(BQ) Part 2 book Imaging for surgical disease presents the following contents: Appendicitis, renal cyst, renal cell carcinoma, wilms tumor, horseshoe kidney, splenic artery aneurysm, splenic cyst, splenic infarction, traumatic brain injury, subdural hematoma,...
9 Appendix Appendicitis Overview Most common in teenage years and patients in their 20s Rate of appendectomy for appendicitis is 10 per 10,000 patients ■ ■ per year Usually due to lymphoid hyperplasia or fecalith causing luminal obstruction ■ Signs and Symptoms Anorexia (90%) ■ Abdominal pain: Periumbilical migrating to RLQ ■ Nausea and vomiting (70%) ■ Low-grade fever ■ Physical Examination Findings Point tenderness typically over McBurney point Psoas sign: Pain with extension of right thigh while in left lateral ■ ■ decubitus position Obturator sign: Pain with passive rotation of flexed right hip ■ Rovsing’s sign: Pain in RLQ while palpating LLQ ■ Rectal examination may reveal a pelvic mass or abscess ■ Laboratory Findings Patients can have a normal WBC count, but usually mild ■ leukocytosis in the range of 10,000 to 18,000/mm3 ■ Urinalysis may be positive with pyuria, hematuria, and albuminuria LWBK1240-Ch09_p244-264.indd 244 23/07/13 9:19 PM Chapter 9 Appendix 245 Treatment IV fluid resuscitation and peri-operative antibiotics Laparoscopic or open appendectomy ■ For perforated appendix, may undergo appendectomy if there is ■ ■ no inflammatory phlegmon If there is an inflammatory phlegmon, conservative management with IV antibiotic, with percutaneous drainage of any associated abscess KEY POINT The risk of a ruptured appendicitis increases at 24 hours ■ from the initial presentation of signs and symptoms R A D I O LO G Y Appendicitis Plain film findings • Usually normal • Adynamic ileus may be seen • Sometimes, a calcified appendicolith in the right lower quadrant ■ is seen ■ US findings • Blind-ending tubular structure that is noncompressible, outer wall to outer wall diameter greater than mm • If identified, an appendicolith casts a clean posterior acoustic shadow • Tenderness over appendix • False negative can result from retrocecal appendicitis, gangrenous or perforated appendicitis, gas-filled appendix, and massively enlarged appendix ■ CT findings (Fig 9.1) • Appendix measuring greater than mm in diameter, failure of appendix to fill with oral contrast or air up to its tip • Adjacent cecal thickening due to edema at the origin of the appendix LWBK1240-Ch09_p244-264.indd 245 23/07/13 9:19 PM 246 Imaging for Surgical Disease • Inflammation/fatty stranding/fluid in the retroperitoneum/frank abscess • Appendicolith MRI findings • Dilated, thickened appendix with adjacent inflammation seen on ■ contrast-enhanced T1-weighted and T2-weighted images LWBK1240-Ch09_p244-264.indd 246 23/07/13 9:19 PM Chapter 9 Appendix 247 FIGURE 9.1 A,B A Vertebra B Psoas muscle C Colon D Stomach E Spleen F Bladder Periappendiceal fat stranding Dilated appendix containing fluid C A B 14 mm FIGURE 9.1 A LWBK1240-Ch09_p244-264.indd 247 23/07/13 9:19 PM 248 Imaging for Surgical Disease D Dilated appendix filled with fluid C E Periappendiceal fat stranding 14 mm F FIGURE 9.1 B LWBK1240-Ch09_p244-264.indd 248 23/07/13 9:19 PM Chapter 9 Appendix 249 Appendicitis with Fat Stranding Plain film findings • Inflammation in the adjacent fat can lead to loss of the right ■ psoas muscle shadow • An associated obstruction may be seen as dilated loops of small bowel US findings • Dilated, inflamed appendix with increased echogenicity in the surrounding fat • Edema of the adjacent cecum ■ CT findings (Fig 9.2) • Increased attenuation of the surrounding fat with or without adjacent cecal wall thickening ■ LWBK1240-Ch09_p244-264.indd 249 23/07/13 9:19 PM 250 Imaging for Surgical Disease FIGURE 9.2 