(BQ) Part 2 book Diagnostic imaging gastrointestinal presents the following contents: Spleen (normal variants and artifacts, congenital, congenital,...), liver (congenital, infection, metabolic or inherited,...), biliary system (normal variants and artifacts, congenital, vascular disorders,...), pancreas (degenerative, treatment related, malignant neoplasms,...).
SECTION Spleen Introduction and Overview Imaging Approach to the Spleen 544 Normal Variants and Artifacts Accessory Spleen 548 Congenital Asplenia and Polysplenia 550 Infection Splenic Infection and Abscess 554 Degenerative Splenomegaly and Hypersplenism 558 Vascular Disorders Splenic Infarction 562 Trauma Splenic Trauma 566 Splenosis 570 Benign Neoplasms Splenic Cyst 572 Primary Splenic Tumors 574 Malignant Neoplasms Splenic Metastases and Lymphoma 578 Spleen Imaging Approach to the Spleen Embryology, Anatomy, and Physiology The spleen develops from the dorsal mesogastrium and usually rotates to the left, becoming fixed in the left subphrenic location by peritoneal reflections linking it to the diaphragm, abdominal wall, stomach (gastrosplenic ligament), and kidney (splenorenal ligament) It usually develops as "fused" mass of tissue, but variations are common One or more accessory spleens are found in up to 30% of the general population, usually small spherical structures near the splenic hilum These can enlarge, especially following splenectomy, and may simulate a neoplastic mass or cause recurrence of hematologic disease The spleen may be congenitally absent (asplenia) or have many unfused components (polysplenia) These are rare splenic anomalies and are associated with cardiovascular anomalies, situs inversus, and other anomalies, often with serious and even life-threatening consequences The spleen is rarely on a long mesentery and may be found in any abdominal or pelvic location ("wandering spleen"), placing it at risk for trauma and torsion with infarction The spleen is the largest lymphatic organ, the size of which varies among individuals and even in the same person by blood volume, state of nutrition and hydration The usual volume range is 100-250 cm³, with a mean of 150 cm³ A calculated splenic index (length x width x breadth) over 480 cm³ is considered splenomegaly The average length is up to 12 cm, with a width and breadth of and cm, respectively Imaging Issues The spleen has a unique histology, consisting of the red and white pulp, which directly affects its appearance on imaging exams The white pulp is the lymphoid tissue and the red is composed of the vascular tissue and splenic cords (plates of cells and sinusoids) Because of its vascularity, the red pulp enhances rapidly, giving the spleen a very heterogeneous pattern of enhancement on arterial phase enhanced CT or MR imaging This may be mistaken for splenic pathology but is a transient phenomenon not evident on unenhanced or later phases of enhanced imaging CT is the imaging modality of choice for the evaluation of the spleen in the acute setting (trauma or pain) MR can be additive in evaluating splenic masses and some metabolic diseases (e.g., hemochromatosis) The spleen has a relatively long T1 and T2 relaxation time This results in its appearing somewhat hypointense compared to the liver on T1WI and hyperintense on T2WI With iron deposition, the spleen may show a dramatic loss in signal Approach to the Abnormal Spleen Splenomegaly is a very common finding and may result from numerous causes, usually grouped into general etiologies, including congestion, hematologic, inflammatory-infectious , tumor, or infiltrative Given its function as a blood filter, it is not surprising that the spleen is a frequent site of metastases on postmortem examination of patients who have died from cancer However, with the exception of leukemia and lymphoma, it is uncommon to make an imaging diagnosis of splenic metastasis 544 Many splenic neoplasms are benign, either hemangiomas or lymphangiomas, but these have overlapping imaging features and a specific diagnosis is rarely possible One of the most common focal splenic lesions is the splenic cyst It is not possible to distinguish the primary congenital (epithelial-lined) cyst from the acquired cyst by imaging, with the latter resulting from prior infarction, infection, or trauma These are rarely of clinical importance Multiple lesions within the spleen are most typically the result of a granulomatous process, which may be either infectious (e.g., histoplasmosis, TB) or noninfectious (sarcoidosis) Splenic granulomata commonly calcify The pancreatic tail usually inserts into the splenic hilum through the splenorenal ligament Inflammatory or neoplastic conditions affecting the pancreatic tail can easily invade the splenic parenchyma, resulting in intrasplenic pseudocyst, for instance Conversely, splenic tumors or an accessory spleen may mimic a pancreatic tail mass Splenic infarction is a relatively common cause of acute left upper quadrant pain It appears as a sharply defined, often wedge-shaped zone of minimal enhancement abutting the splenic capsule Patients at risk for infarction include those with sickle cell disease and those with cardiovascular conditions, such as atrial fibrillation Patients with left ventricular assist devices are especially prone to embolic infarction of the spleen The spleen is often injured in blunt and penetrating trauma Most children and adults with splenic lacerations will recover without surgery, but the presence of active extravasation (evident on CT) or clinical instability may demand intervention, either surgery or transcatheter embolization Splenosis is the peritoneal implantation of splenic tissue that may follow traumatic rupture of the spleen This may be mistaken for polysplenia or peritoneal implants of tumor (carcinomatosis) The history of trauma, absence of a normal spleen, and enhancement characteristics identical to spleen usually allow accurate diagnosis Differential Diagnosis Splenomegaly Common • Cirrhosis with portal hypertension • Congestive heart failure • AIDS • Splenic metastases and lymphoma • Hemoglobinopathies • Leukemia • Sarcoidosis • Mononucleosis • Myeloproliferative disorders • Splenic trauma Less common • Splenic tumors (primary) • Systemic infection and abscesses • Splenic vein occlusion • Splenic infarction • Malaria • Collagen vascular diseases: Rheumatoid arthritis, scleroderma, dermatomyositis, polyarteritis nodosa • Storage diseases: Amyloidosis, glycogen storage disease • Peliosis Imaging Approach to the Spleen Less common • Echinococcal (hydatid) cyst • Healed abscess Solid Splenic Mass or Masses Common • Splenic trauma • Splenic infarction • Splenic metastases and lymphoma • Perfusion artifact Less common • Sarcoidosis • Splenic infection and abscess • Splenic tumors • Peliosis Cystic Splenic Mass Common • Acquired or congenital splenic cyst • Splenic trauma • Splenic infarction Spleen Multiple Splenic Calcifications Common • Histoplasmosis • Tuberculosis • Arterial calcification and aneurysm • Pneumocystis jiroveci • Splenic infarction • Splenic cyst Less common • Splenic metastases and lymphoma • Splenic infection and abscess • Splenic tumors • Pancreatic pseudocyst Diffuse Increased Attenuation, Spleen Common • Hemochromatosis • Splenic infarction: Sickle cell anemia Less common • Opportunistic infection • Thorotrast (Left) Arterial phase axial CECT shows a very heterogeneous spleen caused by rapid enhancement of the vascular sinusoids (red pulp) This should not be mistaken for a pathologic process (Right) Axial CECT during the venous phase shows the spleen with a homogeneous appearance (Left) Axial T1WI MR (A) shows the normal spleen ſt as slightly hypointense relative to liver On T2WI MR (B), the normal spleen is slightly hyperintense to liver (Right) Axial CECT shows a "mass" ſt in the pancreatic tail that is isodense to the spleen and represents an accessory spleen This could be mistaken for a primary pancreatic mass, such as a neuroendocrine tumor 545 Spleen Imaging Approach to the Spleen Gastric impression Stomach Renal impression Prominent medial lobulation Kidney Stomach Gastrosplenic ligament Spleen Splenic artery Splenorenal ligament Splenic vein Splenocolic ligament (Top) Graphic shows the medial surface of the spleen and representative axial sections at different levels The spleen is of variable shape and size, even within the same individual, varying with states of nutrition and hydration The medial surface is often quite lobulated as it is interposed between the stomach and the kidney (Bottom) The splenic artery and vein course along the body of the pancreas, entering and exiting the spleen via the splenorenal ligament The tail of the pancreas also inserts into the splenic hilum through the splenorenal ligament The gastrosplenic ligament carries the short gastric and left gastroepiploic vessels to the stomach and upper portion of the spleen 546 Imaging Approach to the Spleen Spleen (Left) Axial CECT in a patient with non-Hodgkin lymphoma shows numerous enlarged upper abdominal lymph nodes ſt Splenomegaly is a common abnormality and can be caused by congestion, hematologic disorders, inflammatory/infectious conditions, tumors, or infiltrative processes (Right) Axial CECT in a different case of splenomegaly caused by congestion secondary to cirrhosis and portal hypertension shows the recanalized umbilical vein ſt (Left) Axial CECT shows splenic lesions The larger lesion has water density contents and thin, sharp walls, typical of simple cyst The smaller lesion has nodular walls and higher density contents, suggestive of splenic lymphangioma (Right) In this patient with non-Hodgkin lymphoma the spleen is markedly enlarged with heterogeneous, hypoattenuating, more discrete tumor foci Lymphomatous infiltration is also present within the adrenal gland and nodes throughout the abdomen (Left) Axial CECT in a patient with heart failure and abdominal pain shows a ventricular assist device st and wedge-shaped regions of nonenhancing splenic parenchyma ſt that extend to the capsular surface, characteristic of acute splenic infarctions (Right) Axial CECT in a patient injured in a motor vehicle crash shows a sentinel clot st adjacent to the spleen and a large hemoperitoneum Note the active extravasation of blood ſt that is isodense to enhanced vessels 547 Spleen Accessory Spleen KEY FACTS TERMINOLOGY • Benign ectopic splenic tissue of congenital origin IMAGING • Most splenules located in or near splenic hilum or ligaments ○ 20% are near or within pancreatic tail and can mimic pancreatic neuroendocrine tumor ○ May also be in diaphragmatic, pararenal, and gastric sites • NECT and CECT: Same enhancement and attenuation as normal spleen ○ Isodense to main spleen on noncontrast images ○ Characteristic serpiginous enhancement on arterial phase ○ Homogeneous enhancement on venous/delayed images • MR: T1WI hypointense and T2WI hyperintense ○ Follows appearance of spleen on all sequences ○ DWI: Isointense to spleen with similar ADC values • Nuclear medicine: Technetium (Tc-99m) sulfur