendix
Collection should lead to caecalpole
>6 mm diam = appendicitisRIF collection+/- appendix
Collection should lead to caecalpole
Appendicular cystadenocarcinoma
Widened low density lumen in RIFLeads to caecal pole
Bracket ca++/- pseudomyxoma
Bezoar
Soft tissue density and mottled airNegative cast of lumen
Bile duct stones
Radio opaque Radio lucent
Bladder leiomyoma
Obtuse angle withlumen
HomogeneousSolid
Muscle densitySmooth
Oval
Choledochal cyst
Fusiform biliary dilatationNormal calibre peripheral ductsIntrahepatic stones on US / MR
Abnormal PBJ
Crohn’s disease
Gradation of severity – skip lesionsAsymmetry – anti-mesenteric sacculations
Mesenteric longitudinal ulcers“Creeping fat” – “Comb” sign
Inter loop fistulae
Coccoon
Colonic lipoma
“cottage loaf appearance” -Liver herniation through a rent in the
diaphragm.
Cushing’s syndrome
Bilateral diffuse adrenal enlargementIncreased RP and IP fatMultiple rib fractures
Exuberant callus
Diverticulosis
Blind pouches containing debrisNo mucosal folds
Mushroom configuration
Diverticular abscess
“Saw tooth” sigmoid colon - LIFAir and contrast within collectionIntramural tracking of contrast
Duodenal carcinoid
EnhancingVascular
Intramural / luminalEnhancing duodenal / pancreatic mass: remember
neuroendocrine!
(Para) duodenal hernia
EnhancingVascular
Intramural / luminalEnhancing duodenal / pancreatic mass: remember
neuroendocrine!
Duplication cyst
Gut signatureEnhancing mucosal folds
Blind
DUPLEX KIDNEY
2 URETERS2 MOIETIES
Gangrene bowel
Air in mucosal foldsDependent air
Circumferential airAir in mesenteric veins / portal veinCheck splanchnic arteries and veins!
Coeliac artery thrombosis
GB carcinoma
GB fossa massIf confined to lumen – mucosa will not be
discernible.Sludge ball: no enhancement; may have moved since
US; turn patient; mucosa seen
Gallbladder carcinomaEnhancing GB Wall
thickeningExtension intoliver
Enhancing GB wallnodular
thickening
Ascites
Porcelain gallbladder
GIST / Leiomyosarcoma
EnhancingVascular
Intramural / luminalExophytic component
EnhancingVascular
Intramural / luminalExophytic component
GIST - stomach
EnhancingVascular
Intramural / luminalExophytic component
GIST – cystic type
Mesenteric cysts:Duplication
Cystic tumoursBCT
Omphalo-mesentericLymphatic
Haemangioma – para vertebral
Soft tissue densityPhleboliths
Mild enhancementWell defined
Bright on T2 MRI
Haemangiomaliver
Hepatic FNH
Hepaticadenoma
HCC
Hepatoblastoma
METASTASIS
Hydatid cysts liver
Daughtercysts
calcification
Hydatid cyst liverbiliary communication
Amoebic abscess Pyogenic abscess
Hepatic Abscesses
Hiatus hernia
Widens oesophageal hiatusGE junction sited above
ligamentum venosumGastric rugae seen above hiatus
Widens oesophageal hiatusGE junction sited above
ligamentum venosumGastric rugae seen above hiatus
Intussusception
Crescent of mesenteric fatLead point 75% adults
Coiled springTarget / Bull’s eyeHayfork / trident
Insulinoma
Jejunal thickening
PerforationCollection
Air fluid level
>3 mmDD: Lymphoma / TB / Crohn’s/ Carcinoma /
ischemia / necrotising infection
Krukenberg lesions
BilateralSolid, fairly homogeneous
OvalWell-defined
Soft tissue density
Leiomyoma - oesophagus
Obtuse angle with lumenHomogeneous
SolidMuscle density
Smooth
Leiomyoma - ileum
Obtuse angle with lumenHomogeneous
SolidMuscle density
SmoothOval
Lintus plastica