A,B A Femoral head B Liver C Stomach D Small bowel loops E Colon Dilated and fluidfilled appendix A Periappendiceal fat stranding 14 mm A FIGURE 9.2 A LWBK1240-Ch09_p244-264.indd 250 23/07/13 9:19 PM Chapter 9 Appendix 251 B C D E 14 mm Dilated and fluidfilled appendix Periappendiceal fat stranding FIGURE 9.2 B LWBK1240-Ch09_p244-264.indd 251 23/07/13 9:19 PM 252 Imaging for Surgical Disease Appendicitis with Appendicolith US findings • Echogenic mass noted within the appendiceal lumen, usually ■ with dense posterior acoustic shadowing CT findings (Fig 9.3) • Enlarged appendix with a hyperdense mass within the lumen ■ FIGURE 9.3 A–C A Small bowel loops B Liver C Stomach D Gallbladder E Spleen Appendicolith within enlarged appendix Periappendiceal fat stranding A FIGURE 9.3 A LWBK1240-Ch09_p244-264.indd 252 23/07/13 9:19 PM Chapter 9 Appendix 253 C B D A Inflamed, dilated appendix containing gas FIGURE 9.3 B LWBK1240-Ch09_p244-264.indd 253 23/07/13 9:19 PM Chapter 13 Vascular 451 Aortoenteric Fistula Overview Fistula typically between the third or fourth portion of duodenum and the aorta ■ Usually secondary to aortic surgery ■ Other causes include AAA rupture, perforated duodenal ulcer ■ Mortality is 30% in recognized cases, 100% in unrecognized cases ■ Signs and Symptoms GI hemorrhage, pulsatile mass, and infection ■ Herald bleed followed by massive hemorrhage (hours to days later) ■ Half of the patients report abdominal or back pain initially ■ Imaging ■ CT is test of choice Treatment ■ Resection with extra-anatomic bypass R A D I O LO G Y ■ CT findings (Fig 13.11) • Periaortic air and surrounding fat stranding • Possible pseudoaneurysm • Fistulous connection between the aorta and bowel may be noted on contrast-enhanced scans as demonstrated by extravasation of contrast from the aorta into the bowel lumen • Possible extravasation of IV contrast within duodenal lumen or inner lumen of adjacent bowel walls LWBK1240-Ch13_p409-454.indd 451 23/07/13 10:14 PM 452 Imaging for Surgical Disease FIGURE 13.11 A,B A Liver B Gallbladder C Small bowel loops D Vertebra E Descending aorta Air and soft tissue thickening around the aorta concerning for aortoenteric fistula B E A C D FIGURE 13.11 A LWBK1240-Ch13_p409-454.indd 452 23/07/13 10:14 PM Chapter 13 Vascular 453 Air and soft tissue thickening around aorta concerning for aortoenteric fistula A B E C FIGURE 13.11 B LWBK1240-Ch13_p409-454.indd 453 23/07/13 10:15 PM 454 Imaging for Surgical Disease Suggested Readings Kayani I, Groves AM, Syed R Aortoenteric fistula as shown by multidetector computed tomography Heart 2005;91:304 Lee WK, Mossop PJ, Little AF, et al Infected (mycotic) aneurysms: Spectrum of imaging appearances and management Radiographics 2008;28:1853–1868 LePage MA, Quint LE, Sonnad SS, et al Aortic dissection: CT features that distinguish true lumen from false lumen Am J Roentgenol 2001;177:207–211 Marotta R, Franchetto AA The CT appearance of aortic transection Am J Roentgenol 1996;166:647–651 Orton DF, LeVeen RF, Saigh JA, et al Aortic prosthetic graft infections: Radiologic manifestations and implications for management Radiographics 2000;20:977– 993 Rakita D, Newatia A, Hines JJ, et al Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms Radiographics 2007;27:497– 507 Sakamoto I, Sueyoshi E, Hazama S, et al Endovascular treatment of iliac artery aneurysms Radiographics 2005;25:S213–S227 Sheth S, Fishman EK Imaging of the inferior vena cava with MDCT Am J Roentgenol 2007;189:1243–1251 Siegel CL, Cohan RH CT of abdominal aortic aneurysms Am J Roentgenol 1994;163:17–29 Wright LB, Matchett WJ, Cruz CP, et al Popliteal artery disease: Diagnosis and treatment Radiographics 2004;24:467–479 LWBK1240-Ch13_p409-454.indd 454 23/07/13 10:15 PM Index Title Note: Page number