colloid or Tc99m heat-damaged red blood cell (RBC) scan (Left) Axial CECT shows a small spherical accessory spleen ſt near the splenic hilum Note the foci of calcification from histoplasmosis in the main and accessory spleen This appearance is so characteristic as to require no additional evaluation (Right) Axial CECT demonstrates a large mass ſt abutting the pancreatic tail and the splenic hilum The mass was thought to be a neuroendocrine tumor and was resected Note that the mass is isodense to the spleen The mass was found to be a splenule at surgery (Left) Axial CECT shows an enlarged spleen due to portal hypertension in this patient with cirrhosis Note the prominent accessory spleen ſt as well as the varices An accessory spleen may enlarge in parallel with the main spleen (Right) Axial CECT shows a hypervascular mass ſt within the pancreatic tail that mimics an islet cell tumor A heat-damaged red blood cell scan (not shown) proved this to be an accessory spleen Masses in the splenic hilum may arise from or involve the tail of the pancreas or spleen 548 ○ Functional uptake in splenic tissue differentiates splenule from other masses • Rare complication: Torsion of splenule as cause of abdominal pain in children or young adults TOP DIFFERENTIAL DIAGNOSES • • • • • Splenosis Polysplenia Peritoneal metastases and lymphoma Visceral mass (especially pancreatic neuroendocrine tumor) Splenic artery aneurysm or pseudoaneurysm PATHOLOGY • Congenital: Failure of some embryonic splenic buds to unite within dorsal mesogastrium CLINICAL ISSUES • Asymptomatic (vast majority of cases) • In absence of complications (which are extraordinarily rare), no treatment or intervention Accessory Spleen Synonyms • Splenule, splenunculus DIFFERENTIAL DIAGNOSIS Definitions Splenosis • Benign ectopic splenic tissue of congenital origin • Usually result of trauma; portions of disrupted spleen implant anywhere including abdomen, pelvis, and chest IMAGING General Features • Best diagnostic clue ○ Small, round, well-marginated nodule in left upper quadrant with same enhancement as normal spleen • Location ○ In or near splenic hilum or ligaments (most cases) – 20% are near or within pancreatic tail – Usually left upper quadrant, above renal pedicle – Rarely in diaphragmatic, pararenal, and gastric sites ○ Single splenule in vast majority of patients – splenule (88%), splenules (9%), > splenules (3%) – Multiple splenules usually clustered in location • Size ○ Varies from mm to a few cm, usually < 2.5 cm CT Findings • Same enhancement as normal spleen ○ Isodense to main spleen on noncontrast images ○ Serpiginous enhancement on arterial phase ○ Homogeneous enhancement on venous/delayed images • Most commonly located near splenic hilum or ligaments • 2nd most common location is pancreatic tail ○ Usually < cm medial to pancreatic tail ○ Most often along dorsal surface of pancreas ○ Incompletely surrounded by pancreatic parenchyma • Rare: Torsion of splenule as cause of abdominal pain ○ Nonenhancing mass with surrounding hemorrhage ○ Whorl sign (twisted vascular pedicle) leading to splenule MR Findings • T1WI hypointense and T2WI hyperintense ○ Follows appearance of spleen on all sequences • DWI: Isointense to spleen with similar apparent diffusion coefficient (ADC) values ○ Pancreatic neuroendocrine tumors usually hyperintense on DWI with lower ADC values • Superparamagnetic iron oxide particles (SPIO) contrast media taken up by splenic tissue (but not tumor) Nuclear Medicine Findings • Technetium (Tc-99m) sulfur colloid or Tc-99m heatdamaged red blood cell (RBC) scan ○ Functional uptake in splenic tissue differentiates splenule from other masses ○ Tc-99m heat-damaged RBC scan preferred due to higher specificity and better target to background • PET CT ○ FDG-avid mass can mimic tumor Imaging Recommendations Spleen ○ Multiphase CT followed by Tc-99m heat-damaged RBC scan in equivocal cases TERMINOLOGY Polysplenia • Congenital disorder with multiple small spleens, bilateral left-sidedness of viscera, and cardiovascular anomalies Peritoneal Metastases and Lymphoma • e.g., omental or peritoneal metastases Visceral Mass • Splenules commonly mistaken for pancreatic neuroendocrine tumors • Splenules also mistaken for adrenal, gastric, or renal tumors Splenic Artery Aneurysm or Pseudoaneurysm • Bright homogeneous enhancement on arterial phase PATHOLOGY General Features • Etiology ○ Congenital: Failure of some embryonic splenic buds to unite within dorsal mesogastrium Gross Pathologic & Surgical Features • Structurally normal splenic tissue CLINICAL ISSUES Presentation • Most common signs/symptoms ○ Asymptomatic (vast majority of cases) • Other signs/symptoms ○ May torse, rupture, and bleed (very rare) ○ May cause recurrence of hematologic disease (e.g., lymphoma) following prior splenectomy Demographics • Epidemiology ○ Incidence: 10-30% of patients at autopsy Treatment • In absence of complications (which are extraordinarily rare), no treatment or intervention • Surgical resection: Only in setting of complications, recurrence of lymphoma, or hypersplenism DIAGNOSTIC CHECKLIST Consider • Accessory spleen is common and can be mistaken for tumor SELECTED REFERENCES Coquia SF et al: Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor J Comput Assist Tomogr ePub, 2014 • Best imaging tool 549 Spleen Asplenia and Polysplenia KEY FACTS TERMINOLOGY • Complex inherited syndromes associated with absence or multiplicity of spleens as well as many other anomalies IMAGING • Asplenia (ASP) syndrome: Right isomerism or bilateral right-sidedness ○ Absent spleen in virtually all patients ○ Congenital heart disease in ~ 100% of patients ○ Bilateral trilobed lungs ○ Malrotation in most patients ○ Aorta and inferior vena cava (IVC) are frequently ipsilateral (usually right side) • Polysplenia (PSP) syndrome: Left isomerism or bilateral left-sidedness ○ Usually multiple spleens, but may have single normal spleen ○ Increased risk of complex cardiac anomalies, although less common with PSP than ASP (Left) Coronal volumerendered CECT in a patient with polysplenia (PSP) syndrome demonstrates multiple spleens st in the left upper quadrant The multiple spleens in PSP are typically in the left abdomen, but can rarely be on the right (Right) Axial CECT in the same patient demonstrates a markedly dilated azygous vein (Left) Axial CECT in the same patient again demonstrates multiple spleens st and a dilated azygous vein ſt to the right of the aorta Azygous continuation of the inferior vena cava (IVC) is a very common abnormality in PSP syndrome (Right) Axial CECT in the same patient demonstrates malrotation of the bowel, with the small bowel abnormally located in the right abdomen and the entirety of the colon in the left abdomen Malrotation is quite common with both asplenia (ASP) and PSP syndromes 550 ○ IVC interruption with azygos continuation very common ○ Bilateral bilobed lungs ○ Truncated/short pancreas or agenesis of dorsal pancreas – Increased incidence of diabetes and pancreatitis ○ Intestinal malrotation is seen in most patients ○ Liver often midline with range of biliary abnormalities ○ Aorta usually located to left of midline TOP DIFFERENTIAL DIAGNOSES • Splenosis • Accessory spleen • Splenectomy CLINICAL ISSUES • ASP: Newborn or infant presentation due to cardiac disease with poor prognosis and early mortality ○ ↑ risk of sepsis due to lack of spleen • PSP: Infant or adult presentation with better prognosis due to lesser incidence of cardiac disease Asplenia and Polysplenia Abbreviations • Asplenia (ASP), polysplenia (PSP) Synonyms • Heterotaxy syndromes • ASP: Asplenia syndrome, Ivemark syndrome, bilateral rightsidedness • PSP: Polysplenia syndrome, bilateral left-sidedness Definitions • Complex inherited syndromes associated with absence (ASP) or multiplicity (PSP) of spleens, as well as many other anomalies Associated Syndromes • Heterotaxy: Abnormal embryologic placement of thoracoabdominal structures across right-left axis of body • Situs solitus: Normal placement of thoracoabdominal organs in right-left axis • Situs inversus: Reversal of normal positions of thoracoabdominal organs across right-left axis (mirrorimage of situs solitus) • Situs ambiguus (heterotaxy syndrome): Abnormal placement of thoracoabdominal structures without situs inversus IMAGING General Features • Best diagnostic clue ○ ASP: Absence of spleen, abdominal aorta and inferior vena cava (IVC) on same side (usually right), and bilateral distribution of right-sided viscera ○ PSP: Multiple small spleens, intrahepatic interruption of IVC with continuation of azygos vein, bilateral distribution of left-sided viscera • PSP ○ Number of spleens varies from to 16 • Key concepts ○ ASP syndrome: Right isomerism or bilateral rightsidedness – Situs ambiguus and bilateral right-sidedness; no fixed set of findings, abnormalities exist across a spectrum – Spleen □ Absent spleen in virtually all patients – Cardiovascular □ Congenital heart disease in ~ 100% of patients □ Total anomalous pulmonary venous return (almost 100%), endocardial cushion defect (85%), single ventricle (51%), transposition of great vessels (58%), pulmonary stenosis or atresia (70%), dextrocardia (42%), mesocardia, ventricular septal defect, single atrioventricular valve, bilateral superior vena cava (SVC) □ Aorta and IVC are frequently ipsilateral (usually right side) – Pulmonary □ Abnormal distribution of lobes with bilateral trilobed lungs – Gastrointestinal □ Malrotation in most patients with ASP □ Other associations: Imperforate anus, ectopic liver, annular pancreas, esophageal varices, gallbladder agenesis, Hirschsprung disease, and duplication or hypoplasia of stomach – Genitourinary □ Horseshoe kidney, bilobed urinary bladder, hydroureter, double collecting system, cystic kidney – Miscellaneous □ Cleft palate, cleft lip, fused or horseshoe adrenal gland, absent left adrenal gland, scoliosis, bicornuate uterus, single umbilical artery, lumbar myelomeningocele ○ PSP syndrome: Left isomerism or bilateral left-sidedness – Situs ambiguus and bilateral left-sidedness: No fixed set of findings and abnormalities exist across a spectrum – Spleen □ Usually multiple spleens in left upper quadrant, but some cases may have single normal spleen □ Isolated reversal of splenic position (in right abdomen) common – Cardiovascular □ Increased risk of complex cardiac anomalies, although less common with PSP than with ASP, accounting for better long-term survival □ Transposition of great vessels (13%), double outlet right ventricle (13%), pulmonary valvular stenosis (23%), subaortic stenosis, or atresia □ IVC interruption with azygos vein continuation is 2nd most common abnormality (65%) after multiple spleens □ Aorta usually located to left of midline – Pulmonary □ Abnormal distribution of lobes with bilateral bilobed lungs □ Only seen in 55% of patients – Gastrointestinal □ Truncated/short pancreas or agenesis of dorsal pancreas with increased incidence of diabetes and pancreatitis □ Intestinal malrotation seen in most patients with PSP and may range