Rigid small capacity stomachThick wall
Intact mucosaPrimary / secondary
Omental cake & ascites can be seen in both
Liposarcoma
Fat and soft tissue density nodulesInsinuating
Encases and separates vesselsSOL effect on adjacent organs
Mg always a possibility
Lymphoma
Splenomegaly & splenic lesionsHomogeneous solid nodes
DD: TB
Lymphoma / TB
Mesenteric lymphomaSANDWICH SIGN… seen in
– – vessels and fat sandwiched by adenopathy
Mesenteric carcinoidMesenteric carcinoid
•Desmoplastic process ortethering process
•DD: radiation fibrosis,adhesions
Mesenteric carcinoidMesenteric carcinoid
•Desmoplastic process ortethering process
•DD: radiation fibrosis,adhesions
Anterior sacral meningocoele
sacral defect
mass
Neuroblastoma
Midline and para vertberal solidEncases major vessels
Ca+Extends into spinal canal
Displaces bowel anteriorly, kidneyslaterally
Midline and para vertberal solidEncases major vessels
Ca+Extends into spinal canal
Displaces bowel anteriorly, kidneyslaterally
Omental cake
OVARIAN CARCINOMAULTRASOUND
Serous cystadenoma Serous cystadenocarcinoma
OVARIAN TUMOURS
Mucinous cystadenoma
Mucinous cystadenocarcinoma
OVARIAN CARCINOMACT
OVARIAN CARCINOMAperitoneal metastases
PANCREATITIS - ACUTE NECROTISING
Low density areas lackingenhancement
Extra-pancreatic fat necrosis –mottled / bubbly soft tissueVessels seen “skeletonized”Thickening of Gerota’s and
lateroconal fascia
Pancreatic abscess
Air within necrosis / collectionRemember fistula – check contiguous
bowelFever, raised WBC count, toxic
CHRONICPANCREATITIS
Pancreatic carcinoma
Soft tissue densityInfiltrates & encases RP structures
Loss of peri vascular fat sleeveDisruption of ca+
Pancreatic cystadenocarcinoma
Solid, enhancing with central irregular low densityThick irregular septae
Well definedMay be exophytic
Extends up to splenic vesselsDD: Gastric stromal tumour
Traumatic pancreatic transection
Portal and splenic vein thrombosis
Pelvic lipomatosis
Excess fat around the rectum, bladder,ureters
Mass effect on rectal lumen, uterus / bladder
Peritoneal metastasesCa colon
Perinephric abscess
Perinephric hematoma
Pheochromocytoma
PNET
Pseudomyxoma peritonei
PUJ obstruction
RCC
Rectal haemangioma
Renal AVM
Renal trauma
RETROPERITONEAL FIBROSIS
Mantle / plaques of peri-aortic softtissue density
Elevated duodenumEncases aorta and origins
Compresses IVCCollaterals
Medial ureteric deviation
Pseudo-RPF
(Cystic) Teratoma
Rokitansky nodule
Teratomafat-fluid level
(Immature) Teratoma
Tubo-ovarian abscess
Tuberous sclerosis
TCC KIDNEY
CORONAL MPR
TCC BLADDER WITH INVOLVEMENTOF RIGHT DISTAL URETER
Uterine fibroid
Uterine: CERVICAL CARCINOMA
Vaginal extensionVaginal extension
Myometrial extension
Uterine: ENDOMETRIAL CARCINOMAUterine: ENDOMETRIAL CARCINOMA
Vascular: aorto-arteritis
Vascular: aortic aneurysm
*Contrast =aorta
*Unopacified =thrombus
*Perianeurysmalfibrosis
*Subacute leak– soft tissue
density
*Contrast =aorta
*Unopacified =thrombus
*Perianeurysmalfibrosis
*Subacute leak– soft tissue
density
Vascular: Pseudo aneurysm ofSplenic artery
contrastfilled
aneurysmlumen
contrastfilled
aneurysmlumen
thrombus
Vascular: Intra-renal pseudoaneurysm
Vascular: IVC leiomyosarcoma
Vascular: SMA SYNDROME
Beaking of 3rd part of duodenumbetween SMA and aorta
Dilated duodenum and stomachDebris in stomach
Normal duodenal wallNo RP pathology
VHL
Wilm’s tumour