followed by f indicates figure only A Abdominal aortic aneurysm (AAA), 281, 409–410 CT findings, 410, 411f–413f defined, 409 management, 410 normal vessel dimensions, 409 with rupture CT findings, 414, 414f–415f signs and symptoms, 409 treatment, 410 Abdominal trauma, 349 bladder, 390–391 bladder rupture CT findings, 392, 392f, 393f cystography findings, 391 plain film findings, 391 CT findings, 351, 351f–363f duodenum, 390 extraperitoneal bladder rupture, 394f–397f kidney, 375 CT findings, 375, 376f–389f liver, 349 pancreas, 390 retroperitoneal hematoma, 390 solid organ injury scale, 350 spleen, 364 CT findings, 365, 366f–374f US findings, 365 Adenocarcinoma, treatment, 61 Amebic abscess, 115 cause, 115 signs and symptoms, 115 treatment, 115 Anorexia and appendicitis, 244 See also Appendicitis Aortic dissection, 424 antihypertensive therapy, 425 aortic transection CT findings, 425, 426f, 427f plain film findings, 425, 426f, 427f diagnosis, 424–425 risk factors, 424 signs and symptoms, 424 treatment, 425 type A and type B CT findings, 428, 429f–434f plain film findings, 428 Aortoenteric fistula, 451 causes, 451 CT findings, 451, 452f–453f imaging, 451 signs and symptoms, 451 treatment, 451 Appendicitis with appendicolith CT findings, 252, 252f–254f US findings, 252 causes, 244 CT findings, 245–46, 247f, 248f enlarged appendix CT findings, 255, 255f, 256f with fat stranding CT findings, 249, 250f, 251f plain film findings, 249 US findings, 249 laboratory findings, 244 MR findings, 246 occurrence, 244 physical examination findings, 244 plain film findings, 245 residual appendix CT findings, 257, 257f–259f ruptured appendix with abscess CT findings, 260, 260f–263f plain film findings, 260 US findings, 260 signs and symptoms, 244 treatment, 245 US findings, 245 455 LWBK1240-Ind-p455-468.indd 455 23/07/13 9:26 PM 456 Index B Bladder, 390–391 See also Abdominal trauma extraperitoneal rupture, 391 intraperitoneal rupture, 390 rupture CT findings, 392, 392f, 393f extraperitoneal, 394f–397f Bochdalek hernia See also Diaphragmatic hernia CT findings, 38, 39f–41f plain film findings, 38 Bosniak classification, for renal cyst, 266 See also Renal cyst Brain herniation cingulate gyrus, 312 CT findings, 312, 313f–315f subfalcine herniation, 312 C Cameron ulcers, Cervical spine injuries (C-spine), 318, 319f–322f extension injuries, 330–332 extension teardrop, 331 Hangman fracture, 330 Jefferson fracture, 332 flexion/compression, 335–336 burst fracture, 336 wedge and compression fractures, 335 flexion-distraction, 337–338 chance fracture, 337 rotational fracture–dislocation, 338 flexion injuries, 323–329 anterior subluxation, 325 bilateral facet dislocation, 326 clay shoveler, 327 flexion–rotation, 328 flexion teardrop, 324 rotatory atlantoaxial dislocation, 329 simple wedge fracture, 323 T and L spine injuries, 333f–334f Charcot triad, 92 Chest tube placement, 347, 347f See also Thoracic trauma Chest wall trauma, 344 See also Thoracic trauma LWBK1240-Ind-p455-468.indd 456 Cholecystitis, acute CT findings, 94 definitions, 92 diagnosis, 93 HIDA findings, 94 signs and symptoms, 92 treatment, 93 US findings, 94, 95f Choledocholithiasis, 110 CT findings, 110 definitions, 92 intraoperative cholangiogram, 111f–112f MRCP findings, 110 signs and symptoms, 92 treatment, 93 US findings, 110 Cholelithiasis CT findings, 96, 99f–101f plain film findings, 96 US findings, 96, 97f–98f Cholesterol gallstones, 92 cause, 92 risk factors, 92 Cingulate gyrus, 312 See also Brain herniation Clavicle fracture, 346, 346f See also Thoracic trauma Colorectal cancer colon cancer CT findings, 218, 219f, 220f plain film findings, 218 diagnosis, 217–218 FAP, 217 hereditary, 216 HNPCC, 216 management, 218 rectal cancer CT findings, 221, 221f, 222f EUS findings, 