from nonrotation to complete malrotation □ Liver often midline with range of biliary tree abnormalities (absent gallbladder, biliary atresia) □ Isolated reversal of stomach position common □ Other associations: Esophageal or duodenal atresia, tracheoesophageal fistula, semiannular pancreas, gastric duplication, short bowel – Genitourinary □ Renal agenesis, renal and ovarian cysts Spleen TERMINOLOGY Radiographic Findings • Radiography ○ ASP – Heart: Mesocardia or dextrocardia – Right-sided bronchial pattern and minor fissure may be seen bilaterally – Superior mediastinal widening (due to bilateral SVC) 551 Spleen Asplenia and Polysplenia – Both pulmonary arteries anterior to trachea on lateral chest film ○ PSP – Frontal view: Paratracheal soft tissue prominence (dilated azygos/hemiazygos) mimicking mass – Chest lateral view: Both pulmonary arteries posterior to trachea and absence of IVC shadow CT Findings • ASP ○ Absence of spleen ○ Situs abnormalities: Liver, gallbladder, stomach, bowel, heart, trilobed lungs ○ IVC and abdominal aorta lie on same side of spine (usually on right side with aorta lying posteriorly) • PSP ○ Multiple splenules in right or left upper quadrants – ± asymmetric liver and midgut malrotation ○ Enlarged azygos or hemiazygos vein with azygous continuation of IVC – Absence of IVC between renal and hepatic veins with independent drainage of hepatic veins into right atrium Imaging Recommendations • Best imaging tool ○ CECT or MR can demonstrate position and number of spleen(s), as well as other visceral organ abnormalities associated with heterotaxy syndromes DIFFERENTIAL DIAGNOSIS Splenosis • Scattered splenic tissue throughout abdomen usually seen in setting of traumatic splenectomy • Multiple small implants ranging in size from few mm to few cm; should enhance similarly to normal splenic tissue • No other associated anomalies Accessory Spleen • Normal embryologic variant usually found near splenic hilum along course of splenic vessels • Identical to normal splenic tissue on any phase of enhancement • No other associated anomalies Splenectomy • No splenic visualization after surgical splenectomy • No other associated anomalies PATHOLOGY General Features • Etiology ○ Uncertain etiology, but may be associated with gene mutations (CFC1 gene, SHROOM3 gene, etc.) – Altered timing in development of embryonic body curvature leads to visceroatrial situs abnormalities □ ASP: Delayed embryonic body curvature □ PSP: Accelerated embryonic body curvature – Pressure of adjacent structures may interfere with splenic blood supply leading to development of ASP/PSP 552 CLINICAL ISSUES Presentation • Most common signs/symptoms ○ ASP – Most commonly present with cardiopulmonary disease (83%), including cyanosis as neonates or in infancy – Patients are prone to overwhelming sepsis (especially postoperatively) due to lack of spleen – Bowel obstruction (17%) due to malrotation ○ PSP – 10-15% may not present clinically until adulthood – Often present with cardiac disease, including heart murmur, congestive heart failure, occasional cyanosis, heart block – Jaundice due to biliary atresia or other biliary abnormalities – Abdominal pain related to bowel obstruction or intestinal ischemia related to malrotation Demographics • Age ○ ASP: Newborn or infant presentation ○ PSP: Infant or adult • Gender ○ ASP: M > F (2:1) ○ PSP: F > M • Epidemiology ○ ASP: in 40,000 live births ○ Heterotaxia syndromes: in 10,000 Natural History & Prognosis • ASP: Very poor prognosis ○ Mortality rate: Prognosis depends on extent of cardiac abnormalities, but only 20% survive to age of 16 • Polysplenia: Fair prognosis, better than asplenia ○ Mortality rate: 50-60% mortality in 1st year, 25% of patients live up to years, and 10% survive to mid adolescence Treatment • ASP: Prophylactic antibiotics (not needed in PSP) • Surgical correction of cardiac disease or malrotation in either ASP or PSP DIAGNOSTIC CHECKLIST Image Interpretation Pearls • Left liver lobe can simulate spleen on US leading to missed diagnosis of ASP • Differentiate PSP from accessory spleens and splenosis SELECTED REFERENCES Tawfik AM et al: Polysplenia syndrome: a review of the relationship with viscero-atrial situs and the spectrum of extra-cardiac anomalies Surg Radiol Anat 35(8):647-53, 2013 INDEX - lipomatous pseudohypertrophy, 1012–1013 cystic fibrosis vs., 20 differential diagnosis, 1013 - mass See Pancreatic mass - neoplasms See Pancreatic neoplasms, benign; Pancreatic neoplasms, malignant - nonneoplastic pancreatic cysts, 1030–1033 differential diagnosis, 1031 mucinous cystic pancreatic tumor vs., 1044 - pancreas divisum, 982–985 agenesis of dorsal pancreas vs., 980 differential diagnosis, 983–984 - pancreatitis See Pancreatitis - postoperative, 1018–1021 - progressive injury, hemochromatosis associated with, 681 - senescent change chronic pancreatitis vs., 1002 pancreatic lipomatous pseudohypertrophy vs., 1013 - shock pancreas acute pancreatitis and complications vs., 992 CT findings, 35 pancreatic trauma vs., 1015 - transplantation, 1022–1025 - trauma, 1014–1017 chronic pancreatitis associated with, 1002 differential diagnosis, 1015 systemic hypotension vs., 35 Pancreas divisum, 982–985 - agenesis of dorsal pancreas vs., 980 - anatomy, 984 - associated abnormalities, 984 - differential diagnosis, 983–984 - image gallery, 982, 985 - staging, grading, & classification, 984 Pancreatecomy - central, 1019 - distal, 1019 Pancreatic abscess, complication of pancreatic surgery, 1019 Pancreatic adenocarcinoma See Pancreatic ductal carcinoma Pancreatic cystic neoplasms - choledochal cyst vs., 876 - cystic fibrosis vs., 20 Pancreatic cysts, nonneoplastic, 1030–1033 - differential diagnosis, 1031 - mucinous cystic pancreatic tumor vs., 1044 Pancreatic duct - dilated, differential diagnosis, 973–974 - pseudostenosis, 864 Pancreatic ductal anatomy, other anatomic variants: pancreas divisum vs., 984 Pancreatic ductal carcinoma, 1034–1041 - agenesis of dorsal pancreas vs., 980 - annular pancreas vs., 981 - associated abnormalities, 1036 - atypical and rare pancreatic tumors vs., 1069 - autoimmune (IgG4) cholangitis vs., 932 - autoimmune (IgG4) pancreatitis vs., 1009 - biliary trauma vs., 947 - chronic pancreatitis vs., 1002 differential diagnosis, 1036 duodenal carcinoma vs., 335 extrinsic invasion, duodenal ulcer vs., 319–320 genetics, 1036 groove pancreatitis vs., 1004 image gallery, 1034, 1037–1041 infiltrating, acute pancreatitis and complications vs., 992 pancreas divisum vs., 983 pancreatic intraductal papillary mucinous neoplasm (IPMN) vs., 1049 - pancreatic metastases and lymphoma vs., 1065 - pancreatic neuroendocrine tumors vs., 1056 - pancreatic solid and pseudopapillary neoplasm vs., 1063 - staging, grading, & classification, 1036–1037 Pancreatic epithelial (true) cyst, mucinous cystic pancreatic tumor vs., 1043 Pancreatic fistula, complication of pancreatic surgery, 1019 Pancreatic focal fatty infiltration, pancreatic lipomatous pseudohypertrophy vs., 1013 Pancreatic hamartoma, duodenal wall See Groove pancreatitis Pancreatic head adenocarcinoma - asymmetric fatty lobulation of pancreas vs., 987 - involving ampulla, ampullary carcinoma vs., 961 Pancreatic head, asymmetric fatty infiltration of: pancreatic ductal carcinoma vs., 1036 Pancreatic injury, hepatic trauma associated with, 738 Pancreatic IPMN (intraductal papillary mucinous neoplasm), 1048–1053 - chronic pancreatitis vs., 1002 - differential diagnosis, 1049–1050 - genetics, 1050 - image gallery, 1048, 1051–1053 - mucinous cystic pancreatic tumor vs., 1043 - nonneoplastic pancreatic cysts vs., 1031 - pancreatic serous cystadenoma vs., 1027 - staging, grading, & classification, 1050 Pancreatic laceration/fracture, gastroduodenal trauma associated with, 327 Pancreatic lipoma, 1069 See also Atypical and rare pancreatic tumors Pancreatic lipomatosis, agenesis of dorsal pancreas vs., 980 Pancreatic lipomatous pseudohypertrophy, 1012–1013 - associated abnormalities, 1013 - cystic fibrosis vs., 20 - differential diagnosis, 1013 Pancreatic mass - cystic, differential diagnosis, 973 - hypervascular pancreatic mass, differential diagnosis, 973 - hypovascular, differential diagnosis, 973 Pancreatic metastases and lymphoma, 1064–1067 - acute pancreatitis and complications vs., 992 - differential diagnosis, 1065 - image gallery, 1064, 1066–1067 - pancreatic ductal carcinoma vs., 1036 - pancreatic neuroendocrine tumors vs., 1056 xxxix INDEX Pancreatic necrosis - central (disconnected duct syndrome), 991 - infected, 991 Pancreatic neoplasms, benign - cystic choledochal cyst vs., 876 cystic fibrosis vs., 20 - nonneoplastic pancreatic cysts, 1030–1033 differential diagnosis, 1031 mucinous cystic pancreatic tumor vs., 1044 - serous cystadenoma See Pancreatic serous cystadenoma Pancreatic neoplasms, malignant - atypical and rare pancreatic tumors, 1068–1071 - ductal carcinoma See Pancreatic ductal carcinoma - duodenal metastases and lymphoma associated with, 339 - hypervascular pancreatic mass, differential diagnosis, 973 - hypovascular pancreatic mass, differential diagnosis, 973 - metastases and lymphoma See Pancreatic metastases and lymphoma - mucinous cystic pancreatic tumor See Mucinous cystic pancreatic tumor - neuroendocrine tumors See Pancreatic neuroendocrine tumors - pancreatic head adenocarcinoma asymmetric fatty lobulation of pancreas vs., 987 involving ampulla, ampullary carcinoma vs., 961 - pancreatic IPMN See Pancreatic IPMN (intraductal papillary mucinous neoplasm) - solid and pseudopapillary neoplasm, 1060–1063 - tumor recurrence, complication of pancreatic surgery, 1020 Pancreatic neuroendocrine tumors, 1054–1059 - atypical and rare pancreatic tumors vs., 1069 - cystic mucinous cystic pancreatic tumor vs., 1043 nonneoplastic pancreatic cysts vs., 1031–1032 - differential diagnosis, 1056 - genetics, 1056 - image gallery, 1054, 1057–1059 - pancreatic ductal carcinoma vs., 1036 - pancreatic metastases and lymphoma vs., 1065 - pancreatic serous cystadenoma vs., 1027 - Zollinger-Ellison syndrome associated with, 251 Pancreatic plasmacytoma, 1069 See also Atypical and rare pancreatic tumors Pancreatic pseudocyst - abdominal abscess vs., 74 - choledochal cyst vs., 876 - complication of pancreatic surgery, 1019 - intramural benign gastric tumors vs., 291 - lymphangioma (mesenteric cyst), 133 - mucinous cystic pancreatic tumor vs., 1043 - nonneoplastic pancreatic cysts vs., 1031 - pancreatic intraductal papillary mucinous neoplasm (IPMN) vs., 1050 xl Pancreatic pseudocyst or cystic tumor, small intestine duplication cyst vs., 350 Pancreatic schwannoma, 1069 See also Atypical and rare pancreatic tumors Pancreatic serous cystadenoma, 1026–1029 - differential diagnosis, 1027 - image gallery, 1026, 1028–1029 - mucinous cystic pancreatic tumor vs., 1043 - nonneoplastic pancreatic cysts vs., 1031 - pancreatic intraductal papillary mucinous neoplasm (IPMN) vs., 1050 - pancreatic neuroendocrine tumors vs., 1056 - pancreatic solid and pseudopapillary neoplasm vs., 1063 Pancreatic solid and pseudopapillary neoplasm, 1060–1063 - differential diagnosis, 1063 - image gallery, 1062–1063 - staging, grading, & classification, 1063 Pancreatic transplantation, 1022–1025 Pancreatic trauma, 1014–1017 - associated abnormalities, 1016 - chronic pancreatitis associated with, 1002 - differential diagnosis, 1015 - hepatic trauma associated with, 738 - image gallery, 1014, 1017 - laceration/fracture, gastroduodenal trauma associated with, 327 - staging, grading, & classification, 1016 - systemic hypotension vs., 35 Pancreatic tuberculosis, radiologic findings, 14 Pancreatic tumor, gastric diverticulum vs., 243 Pancreatic tumors, atypical and rare, 1068–1071 Pancreaticobiliary duct junction, abnormal, gallbladder carcinoma associated with, 957 Pancreatitis - acute edematous pancreatitis autoimmune (IgG4) pancreatitis vs., 1009 involving groove, groove pancreatitis vs., 1004 - acute pancreatitis and complications See Acute pancreatitis and complications - autoimmune See Autoimmune (IgG4) pancreatitis - chronic See Chronic pancreatitis - duodenitis vs., 317 - edematous See Edematous pancreatitis - extrinsic inflammation gastric carcinoma vs., 300 gastric metastases and lymphoma vs., 305 - focal, asymmetric fatty lobulation of pancreas vs., 987 - groove pancreatitis, 1004–1007 differential diagnosis, 1004 pancreatic ductal carcinoma vs., 1036 - interstitial edematous pancreatitis, 991 - ischemic enteritis associated with, 413 - necrotizing pancreatitis, 991 - portal vein occlusion associated with, 702 - postoperative, 1019 - with extrapancreatic fat necrosis, omental infarct vs., 89 - with fistula, 406 Pancreatobiliary parasites, 886–889 Pancreatoblastoma, 1069 See also Atypical and rare pancreatic tumors INDEX Panniculitis - mesenteric See Sclerosing mesenteritis - systemic nodular See Sclerosing mesenteritis Parabiliary venous plexus, aberrant venous drainage: arterioportal shunt associated with, 697 Paraduodenal hernia, 104–107 - associated abnormalities, 106 - differential diagnosis, 105–106 - image gallery, 104, 107 - malrotation of small intestine vs., 349 - staging, grading, & classification, 106 - with obstruction, transmesenteric postoperative hernia vs., 110 Paraesophageal hernia, gastric volvulus associated with, 264 Paraesophageal varices, imaging, in portal hypertension, 115 Paralysis of diaphragm See Diaphragmatic eventration and paralysis Paralytic ileus See Ileus, adynamic or paralytic Paralyzed diaphragm, traumatic diaphragmatic rupture vs., 122 Paraneoplastic syndrome, sclerosing mesenteritis associated with, 82 Paraovarian cyst, peritoneal inclusion cyst vs., 131 Parasitic infections - clonorchiasis biliary IPMN associated with, 968 peripheral (intrahepatic) cholangiocarcinoma associated with, 822 - Cryptosporidium infection, intestinal, 361, 362 - echinococcosis pancreatobiliary See Pancreatobiliary parasites splenic infection and abscess associated with, 556 - Echinococcus granulosus and Echinococcus multilocularis, hepatic hydatid cyst associated with, 613 - eosinophilic gastroenteritis and esophagitis vs., 176 - Giardia, intestinal, 361 - intestinal parasites and infestation, 358–359 differential diagnosis, 359 eosinophilic gastroenteritis and esophagitis vs., 176 - pancreatobiliary, 886–889 - recurrent pyogenic cholangitis associated with, 880 Parasympathetic dysfunction, colonic ileus and Ogilvie syndrome associated with, 510 Paraumbilical vein, recanalized: imaging in portal hypertension, 115 Parenteral hyperalimentation, steatosis and steatohepatitis associated with, 634 Parkinsonism, pancreatic lipomatous pseudohypertrophy associated with, 1013 Partial gastrectomy: Bilroth procedures, 270–273 - gastric carcinoma associated with, 300 - image gallery, 270, 273 - imaging findings Bilroth procedure, 271 Bilroth procedure, 271 complications, 271–272 recommendations, 272 surgery for gastric cancer, 271 surgical procedures, 271 Passive hepatic congestion, 706–709 - differential diagnosis, 707 - hepatomegaly associated with, 689 - image gallery, 706, 708–709 - viral hepatitis vs., 621 Pedunculated polyps, colonic, 517 Peliosis hepatis, 722–725 - associated abnormalities, 724 - differential diagnosis, 722 - image gallery, 722, 725 Pelvic floor defect, obturator hernia associated with, 99 Pelvic fractures, colorectal trauma associated with, 515 Pelvic hernia See Inguinal hernia Pelvic surgery, peritoneal inclusion cyst associated with, 131 Pemphigoid and epidermolysis of esophagus, 177 - esophageal webs associated with, 178 - Zenker diverticulum vs., 204 Penetrating peptic ulcer, aortoenteric fistula associated with, 329 Peptic stricture, esophageal achalasia associated with, 182 Peptic ulcer disease See Duodenal ulcer Perforated duodenal ulcer - acute pancreatitis and complications vs., 992 - barotrauma vs., 49 - gastroduodenal trauma vs., 327 Perforated gastric ulcer, barotrauma vs., 49 Periampullary adenocarcinoma, duodenal carcinoma vs., 335 Periampullary duodenal carcinoma, ampullary carcinoma vs., 961 Periampullary duodenal wall cyst See Groove pancreatitis Perianal fistulas - classification, 405–406 - CT findings colovaginal fistula, 406 colovesical fistula to thick-walled bladder, 406 Crohn disease with fistula, 406 diverticulitis with fistula, 406 duodenal fistula, 406 enterocutaneous fistula, 406 gut-to-gut fistula, 406 pancreatitis with fistula, 406 - enteric fistulas and sinus tracts associated with, 407 - MR findings, 405 - MR findings for perianal fistulas, 405–406 Periaortitis, aortoenteric fistula vs., 329 Peribiliary cysts, 677 Pericardial effusion, passive hepatic congestion associated with, 707 Pericardial fat pad, Morgagni hernia vs., 113 Pericarditis, constrictive See Constrictive pericarditis Pericecal internal hernia - paraduodenal hernia vs., 106 - with obstruction, transmesenteric postoperative hernia vs., 110 Perineal hernia, obturator hernia vs., 99 Peripancreatic fat planes, infiltration of: differential diagnosis, 974 xli INDEX Peripancreatic gastrointestinal stromal tumor, pancreatic neuroendocrine tumors vs., 1056 Peripheral (intrahepatic) cholangiocarcinoma, 820–825 - associated abnormalities, 822 - autoimmune (IgG4) cholangitis vs., 932 - biliary papillomatosis vs., 965 - biliary trauma vs., 947 - differential diagnosis, 882–822 - duodenal carcinoma vs., 335 - epithelioid hemangioendothelioma vs., 827 - fibrolamellar carcinoma vs., 815–816 - focal confluent fibrosis vs., 659 - hepatic cavernous hemangioma vs., 774 - hepatic inflammatory pseudotumor vs., 803–804 - hepatic metastases and lymphoma vs., 846 - hepatocellular carcinoma vs., 808 - image gallery, 820, 823–825 - Mirizzi syndrome vs., 919 - pancreatobiliary parasites vs., 888 - postoperative changes of liver vs., 746 - recurrent pyogenic cholangitis vs., 880 - solitary necrotic nodule vs., 676 - staging, grading, & classification, 822 Periportal edema/inflammation, peribiliary cysts vs., 677 Periportal lucency or edema, differential diagnosis, 586 Perisplenic varices, imaging in portal hypertension, 115 Peritoneal carcinomatosis See also Peritoneal metastases - ascites associated with, 86 - omental infarct vs., 90 - peritonitis vs., 77 - splenosis vs., 571 Peritoneal cavity - embryology and anatomy, 66 graphic image, 70 - fat-containing lesion, differential diagnosis, 67 Peritoneal endometriosis, splenosis vs., 571 Peritoneal implants See Peritoneal metastases Peritoneal inclusion cyst, 130–131 - abdominal mesothelioma vs., 142 - differential diagnosis, 131 - lymphangioma (mesenteric cyst), 133 Peritoneal lymphomatosis, peritoneal metastases vs., 146 Peritoneal mesothelioma See Abdominal mesothelioma Peritoneal metastases, 144–147 - abdominal mesothelioma vs., 141 - differential diagnosis, 146 - image gallery, 144, 147 - metastases and lymphoma, accessory spleen vs., 549 - omental infarct vs., 90 - patterns of carcinomatosis, 145 - peritonitis vs., 77 - staging, grading, & classification, 146 - with mucinous ascites, pseudomyxoma peritonei vs., 149 - without mucinous ascites, pseudomyxoma peritonei vs., 149 Peritoneal serous papillary carcinoma, primary: peritoneal metastases vs., 146 Peritoneum - ascites See Ascites - CT findings in leukemia and lymphoma, 55 xlii - imaging approach, 66–71 differential diagnosis, 67–68 embryology and relevant anatomy, 66 image gallery, 71 - portal hypertension and varices, 114–117 - vicarious excretion of contrast medium, 153 differential diagnosis, 153 milk of calcium bile vs., 929 Peritonitis, 76–79 - bacterial, pseudomyxoma peritonei vs., 150 - differential diagnosis, 77–78 - image gallery, 76, 79 - ischemic enteritis associated with, 413 - sclerosing encapsulating peritonitis, 78 - tuberculosis vs., 14 Pernicious anemia, gastric carcinoma associated with, 300 Persimmons, unripe: gastric bezoar associated with, 261 Peutz-Jeghers syndrome See also Hamartomatous polyposis syndrome - duodenal polyps associated with, 332 - gallbladder polyps associated with, 953 - pancreatic ductal carcinoma associated with, 1036 - small bowel carcinoma associated with, 443 Pharyngoesophageal diverticulum See Zenker diverticulum Pharyngoesophageal junction lesion, differential diagnosis, 157 Pharynx, anatomy, 156 Phrenic ampulla, hiatal hernia vs., 195 Phrygian cap, hyperplastic cholecystoses vs., 924 Physiologic free fluid, ascites vs., 86 Phytobezoar, 261 PKHD1 gene mutation, Caroli disease associated with, 872 Placental bed origin, HELLP syndrome associated with, 733 Pleural effusion - Ménétrier disease associated with, 257 - traumatic diaphragmatic rupture vs., 122 Pleural lesions, Bochdalek hernia vs., 112 Plummer-Vinson (Paterson-Kelly) syndrome, esophageal webs associated with, 178 Pneumatosis coli, primary: familial polyposis and Gardner syndrome vs., 536 Pneumatosis of intestine, 394–397 - complication of small intestine transplantation, 432 - differential diagnosis, 344, 395 - image gallery, 394, 397 - staging, grading, & classification, 396 Pneumobilia, biliary papillomatosis vs., 965 Pneumoperitoneum - differential diagnosis, 68 - from other causes, colorectal trauma vs., 515 Polyarteritis nodosa See also Vasculitis - definition, 39 - imaging findings, 39 - ischemic enteritis associated with, 413 Polycystic kidney disease - autosomal dominant See Autosomal dominant polycystic kidney disease (ADPKD) - autosomal recessive polycystic kidney disease (ARPKD) AD polycystic liver disease associated with, 595 congenital hepatic fibrosis associated with, 592 INDEX - biliary hamartoma associated with, 795 Polycystic liver disease - autosomal dominant See AD (autosomal dominant) polycystic liver disease - autosomal recessive, Caroli disease associated with, 872 - biliary hamartoma associated with, 795 - isolated, congenital hepatic fibrosis vs., 591 Polygonal fluid collections, in mesenteric and small bowel trauma, 417 Polymyositis - esophageal scleroderma associated with, 190 - intestinal scleroderma associated with, 378 Polypoid gallbladder carcinoma, gallbladder polyps vs., 953 Polyposis syndromes - duodenal polyps associated with, 332 - familial See Familial polyposis and Gardner syndrome - familial adenomatous See