220 MRI findings, 221 treatment, 218 Colovesicular fistula, 214 CT findings, 214, 214f–216f Computed tomography (CT) findings abdominal aortic aneurysm, 410, 411f–413f with rupture, 414, 414f–415f abdominal incisional hernia, 19, 19f–21f 23/07/13 9:26 PM Index 457 abdominal trauma, 349, 351f–363f acute cholecystitis, 94 acute pancreatitis with necrosis, 145, 145f, 146f with surrounding fluid, 143, 144f amebic abscess, 118 aortic dissection type A and type B, 428, 429f–434f aortic transection, 425, 426f, 427f aortoenteric fistula, 451, 452f–453f appendicitis, 245, 247f, 248f with appendicolith, 252, 252f–254f with fat stranding, 249, 250f, 251f ascending thoracic aortic aneurysm, 417, 418f, 419f bilateral inguinal hernia, 42, 43f–46f bladder rupture, 391, 392f, 393f bochdalek hernia, 38, 39f–41f cecal volvulus, 230, 231f–234f choledocholithiasis, 110 cholelithiasis, 96, 99f–101f colon cancer, 218, 219f, 220f colovesicular fistula, 214, 214f–216f descending thoracic aortic aneurysm, 420, 421f–423f diaphragmatic injury with pneumothorax, 340, 341f–343f diverticular pelvic abscess, 211, 211f–213f diverticulitis, 204, 205f–206f diverticulosis, 197, 199f–203f duodenal perforation, 87, 88f–90f duodenal ulcer, 80, 81f–86f emphysematous gallbladder, 102, 104f–106f enlarged appendix, 255, 255f, 256f epidural hematoma, 302, 303f esophageal cancer, 3, 4f–5f flank incisional hernia, 30, 30f–31f focal nodular hyperplasia, 121, 122f–126f gallbladder calcification, 107, 107f–108f polyp, 109 gastric cancer, 62, 63f lymphoma, 64, 65f–67f outlet obstruction, 72, 73f–75f LWBK1240-Ind-p455-468.indd 457 GIST tumor, 68, 69f–71f hemangioma, 118, 119f–120f hepatic adenoma, 126, 127f–128f hepatocellular carcinoma, 128, 130f–132f horseshoe abscess, 238 kidney, 277, 278f–279f iliac artery aneurysm, 435, 436f, 437f incarcerated inguinal hernia, 47, 48f–50f incisional hernia with acutely incarcerated bowel, 22, 22f–24f intussusception, 187, 189f–191f invasive pancreatic tumors, 158, 158f, 159f kidney, 375, 376f–389f Meckel diverticulum, 185, 186f–187f mesenteric ischemia, 192, 193f–195f morgagni hernia, 32 mycotic aneurysm, 443, 445f–450f Ogilvie’s syndrome, 240, 240f–242f pancreas, cystic diseases of hypodense lesion, 152, 153f–154f pancreatic tumor, 155, 156f, 157f paraesophageal hernia, 10, 11f–14f parastomal hernia, 51, 52f–54f pelvic fractures, 397 perforated diverticulitis, 207, 207f–210f perirectal abscess, 235, 236f–237f pneumatosis intestinalis, 179, 183f–185f pneumobilia, 136f–137f popliteal aneurysm, 438, 439f–442f portal vein thrombosis, 137, 137f–140f pseudocyst, 148, 148f–150f pyloric stenosis, 77 pyogenic abscess, 117 rectal cancer, 220–221, 221f, 222f renal cell carcinoma, 270, 272f, 273f renal cyst, 265, 267f–269f residual appendix, 257, 257f–259f rib fracture, 344 ruptured appendix with abscess, 260, 260f–263f sigmoid volvulus, 223, 224f–230f 23/07/13 9:26 PM 458 Index Computed tomography (CT) findings (continued) sliding hiatal hernia, small bowel obstruction, 162, 163f–170f spleen, 364, 366f–374f splenic cyst, 287, 289f–292f infarction, 293, 294f, 295f splenomegaly, 296, 297f–299f status post nissen fundoplication, 15 status post ventral hernia repair, 25, 25f–27f and infected mesh with abscess, 28, 28f–29f subarachnoid hemorrhage, 309, 310f–312f subdural hematoma, 304, 305f–306f with diffuse cerebral edema, 308, 308f umbilical hernia, 55, 56f–58f Wilms tumor, 274, 275f, 276f Courvoisier sign, 151 Cullen sign, 141 Curling ulcer, 78 Cystoduodenostomy, for pseudocyst treatment, 147 Cystojejunostomy, for pseudocyst treatment, 147 D Diaphragmatic hernia, 32 See also Hernias radiology bochdalek hernia, 38, 39f–41f morgagni hernia, 32, 33f–37f Diffuse axonal Injury, 315 See also Traumatic brain injury Diverticular diseases, 197 diagnosis, 