Familial adenomatous polyposis (FAP) - gastric polyps associated with, 288 - hamartomatous See Hamartomatous polyposis syndrome - small bowel carcinoma associated with, 443 Polyps - adenomatous See Adenomatous polyps - colonic, 516–519 colonic diverticulosis vs., 489 differential diagnosis, 518 - duodenal, 330–333 - fibrovascular, esophageal, 226 - fundic gland polyps, gastric polyps associated with, 288 - gallbladder See Gallbladder polyps - gastric, 286–289 - hamartomatous colonic, 518 duodenal, 331 - hyperplastic colonic, 518 duodenal, 331 - inflammatory colonic, 518 esophageal, 227 - pedunculated, colonic, 517 - sessile, colonic, 517 - tubular adenomatous, colonic, 517 - tubulovillous adenomatous, colonic, 517 - villous adenomatous, colonic, 517 Polysplenia, 550–553 See also Asplenia - accessory spleen vs., 549 - associated syndromes, 550 - differential diagnosis, 552 - image gallery, 550, 553 - imaging, 551–552 - malrotation of small intestine associated with, 349 - splenosis vs., 571 Polyvinyl chloride, hepatic angiosarcoma associated with, 839 Poor nutrition, recurrent pyogenic cholangitis associated with, 880 Porcelain gallbladder, 926–927 - associated abnormalities, 927 - differential diagnosis, 927 - emphysematous cholecystitis vs., 916 - gallbladder carcinoma associated with, 957 - gallstones and sludge vs., 898 - milk of calcium bile vs., 929 Porphyria, Chagas disease of esophagus vs., 165 Portal hypertension and varices, 114–117 - ascites associated with, 86 - differential diagnosis, 116 - esophageal varices associated with, 200 - image gallery, 114, 117 - post-sinusoidal, 116 - pre-sinusoidal, 116 - sinusoidal, 116 Portal vein compression - extrinsic, portal vein occlusion vs., 702 - portal hypertension and varices associated with, 116 Portal vein occlusion, 700–705 - arterioportal shunt associated with, 697 - ascending cholangitis associated with, 883–884 - ascites associated with, 86 - associated abnormalities, 702 - differential diagnosis, 702 - image gallery, 700, 703–705 - portal hypertension and varices associated with, 116 - primary, cirrhosis vs., 644 - staging, grading, & classification, 702 - transient hepatic attenuation or intensity difference associated with, 691–692 - transjugular intrahepatic portosystemic shunt vs., 750 Portal vein, preduodenal: malrotation of small intestine associated with, 349 Portal vein thrombosis See Portal vein occlusion Portal venous gas - pneumatosis of intestine associated with, 396 - with bowel infarction, postoperative changes of liver vs., 745 Portomesenteric venous thrombosis, complication of pancreatic surgery, 1019 Portosystemic shunt See Transjugular intrahepatic portosystemic shunt Positive-pressure ventilation, barotrauma associated with, 49 Post chemoembolization or ablation, congenital absence of hepatic segments vs., 599 Post-endoscopy, pneumatosis of intestine vs., 395 Post sphincterotomy, gas in biliary tree due to: emphysematous cholecystitis vs., 915 Post-transplant lymphoproliferative disorder, 50–53 - complication of small intestine transplantation, 432 - differential diagnosis, 52 - image gallery, 50, 53 - staging, grading, & classification, 52 Post-traumatic pancreatic atrophy, agenesis of dorsal pancreas vs., 980 Post-treatment metastases, hepatic amebic abscess vs., 609 xliii INDEX Post-vagotomy effect, esophageal achalasia associated with, 182 Postappendicitis scarring, mucocele of appendix associated with, 485 Postendovascular stent, aortoenteric fistula vs., 329 Posterior hypopharyngeal diverticulum/outpouching See Zenker diverticulum Postnecrotic (viral) or alcoholic cirrhosis, primary biliary cirrhosis vs., 653 Postoperative changes - aortoenteric fistula vs., 329 - hiatal hernia vs., 195 - liver, 744–747 Postoperative fat necrosis in mesentery or greater omentum, postoperative pancreas vs., 1020 Postoperative fluid collection, biloma vs., 939 Postoperative lymphocele, abdominal abscess vs., 73 Postoperative pancreas, 1018–1021 - complications, 1019–1020 - differential diagnosis, 1020 - image gallery, 1018, 1021 - imaging central pancreatectomy, 1019 distal pancreatectomy, 1019 enudation, 1019 Frey procedure, 1019 normal findings immediately after Whipple procedure, 1019 Puestow procedure, 1019 Whipple procedure, 1019 Postoperative pancreatitis, 1019 Postoperative seroma, abdominal abscess vs., 73–74 Postoperative state, abdomen, 124–125 Postoperative state, bowel, 422–425 - image gallery, 422, 425 - imaging colonoscopy, 423 endoscopic procedures, 423 enterectomy and anastomosis, 423 enterostomy, 423 gastrointestinal surgery, 423 ileostomy, 423–424 small bowel reservoirs, 424 - intussusception associated with, 400 - pneumatosis of intestine vs., 395 Postoperative state, duodenum: SMA (superior mesenteric artery) syndrome associated with, 325 Postoperative state, esophagus - esophageal achalasia vs., 182 - esophageal motility disturbances vs., 185 - esophageal perforation vs., 213 Postoperative state, liver: hepatic angiomyolipoma and lipoma vs., 799 Postoperative state, stomach - gastric volvulus vs., 263 - gastroparesis vs., 259 Postprandial food, gastric bezoar vs., 261 Postsurgical resection, congenital absence of hepatic segments vs., 599 xliv Preduodenal portal vein, malrotation of small intestine associated with, 349 Preeclampsia, HELLP syndrome associated with, 733 Pregnancy - steatosis and steatohepatitis associated with, 634 - with HELLP syndrome, hepatic infarction associated with, 719 Presbyesophagus, form of esophageal motility disturbances, imaging, 185 Primary biliary cirrhosis, 652–657 - associated abnormalities, 654 - autoimmune hepatitis vs., 631 - differential diagnosis, 653 - genetics, 654 - image gallery, 652, 655–657 - sarcoidosis vs., 29 Primary bowel tumor - intussusception vs., 399 - radiation enteritis and colitis vs., 427 Primary liver cancer See Hepatocellular carcinoma Primary peritoneal serous papillary carcinoma, peritoneal metastases vs., 146 Primary pneumatosis coli, familial polyposis and Gardner syndrome vs., 535–536 Primary portal vein thrombosis, cirrhosis vs., 644 Primary sclerosing cholangitis, 934–937 - AIDS cholangiopathy vs., 891 - ascending cholangitis vs., 883 - associated abnormalities, 936 - autoimmune (IgG4) cholangitis vs., 931–932 - autoimmune hepatitis vs., 631 - biliary trauma vs., 947 - Caroli disease vs., 872 - chemotherapy-induced See Chemotherapy-induced cholangitis - choledochal cyst vs., 876 - congenital hepatic fibrosis vs., 591 - Crohn disease associated with, 372 - differential diagnosis, 936 - gallbladder carcinoma associated with, 958 - image gallery, 934, 937 - ischemic bile duct injury vs., 944 - mastocytosis vs., 369 - peripheral (intrahepatic) cholangiocarcinoma associated with, 822 - primary biliary cirrhosis associated with, 654 - recurrent pyogenic cholangitis vs., 879 - sclerosing mesenteritis associated with, 82 - ulcerative colitis associated with, 468 Primary splenic lymphoma - CT findings, 575–576 - key concepts, 575 - MR findings, 576 - ultrasonographic findings, 576 Primary splenic tumors, 574–577 - angiomyolipoma See Angiomyolipoma and lipoma, hepatic - angiosarcoma See Angiosarcoma, splenic; Hepatic angiosarcoma - benign, splenic cyst vs., 573 INDEX - differential diagnosis, 576 hamartoma See Hamartoma, splenic hemangioma See Hemangioma, splenic image gallery, 574, 577 littoral cell angioma See Littoral cell angioma, splenic lymphangioma See Lymphangioma, splenic lymphoma See Primary splenic lymphoma sclerosing angiomatoid nodular transformation See Sclerosing angiomatoid nodular transformation (SANT), splenic - splenic infarction vs., 564 - splenic infection and abscess vs., 555 - splenic metastases and lymphoma vs., 580 Primary visceral malignancy, sclerosing mesenteritis vs., 82 PRKCSH gene mutation, AD polycystic liver disease associated with, 595 Progressive systemic sclerosis - esophageal See Esophageal scleroderma - intestinal See Intestinal scleroderma Prostate carcinoma, rectal carcinoma vs., 531 Protein-losing gastropathy See Ménétrier disease Protein malnutrition, steatosis and steatohepatitis associated with, 634 Protozoan infections - Entamoeba histolytica, hepatic amebic abscess associated with, 609 - infectious colitis associated with, 460 - intestinal, 361 PRSS1 gene mutation - acute pancreatitis associated with, 992 - chronic pancreatitis associated with, 1002 Pseudoaneurysm - complication of acute pancreatitis, 991 - complication of small intestine transplantation, 431 - splenic artery aneurysm or pseudoaneurysm, accessory spleen vs., 549 Pseudodiverticulosis, intramural esophageal, 206–207 Pseudomegacolon See Colonic ileus and Ogilvie syndrome Pseudomembranous colitis, diverticulitis vs., 494 Pseudomyxoma peritonei, 148–151 - abdominal mesothelioma vs., 141 - differential diagnosis, 149–150 - image gallery, 148–151 - peritoneal metastases vs., 146 - peritonitis vs., 78 - staging, grading, & classification, 150 Pseudopapillary neoplasm, pancreatic See Pancreatic solid and pseudopapillary neoplasm Pseudopneumatosis, pneumatosis of intestine vs., 395 Pseudopolyps, familial polyposis and Gardner syndrome vs., 535–536 Psychiatric disease, sigmoid volvulus associated with, 504 PTEN gene mutation, hamartomatous polyposis syndrome associated with, 437 Puestow procedure, 1019 Pulmonary arteriovenous malformations, hereditary hemorrhagic telangiectasia associated with, 728 Pulmonary diseases, pneumatosis of intestine vs., 395 Pulmonary edema, HELLP syndrome associated with, 734 Pulmonary/extrapleural mass, traumatic diaphragmatic rupture vs., 122 Pulmonary lesions - Bochdalek hernia vs., 112 - parenchymal, Morgagni hernia vs., 113 Pulmonary valve disease, passive hepatic congestion associated with, 707 Pulsatile vascular compression artifact, biliary, 864 Pulsion diverticulum, 209 - Boerhaave syndrome vs., 217 - differential diagnosis, 209 - gastric volvulus vs., 263 - hiatal hernia vs., 195 - traction diverticulum vs., 208 Pyloroplasty, gastric bezoar associated with, 261 Pyodema gangrenosum, ulcerative colitis associated with, 468 Pyogenic abscess, hepatic See Hepatic pyogenic abscess Pyogenic cholangitis, recurrent See Recurrent pyogenic cholangitis R Radiation - aortoenteric fistula associated with, 329 - duodenitis associated with, 317 - enteric fistulas and sinus tracts associated with, 407 - hepatic angiosarcoma associated with, 839 - ischemic enteritis associated with, 413 - viral esophagitis associated with, 164 Radiation enteritis and colitis, 426–429 - Crohn disease vs., 372 - differential diagnosis, 427 - diverticulitis vs., 493 - image gallery, 426, 429 - radiation tolerance of intestinal organs, 428 - risk factors, 427–428 - small bowel NSAID stricture vs., 383 - staging, grading, & classification, 428 Radiation esophagitis, 175 - caustic esophagitis vs., 173 - differential diagnosis, 175 - esophageal carcinoma vs., 230 Radiation gastritis, 245 Radiation-induced liver disease, 740–743 Rare pancreatic tumors See Atypical and rare pancreatic tumors Recanalized umbilical vein, imaging, in portal hypertension, 115 Reconstruction artifacts, biliary, 863 Rectal carcinoma, 530–533 - differential diagnosis, 531 - genetics, 532 - image gallery, 530, 533 - staging, grading, & classification, 532 Rectal prolapse and intussusception, 513 Rectal villous adenoma, rectal carcinoma vs., 531 Recurrent pyogenic cholangitis, 878–881 - ascending cholangitis vs., 883 - biliary IPMN vs., 967 xlv INDEX - Caroli disease vs., 872 choledochal cyst vs., 876 differential diagnosis, 879–880 image gallery, 878, 881 pancreatobiliary parasites vs., 888 peripheral (intrahepatic) cholangiocarcinoma associated with, 822 Reflux esophagitis, 166–169 - Barrett esophagus vs., 171 - Candida esophagitis vs., 163 - caustic esophagitis vs., 173 - differential diagnosis, 167 - drug-induced esophagitis vs., 174 - esophageal motility disturbances vs., 185 - esophageal perforation vs., 213 - esophageal varices vs., 199 - image gallery, 166, 169 - radiation esophagitis vs., 175 - Schatzki ring vs., 193 - staging, grading, & classification, 168 - viral esophagitis vs., 164 - with stricture esophageal carcinoma vs., 229 esophageal scleroderma vs., 189 - Zenker diverticulum associated with, 204 Regenerative and dysplastic nodules, 668–675 - associated abnormalities, 670 - differential diagnosis, 669–670 - hepatocellular carcinoma vs., 808 - image gallery, 668, 671–675 - postoperative changes of liver vs., 746 - solitary necrotic nodule vs., 676 - staging, grading, & classification, 670 Regional enteritis See Crohn disease Regional lymphadenopathy, duodenal metastases and lymphoma associated with, 339 Rejection, complication of small intestine transplantation, 432 Renal failure - acute, HELLP syndrome associated with, 734 - chronic ascites associated with, 86 duodenal ulcer associated with, 320 ischemic colitis associated with, 476 Renal fibrosis, Caroli disease associated with, 872 Renal lesions, tuberculosis vs., 14 Renal nephrotic syndrome, ascites associated with, 86 Renal tuberculosis, radiologic findings, 13 Respiratory motion artifacts, biliary, 863 Retained fecal debris - colonic polyps vs., 518 - familial polyposis and Gardner syndrome vs., 535 Retained foods and pills - familial polyposis and Gardner syndrome vs., 535 - gastric polyps vs., 287 Retained oxidized cellulose (Surgicel), abdominal abscess vs., 74 Retractile mesenteritis See Sclerosing mesenteritis Retrogastric varices, imaging, in portal hypertension, 115 Retroperionteal-paravertebral varices, imaging in portal hypertension, 115 xlvi Retroperitoneal fibrosis - aortoenteric fistula vs., 329 - intestinal lymphangiectasia associated with, 385 - primary sclerosing cholangitis associated with, 936 - sclerosing mesenteritis associated with, 82 Retroperitoneal gas, emphysematous cholecystitis vs., 916 Retroperitoneal hemorrhage, ileus associated with, 387 Retroperitoneal liposarcoma, pancreatic lipomatous pseudohypertrophy vs., 1013 Retroperitoneal lymphoma, sclerosing mesenteritis vs., 81 Retroperitoneal neoplasms, intestinal lymphangiectasia associated with, 385 Reye syndrome, steatosis and steatohepatitis associated with, 634 Rheumatoid arthritis - primary biliary cirrhosis associated with, 654 - ulcerative colitis associated with, 468 Rib fractures, hepatic trauma associated with, 738 Riedel lobe, hepatomegaly vs., 689 Riedel thyroiditis, sclerosing mesenteritis associated with, 82 Right heart failure - hepatomegaly associated with, 689 - portal hypertension and varices associated with, 116 Right lower quadrant pain, acute: differential diagnosis, 454 Rim-enhancing hepatic metastases, postoperative pancreas vs., 1020 S Sacroiliitis, ulcerative colitis associated with, 468 Salted meat, gastric carcinoma associated with, 300 Sarcoidosis, 28–33 - differential diagnosis, 29–30 - hepatic, cirrhosis vs., 644 - HIV/AIDS vs., 10 - image gallery, 28, 31–33 - intestinal lymphangiectasia associated with, 385 - leukemia and lymphoma vs., 56 - primary biliary cirrhosis vs., 653 - splenic infection and abscess vs., 556 - splenic metastases and lymphoma vs., 580 Sarcoma - angiosarcoma See Angiosarcoma, hepatic - hepatic angiosarcoma See Hepatic angiosarcoma - invading stomach, gastric GIST vs., 295 - Kaposi sarcoma See Kaposi sarcoma - liposarcoma See Liposarcoma - soft tissue sarcoma, desmoid neoplasms vs., 137 - undifferentiated, hepatic, 842–843 Schatzki ring, 192–193 - differential diagnosis, 193 - esophageal webs vs., 178 Schistosomiasis - hepatic, 616–619 - portal hypertension and varices associated with, 116 Schwannoma - pancreatic, 1069 See also Atypical and rare pancreatic tumors INDEX - type of intramural benign gastric tumor, 292 Sciatic hernia, obturator hernia vs., 99 Scleroderma - esophageal See Esophageal scleroderma - intestinal See Intestinal scleroderma - primary biliary cirrhosis associated with, 654 Sclerosing angiomatoid nodular transformation (SANT), splenic - CT findings, 575 - key concepts, 575 - MR findings, 576 Sclerosing cholangitis See Primary sclerosing cholangitis Sclerosing encapsulating peritonitis, 78 Sclerosing mesenteritis, 80–83 - abdominal mesothelioma vs., 142 - associated abnormalities, 82 - desmoid neoplasms vs., 139 - image gallery, 80, 83 - intestinal carcinoid tumor vs., 440 - intestinal lymphangiectasia associated with, 385 - ischemic enteritis vs., 413 - omental infarct vs., 89 Seat belt sign, in mesenteric and small bowel trauma, 417 Seizures, Boerhaave syndrome associated with, 217 Sentinel clot sign, in mesenteric and small bowel trauma, 417 Sepsis, ileus associated with, 387 Septic emboli, splenic infection and abscess associated with, 556 Septicemia, splenic infection and abscess associated with, 556 Seroma - biloma vs., 939 - intramural benign gastric tumors vs., 291 - postoperative, abdominal abscess vs., 73–74 Serous pancreatic cystadenoma See Pancreatic serous cystadenoma Sessile polyps, colonic, 517 Shock bowel See Systemic hypotension Shock pancreas - acute pancreatitis and complications vs., 992 - CT findings, 35 - pancreatic trauma vs., 1015 SHROOM3 gene mutation, asplenia and polysplenia associated with, 552 Shwachman-Diamond syndrome - cystic fibrosis vs., 20 - pancreatic lipomatous pseudohypertrophy vs., 1013 Sickle cell anemia, 22–25 - differential diagnosis, 24 - genetics, 24 - hepatomegaly associated with, 689 - image gallery, 22, 25 - splenic infection and abscess associated with, 556 - splenomegaly and hypersplenism associated with, 559, 560 Sickle cell trait, 24 Siderosis, hepatocellular carcinoma associated with, 808 Sigmoid diverticulum, giant: colonic diverticulosis vs., 489 Sigmoid ischemic colitis, colonic diverticulosis vs., 489 Sigmoid volvulus, 502–505 - associated abnormalities, 503–504 - cecal volvulus vs., 507 - colonic ileus and Ogilvie syndrome vs., 509 - compound volvulus, 503 - differential diagnosis, 503 - image gallery, 502, 505 Simple hepatic cyst See Hepatic cyst Sinus tracts and fistulas, enteric, 404–411 Situs ambiguus, asplenia and polysplenia associated with, 551 Situs inversus, asplenia and polysplenia associated with, 551 Situs solitus, asplenia and polysplenia associated with, 551 Sjögren syndrome, primary biliary cirrhosis associated with, 654 Sludge See Gallstones and sludge SMA (superior mesenteric artery) syndrome, 324–325 - differential diagnosis, 325 - intestinal scleroderma vs., 377 - predisposing conditions, 325 SMAD4 gene deletion, colon carcinoma associated with, 526 Small aorta, CT findings in systemic hypotension, 35 Small bowel carcinoma, 442–443 - associated abnormalities, 443 - differential diagnosis, 443 - genetics, 443 - intestinal carcinoid tumor vs., 440 - intramural (mesenchymal) intestinal tumors vs., 434 - primary, intestinal metastases and lymphoma vs., 445 Small bowel diverticula, 351 Small bowel feces sign, in small bowel obstruction, 389 Small bowel NSAID stricture, 382–383 Small bowel obstruction, 388–393 - CT findings closed loop obstruction, 389 extraluminal lesions, 389 extrinsic lesions, 389 intrinsic lesions, 389 small bowel feces sign, 389 strangulating SBO, 389 - differential diagnosis, 344, 390 - ileus vs., 387 - image gallery, 388, 391–393 - staging, grading, & classification, 390 Small bowel stasis, intestinal scleroderma associated with, 378 Small bowel trauma See Mesenteric and small bowel trauma Small cell carcinoma, pancreatic, 1069 See also Atypical and rare pancreatic tumors Small intestine, 342–449 - aneurysmal dilation of small bowel lumen, differential diagnosis, 343 - bezoar, gastric bezoar associated with, 261 - celiac-sprue disease See Celiac-sprue disease - closed loop bowel obstruction ischemic enteritis associated with, 413 paraduodenal hernia vs., 105 xlvii INDEX transmesenteric postoperative hernia vs., 110 - cluster of dilated small bowel, differential diagnosis, 343 - Crohn disease See Crohn disease - CT findings amyloidosis, 27 HIV/AIDS, - differential diagnosis, 343–344 aneurysmal dilation of small bowel lumen, 343 cluster of dilated small bowel, 343 irregular diffuse small bowel fold thickening, 344 multiple masses or filling defects, 343 occult GI bleeding, 344 pneumatosis of small intestine or colon, 344 segmental or diffuse small bowel wall thickening, 343–344 small bowel obstruction, 344 stenosis, terminal ileum, 343 - diverticula, 351 - duplication cyst, 350 - enteric fistulas and sinus tracts, 404–411 - fold thickening, irregular or diffuse, differential diagnosis, 1044 - gallstone ileus, 403 - ileus See Ileus - imaging approach, 342–347 abnormal small bowel, 342–343 anatomy (graphic images), 345 differential diagnosis, 343–344 embryology and congenital malformation, 342 gross anatomy, 342 image gallery, 346–347 imaging issues, 342 mural small bowel anatomy, 342 - imaging findings, in cystic fibrosis, 19 - injuries, colorectal trauma associated with, 515 - intestinal (angioneurotic) angioedema, 380–381 differential diagnosis, 381 ischemic enteritis vs., 413 - intussusception See Intussusception - ischemic enteritis See Ischemic enteritis - lymphangiectasia, 384–385 - malabsorption conditions, 402 mastocytosis vs., 369 steatosis and steatohepatitis associated with, 634 - malrotation, 348–349 associated abnormalities, 349 congenital absence of hepatic segments associated with, 599 differential diagnosis, 349 intestinal nonrotation, paraduodenal hernia associated with, 106 - mastocytosis See Mastocytosis, systemic - Meckel diverticulum See Meckel diverticulum - mesenteric adenitis and enteritis See Mesenteric adenitis and enteritis - mesenteric and small bowel trauma, 416–421 - metastatic tumors, metastatic melanoma vs., 60 - motility disturbance, complication of small intestine transplantation, 432 xlviii - multiple masses or filling defects, differential diagnosis, 343 - necrosis, pneumatosis of intestine vs., 395 - opportunistic infection See Opportunistic intestinal infection - parasites and infestation, 358–359 differential diagnosis, 359 eosinophilic gastroenteritis and esophagitis vs., 176 - pneumatosis, 394–397 complication of small intestine transplantation, 432 differential diagnosis, 344, 395 - postoperative state, bowel See Postoperative state, bowel - radiation enteritis and colitis See Radiation enteritis and colitis - scleroderma See Intestinal scleroderma - small bowel NSAID stricture, 382–383 - small bowel obstruction, 388–393 differential diagnosis, 390 ileus vs., 387 - stenosis of terminal ileum, differential diagnosis, 343 - transplantation, 430–433 - trauma See Mesenteric and small bowel trauma - wall thickening, segmental or diffuse: differential diagnosis, 343–344 - Whipple disease See Whipple disease Small intestine neoplasms, benign - hamartomatous polyposis syndrome See Hamartomatous polyposis syndrome - ileocecal valve lipoma and lipomatous infiltration, 435 - intramural (mesenchymal) intestinal tumors, 434 - small intestine tumors extending into mesentery, desmoid neoplasms vs., 139 Small intestine neoplasms, malignant - adenocarcinoma, duodenal carcinoma associated with, 336 - carcinoid tumor, 438–441 - carcinoma See Small bowel carcinoma - intestinal GIST, 448–449 differential diagnosis, 449 intestinal carcinoid tumor vs., 440 small bowel carcinoma vs., 443 - metastases and lymphoma See Intestinal metastases and lymphoma - primary bowel tumor, intussusception vs., 399 - small bowel obstruction associated with, 390 Small intestine transplantation, 430–433 - complications, 431–432 - image gallery, 430, 433 - indications, 431 Small intestine vasculitis - intestinal metastases and lymphoma vs., 445 - ischemic enteritis vs., 413 - mesenteric and small bowel trauma vs., 417 - small bowel NSAID stricture vs., 383 Smoking - duodenal carcinoma associated with, 335 - gastric carcinoma associated with, 300 - gastric ulcer associated with, 250 - pancreatic ductal carcinoma associated with, 1036 INDEX Soft tissue sarcoma, desmoid neoplasms vs., 137 Solid and pseudopapillary neoplasm, pancreatic See Pancreatic solid and pseudopapillary neoplasm Solid organ injuries, colorectal trauma associated with, 515 Solitary colonic filling defect, differential diagnosis, 453 Solitary necrotic nodule, hepatic, 676 Spermatic cord lipoma or liposarcoma, inguinal hernia vs., 94 Sphincter of Oddi spasm, artifact, 864 Sphincterotomy, gas in biliary tree due to: emphysematous cholecystitis vs., 915 Spigelian hernia, 101 - differential diagnosis, 101 - umbilical hernia vs., 103 Spinal cord injury, ileus associated with, 387 SPINK1-trypsin inhibitor, chronic pancreatitis associated with, 1002 Spleen, 544–581 - accessory spleen, 548–549 differential diagnosis, 549 polysplenia vs., 552 splenosis vs., 571 - anatomic abnormalities, splenic infarction associated with, 564 - asplenia, 550–553 differential diagnosis, 552 malrotation of small intestine associated with, 349 - CT findings HIV/AIDS, leukemia and lymphoma, 55 metastatic melanoma, 59 post-transplant lymphoproliferative disorder, 51 sarcoidosis, 29 sickle cell anemia, 23 systemic hypotension, 35 - cystic splenic masses, differential diagnosis, 545 - differential diagnosis, 544–545 cystic splenic mass, 545 diffuse increased attenuation, 545 multiple splenic calcifications, 545 solid splenic masses, 545 splenomegaly, 544 - diffuse increased attenuation, differential diagnosis, 545 - imaging approach, 544–547 approach to abnormal spleen, 544 differential diagnosis, 544–545 embryology, anatomy, and physiology, 544 image gallery, 545–547 imaging issues, 544 - infarction See Splenic infarction - multiple splenic calcifications, differential diagnosis, 545 - neoplasms See Splenic neoplasms - normal heterogenenous enhancement in arterial phase, splenic infarction vs., 564 - opportunistic infection, post-transplant lymphoproliferative disorder vs., 52 - polysplenia See Polysplenia - radiologic findings, in mononucleosis, 17 - splenic infection and abscess See Splenic infection and abscess - splenomegaly and hypersplenism See Splenomegaly and hypersplenism - splenosis See Splenosis - trauma See Splenic trauma - wandering, gastric volvulus associated with, 264 Splenectomy, asplenia vs., 552 Splenic abscess See Splenic infection and abscess Splenic artery aneurysm or pseudoaneurysm, accessory spleen vs., 549 Splenic calcifications, multiple: differential diagnosis, 545 Splenic cleft, splenic trauma vs., 567 Splenic cyst, 572–573 - differential diagnosis, 573 - primary splenic tumors vs., 576 - splenic infarction vs., 563 - splenic trauma vs., 568 Splenic fracture See Splenic trauma Splenic hematoma, primary splenic tumors vs., 576 Splenic infarction, 562–565 - differential diagnosis, 563–564 - image gallery, 562, 565 - infection and abscess vs., 555 - metastases and lymphoma vs., 580 - radiologic findings, in mononucleosis, 17 - systemic hypotension vs., 35 - trauma vs., 567–568 Splenic infection and abscess, 554–557 - CT findings echinococcal (hydatid) cyst, 555 fungal microabscesses, 555 pyogenic abscess, 555 - cyst vs., 573 - differential diagnosis, 555–556 - genetics, 556 - image gallery, 554, 557 - infarction vs., 563–554 - metastases and lymphoma vs., 580 - primary splenic tumors vs., 576 - splenomegaly and hypersplenism vs., 560 - staging, grading, & classification, 556 - trauma vs., 567 Splenic laceration See Splenic trauma Splenic lymphoma, primary - CT findings, 575–576 - key concepts, 575 - MR findings, 576 - ultrasonographic findings, 576 Splenic masses, cystic, differential diagnosis, 545 Splenic metastases and lymphoma, 578–583 See also Primary splenic lymphoma - differential diagnosis, 580 - image gallery, 578, 581 - primary splenic tumors vs., 576 - splenic cyst vs., 573 Splenic neoplasms - primary splenic tumors See Primary splenic tumors - splenic cyst See Splenic cyst - splenic metastases and lymphoma See Splenic metastases and lymphoma xlix INDEX Splenic rupture, radiologic findings in mononucleosis, 17 Splenic trauma, 566–569 - associated abnormalities, 568 - differential diagnosis, 567–5–568 - gastroduodenal trauma associated with, 327 - hepatic trauma associated with, 738 - image gallery, 566, 569 - infarction vs., 563 - infection and abscess vs., 555 - splenomegaly and hypersplenism vs., 560 - splenosis associated with, 571 - staging, grading, & classification, 568 - systemic hypotension vs., 35 Splenic tumors, primary See Primary splenic tumors Splenic vein thrombosis, portal hypertension and varices associated with, 116 Splenomegaly and hypersplenism, 558–561 - differential diagnosis, 544, 560 - image gallery, 558, 561 - intestinal metastases and lymphoma associated with, 446 - mononucleosis vs., 17 - radiologic findings, in mononucleosis, 17 Splenosis, 570–571 - accessory spleen vs., 549 - differential diagnosis, 571 - intramural benign gastric tumors vs., 291 - polysplenia vs., 552 Splenule See Accessory spleen Spontaneous hemorrhage - HELLP syndrome vs., 733 - hepatic trauma vs., 737 Squamous cell carcinoma - esophageal carcinoma associated with, 230 - rectal carcinoma associated with, 532 Status asthmaticus, Boerhaave syndrome associated with, 217 Steatosis and steatohepatitis, 632–637 See also Nonalcoholic steatohepatitis (NASH) - associated abnormalities, 634 - differential diagnosis, 634 - focal hepatic angiomyolipoma and lipoma vs., 799 hepatic infarction vs., 719 radiation-induced liver disease vs., 741 - glycogen storage disease vs., 679 - hepatic adenoma associated with, 787 - hepatic injury from toxins vs., 639 - hepatocellular carcinoma associated with, 808 - image gallery, 632, 636–637 - multifocal fatty infiltration, hepatic metastases and lymphoma vs., 846 - nonalcoholic, alcoholic liver disease vs., 627 - viral hepatitis vs., 621 - Wilson disease vs., 685 Stercoral ulceration See Fecal impaction and stercoral ulceration Steroid agents - gastric ulcer associated with, 250 - pneumatosis of intestine vs., 395 l Steroids, anabolic - hepatic adenoma associated with, 787 - hepatic angiosarcoma associated with, 839 Stomach, 236–307 - caustic gastroduodenal injury, 258 - CT findings amyloidosis, 27 HIV/AIDS, - differential diagnosis, 237–238 epigastric pain, 238 gastric antral narrowing, 237 gastric dilation or outlet obstruction, 237–238 gastric mass lesions, 237 gastric ulceration (without mass), 237 intramural mass, 237 intrathoracic stomach, 237 left upper quadrant mass, 238 linitis plastica, limited distensibility, 238 "target" or bull's eye lesions, 237 thickened gastric folds, 237 - fundoplication complications, 274–279 esophageal motility disturbances vs., 185 esophageal scleroderma vs., 189 - gastric bezoar, 260–261 complication of partial gastrectomy, 271 differential diagnosis, 261 - gastric diverticulum, 242–243 - gastric neoplasms See Gastric neoplasms, benign; Gastric neoplasms, malignant - gastric ulcer See Gastric ulcer - gastric volvulus, 262–267 - gastritis See Gastritis - gastroparesis, 259 - iatrogenic injury: feeding tubes, 268–269 caustic esophagitis vs., 173 imaging, 269 - imaging approach, 236–241 anatomical considerations, 236 anatomy (graphic images), 239 differential diagnosis, 237–238 gastric anatomy and terminology, 236 image gallery, 240–2241 imaging issues, 236 mural anatomy, 236 thick-walled stomach, 236–237 - imaging of bariatric surgery, 280–285 - intrathoracic stomach, differential diagnosis, 237 - Ménétrier disease, 256–257 differential diagnosis, 257 gastric carcinoma vs., 300 - neoplasms See Gastric neoplasms, benign; Gastric neoplasms, malignant - partial gastrectomy: Bilroth procedures, 270–273 - Zollinger-Ellison syndrome See Zollinger-Ellison syndrome Storage diseases See also Glycogen storage disease - splenomegaly and hypersplenism associated with, 559, 560 Streaming artifact, portal vein occlusion vs., 702 Stress, gastric ulcer associated with, 250 INDEX Stress-induced sympathetic reflexes, ileus associated with, 387 Stromal ulceration, complication of partial gastrectomy, 271–272 Strongyloidiasis, toxic megacolon associated with, 471 Subclavian/IJ vein occlusion, superior vena cava obstruction vs., 37 Subclavian vein occlusion, superior vena cava obstruction vs., 37 Sulfuric acid, caustic esophagitis associated with, 173 Superficial spreading carcinoma, Candida esophagitis vs., 163 Superior mesenteric artery occlusion, omental infarct associated with, 90 Superior mesenteric artery (SMA) syndrome, 324–325 - differential diagnosis, 325 - intestinal scleroderma vs., 377 - predisposing conditions, 325 Superior vena cava compression, superior vena cava obstruction associated with, 37 Superior vena cava obstruction, 36–37 - differential diagnosis, 37 - portal hypertension and varices vs., 116 Suppurative cholangitis See Ascending cholangitis Surgery - enteric fistulas and sinus tracts associated with, 407 - hepatic infarction associated with, 719 - splenic infection and abscess associated with, 556 Susceptibility artifacts, biliary, 864 Systemic hypotension, 34–35 - differential diagnosis, 35 - ischemic enteritis vs., 413 - mesenteric and small bowel trauma vs., 417 Systemic lupus erythematosus - esophageal scleroderma associated with, 190 - intestinal scleroderma associated with, 378 - lupus vasculitis, 39, 40 Systemic mastocytosis, 369 - differential diagnosis, 369 - duodenal ulcer associated with, 320 - gastric ulcer associated with, 250 Systemic nodular panniculitis See Sclerosing mesenteritis T Takayasu arteritis See also Vasculitis - definition, 39 - imaging findings, 39 Tannin, gastric bezoar associated with, 261 Telangiectasias of skin, intramural benign gastric tumors associated with, 291 Teratoma, metastatic: hepatic angiomyolipoma and lipoma vs., 799 Terminal ileitis See Crohn disease Testicles, ultrasonographic findings in leukemia and lymphoma, 56 TGF-b1RII gene deletion, colon carcinoma associated with, 526 THADs See Transient hepatic attenuation or intensity difference (THADs and THIDs) Thiamine deficiency, Chagas disease of esophagus vs., 165 THIDs See Transient hepatic attenuation or intensity difference (THADs and THIDs) Thoracic mass - Bochdalek hernia vs., 112 - Morgagni hernia vs., 113 Thoracic trauma, traumatic diaphragmatic rupture associated with, 122 Thorax, CT findings in sarcoidosis, 29 Thorotrast - hepatic angiosarcoma associated with, 839 - hepatocellular carcinoma associated with, 808 Thromboembolism, splenic infarction associated with, 564 Thrombosed esophageal varices, inflammatory polyp vs., 227 Thrombosis - Budd-Chiari syndrome associated with, 712 - complication of small intestine transplantation, 431 - hepatic artery, ischemic bile duct injury associated with, 944 - portal vein occlusion associated with, 702 - superior vena cava obstruction associated with, 37 Thrombotic events, ischemic enteritis associated with, 413 Thyroiditis - primary biliary cirrhosis associated with, 654 - primary sclerosing cholangitis associated with, 936 Tobacco See Smoking Torsion of appendages, epiploic appendagitis associated with, 500 Toxic megacolon, 470–473 - cecal volvulus vs., 507 - colonic ileus and Ogilvie syndrome vs., 509–510 - differential diagnosis, 471 - image gallery, 470, 472–473 - sigmoid volvulus vs., 503 TP53 gene, small bowel carcinoma associated with, 443 Tracheobronchial aspiration, esophageal perforation vs., 213 Traction diverticulum, 208 - differential diagnosis, 208 - pulsion diverticulum vs., 209 Transient hepatic attenuation or intensity difference (THADs and THIDs), 690–695 - associated abnormalities, 692 - differential diagnosis, 691 - image gallery, 690, 693–695 - other causes, postoperative changes of liver vs., 746 Transjugular intrahepatic portosystemic shunt, 748–753 - differential diagnosis, 750 - image gallery, 748, 751–753 - staging, grading, & classification, 750 Transmesenteric postoperative hernia, 108–111 - differential diagnosis, 109 - image gallery, 108, 111 - paraduodenal hernia vs., 105 - staging, grading, & classification, 110 Transplantation - hepatic infarction associated with, 719 li INDEX - hepatic TB and fungal infections associated with, 605 - nodular regenerative hyperplasia associated with, 664 - pancreatic, 1022–1025 - small intestine, 430–433 Trauma - abdominal, sclerosing mesenteritis associated with, 82 - abdominal wall hernia, traumatic, 118–119 - ascites associated with, 86 - barotrauma, 48–49 differential diagnosis, 49 pneumatosis of intestine vs., 395 - biliary trauma, 946–949 - Boerhaave syndrome, 216–217 differential diagnosis, 217 esophageal perforation vs., 213 - colonic ileus and Ogilvie syndrome associated with, 510 - colorectal trauma, 514–515 - desmoid neoplasms associated with, 38 - diaphragmatic rupture, traumatic, 120–123 - duodenal, pancreatic trauma associated with, 1016 - esophageal perforation See Esophageal perforation - foreign bodies abdominal, 42–47 esophageal See Esophageal foreign body - gastroduodenal trauma, 326–327 differential diagnosis, 327 duodenal carcinoma vs., 335 - hepatic See Hepatic trauma - intestinal trauma, intestinal (angioneurotic) angioedema vs., 381 - intrahepatic arteriovenous fistula, traumatic: hereditary hemorrhagic telangiectasia vs., 727 - mesenteric and small bowel trauma, 416–421 differential diagnosis, 416 hepatic trauma associated with, 738 systemic hypotension vs., 35 - omental infarct associated with, 90 - operative, colonic ileus and Ogilvie syndrome associated with, 510 - pancreatic, 1014–1017 chronic pancreatitis associated with, 1002 differential diagnosis, 1015 systemic hypotension vs., 35 - paraduodenal hernia associated with, 106 - post-traumatic pancreatic atrophy, agenesis of dorsal pancreas vs., 980 - rectal carcinoma vs., 531 - sclerosing mesenteritis associated with, 82 - spleen See Splenic trauma Traumatic abdominal wall hernia, 118–119 Traumatic diaphragmatic rupture, 120–123 - associated abnormalities, 122 - differential diagnosis, 121–122 - image gallery, 120, 123 Traumatic intrahepatic arteriovenous fistula, hereditary hemorrhagic telangiectasia vs., 727 Trichobezoar, 261 Tricuspid valve disease, passive hepatic congestion associated with, 707 Trisomy 18, umbilical hernia associated with, 103 lii Tropical pancreatitis, chronic pancreatitis associated with, 1002 True pancreatic cyst See Nonneoplastic pancreatic cysts Tuberculosis, 12–15 - differential diagnosis, 14 - hepatic TB and fungal infections, 604–607 - image gallery, 12, 15 - infectious lymphadenopathy from, superior vena cava obstruction associated with, 37 - intestinal, duodenal carcinoma vs., 335 - radiologic findings, 13–14 Tuberculous gastritis, 245 Tuberculous peritonitis - abdominal mesothelioma vs., 141 - peritoneal metastases vs., 146 - pseudomyxoma peritonei vs., 149–150 - radiologic findings, 13 Tuberous sclerosis - congenital hepatic fibrosis associated with, 592 - hepatic cyst associated with, 766 Tubular adenomatous polyps, colonic, 517 Tubulovillous adenomatous polyps, colonic, 517 Tumefactive sludge, gallbladder polyps vs., 953 Tumor implantation in abdominal incision sites, 128 Turcot syndrome, colonic polyps associated with, 518 Typhlitis See Neutropenic colitis (typhlitis) Typhoid fever, toxic megacolon associated with, 471 Tyrosine kinase activity, gastric GIST associated with, 296 Tyrosine kinase growth factor receptor, intestinal GIST associated with, 449 U Ulcerative colitis, 466–469 - associated abnormalities, 468 - colon carcinoma vs., 525 - Crohn disease vs., 371 - differential diagnosis, 467–468 - epiploic appendagitis vs., 499–500 - gallbladder carcinoma associated with, 958 - genetics, 468 - image gallery, 466, 469 - infectious colitis vs., 459 - intestinal parasites and infestation vs., 359 - ischemic colitis vs., 475–476 - primary sclerosing cholangitis associated with, 936 Ultraviolet radiation, metastatic melanoma associated with, 60 Umbilical hernia, 103 - differential diagnosis, 103 - spigelian hernia vs., 101 Undifferentiated sarcoma, hepatic, 842–843 Ureteral colic, duodenitis vs., 317 Ureteral tuberculosis, radiologic findings, 13 Uveitis - Crohn disease associated with, 372 - ulcerative colitis associated with, 468 INDEX V Vagal nerve degenerative changes, esophageal achalasia associated with, 182 Vaginal atresia, congenital hepatic fibrosis associated with, 592 Vagotomy - complication, esophageal scleroderma vs., 189 - gastric bezoar associated with, 261 Variants, biliary See Biliary normal variants and artifacts Varices See Esophageal varices; Portal hypertension and varices Vascular congestion, omental infarct associated with, 90 Vascular injuries, pancreatic trauma associated with, 1016 Vascular occlusion, ischemic enteritis associated with, 413 Vasculitis, 38–41 - hepatic infarction associated with, 719 - image gallery, 38, 41 - intestinal (angioneurotic) angioedema vs., 381 - lupus vasculitis, 39, 40 - small intestine See Small intestine vasculitis - staging, grading, & classification, 40 Vena cava - inferior See Inferior vena cava - superior See Superior vena cava obstruction Venoocclusive disease, hepatic, 716–717 Venous thromboses - appendages, epiploic appendagitis associated with, 500 - complication of acute pancreatitis, 991 - Crohn disease associated with, 372 Ventral hernia, 100 - spigelian hernia vs., 101 - umbilical hernia vs., 103 Vicarious excretion (of contrast medium), 153 - differential diagnosis, 153 - milk of calcium bile vs., 929 Vigorous activity, omental infarct associated with, 90 Villous adenoma, colon, 520–523 - differential diagnosis, 521–522 - duodenal metastases and lymphoma vs., 339 - fecal impaction and stercoral ulceration vs., 512 - gastroduodenal trauma vs., 327 - image gallery, 520, 523 - rectal, rectal carcinoma vs., 531 Villous adenomatous polyps, colonic, 517 Villous tumor See Villous adenoma, colon Viral esophagitis, 164 - Barrett esophagus vs., 171 - Candida esophagitis vs., 163 - differential diagnosis, 164 - drug-induced esophagitis vs., 174 - reflux esophagitis vs., 167 Viral hepatitis, 620–625 - acute, passive hepatic congestion vs., 707 - alcoholic liver disease vs., 627 - autoimmune hepatitis vs., 631 - chronic, hepatocellular carcinoma associated with, 808 - differential diagnosis, 621–622 - hepatic injury from toxins vs., 639 - hepatomegaly associated with, 689 - image gallery, 620, 623–625 - steatosis and steatohepatitis vs., 634 Viral infections - cytomegalovirus infection intestinal, 361, 362 post-transplant lymphoproliferative disorder associated with, 52 - duodenitis associated with, 317 - herpesvirus infection, Candida esophagitis associated with, 163 - infectious colitis associated with, 460 - meseneric adenitis and enteritis associated with, 357 Visceral malignancy - primary, sclerosing mesenteritis vs., 82 - splenosis vs., 571 Visceral mass - accessory spleen vs., 549 - splenosis vs., 571 Vitelline duct abnormalities, Meckel diverticulum associated with, 354 Volvulus - cecal, 506–507 colonic ileus and Ogilvie syndrome vs., 509 differential diagnosis, 507 - gastric, 262–267 - sigmoid See Sigmoid volvulus Vomiting, Boerhaave syndrome associated with, 217 von Hippel-Lindau syndrome, nonneoplastic pancreatic cysts associated with, 1032 von Recklinghausen disease, gastric GIST associated with, 296 W Waldenström macroglobulinemia - amyloidosis associated with, 27 - celiac-sprue disease vs., 366 Wandering spleen, gastric volvulus associated with, 264 Wegener granulomatosis See also Vasculitis - definition, 39 - imaging findings, 39 Weight loss, SMA (superior mesenteric artery) syndrome associated with, 325 Weightlifting, Boerhaave syndrome associated with, 217 Whipple disease, 368 - celiac-sprue disease vs., 365 - differential diagnosis, 368 - intestinal lymphangiectasia vs., 385 - intestinal metastases and lymphoma vs., 446 Whipple procedure - normal findings after, 1019 - postoperative imaging, 1019 Wilson disease, 684–687 - differential diagnosis, 685 - genetics, 685 - hepatomegaly associated with, 689 - image gallery, 684, 686–687 liii ... Tonolini M et al: Nontraumatic splenic emergencies: cross-sectional imaging findings and triage Emerg Radiol 20 (4): 323 - 32, 20 13 Splenic Infection and Abscess Spleen (Left) Color Doppler image... infarction J Ultrasound Med 33(6): 929 -38, 20 14 Lawrence YR et al: Splenic infarction: an update on William Osler's observations Isr Med Assoc J 12( 6):3 62- 5, 20 10 Splenic Infarction Spleen (Left)... Radiology 27 0(1):99-106, 20 14 Boscak AR et al: Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans Radiology 26 8(1):79-88, 20 13 Post