197 diverticular pelvic abscess CT findings, 211, 211f–213f diverticulitis CT findings, 204, 205f–206f plain film findings, 204 US findings, 204 diverticulosis CT findings, 198, 199f–203f management, 198 LWBK1240-Ind-p455-468.indd 458 perforated diverticulitis CT findings, 207, 207f–210f signs and symptoms, 197 treatment, 198 Duodenal perforation radiology CT findings, 87, 88f–90f plain film findings, 87 Duodenal ulcer, 78 diagnosis, 79 management, 79 peptic ulcers, Johnson classification of, 79 radiology, 80 CT findings, 80, 81f–86f plain film findings, 80, 81f–86f upper GI findings, 80 signs and symptoms, 79 treatment, 79 Duodenum, 390 See also Abdominal trauma E Emphysematous gallbladder CT findings, 102, 104f–106f plain film findings, 102 US findings, 102, 102f–103f Endoscopic cystogastrostomy, for pseudocyst treatment, 147 Endoscopic retrograde cholangiopancreatography (ERCP), 93, 141 Entamoeba histolytica, 115 Epidural hematoma, 302 See also Traumatic brain injury CT findings, 302, 303f Epigastric pain and acute pancreatitis, 141 See also Pancreatitis, acute Esophageal carcinoma, diagnosis, 1–2 radiology CT findings, 3, 4f–5f endoscopic US findings, PET/CT findings, plain film findings, upper GI findings, 2–3 risk factors, signs and symptoms, treatment, 23/07/13 9:26 PM Index 459 Esophagus slipped nissen upper GI findings, 16, 16f, 17f status post nissen fundoplication CT findings, 15 upper GI findings, 15, 15f F Fistula, defined, 173 Flail chest, 344 See also Thoracic trauma Focal nodular hyperplasia, 121 CT findings, 121, 122f–126f G Gallbladder calcification, 93 CT findings, 107, 107f–108f plain film findings, 107 US findings, 107 emphysematous CT findings, 102, 104f–106f plain film findings, 102 US findings, 102, 102f–103f polyp, 93 CT findings, 109 US findings, 109, 109f–110f Gallstones, cholesterol, 92 cause, 92 risk factors, 92 Gardner’s syndrome, 219 Gastric adenocarcinoma metastasis, 60 cancer CT findings, 62, 63f plain film findings, 61 upper GI findings, 62 lymphoma CT findings, 64, 65f–67f upper GI findings, 64 neoplasms, 60 Blumer shelf, 60 clinical presentation, 60 diagnosis, 60 Krukenberg tumor, 60 Sister Mary Joseph node, 60 treatment, 61 Virchow node, 60 outlet obstruction, 72 cause, 72 LWBK1240-Ind-p455-468.indd 459 CT findings, 72, 73f–75f plain film findings, 72, 73f–75f perforation, 78 CT findings, 80, 81f–86f diagnosis, 79 management, 79 peptic ulcers, Johnson classification of, 79 plain film findings, 80, 81f–86f signs and symptoms, 79 treatment, 79 upper GI findings, 80 Gastroduodenal artery (GDA), 151 Gastroesophageal reflux, symptoms of, Gastrointestinal stromal tumors (GIST), 60 treatment, 61 tumor CT findings, 68, 69f–71f MRI findings, 68 plain film findings, 68 Grey Turner sign, 141 H Hangman fracture, 330 See also Cervical spine injuries (C-spine) Helicobacter pylori, 61 Hemangioma CT findings, 118, 119f–120f MRI findings, 118 occurrence, 118 treatment, 118 Hematoma intrasplenic, 367 perisplenic, 365 retroperitoneal, 390 subcapsular, 365 Hemothorax, 339 See also Thoracic trauma Hepatic adenoma, 126 CT findings, 126, 127f–128f MRI findings, 127 occurrence, 126 Hepatocellular carcinoma, 128 CT findings, 129, 130f–132f MRI findings, 129, 133f–134f risk factors, 128 23/07/13 9:26 PM 460 Index Hepatocellular carcinoma (continued) signs and symptoms, 128 treatment, 129 ultrasound, 129, 130f–134f Hereditary colorectal cancer syndromes, 216 Hernias, 18 diaphragmatic, 32, 33f–37f, 38, 39f–41f incisional, 18 acutely incarcerated bowel, 22, 22f–24f diagnosis, 18 risk factors, 18 inguinal, 42–50, 43f–46f, 48f–50f paraesophageal CT findings, 10, 11f–14f upper GI series findings, 10, 11f–14f parastomal, 51, 52f–54f radiology abdominal incisional, 19, 19f–21f flank incisional hernia, 30, 30f–31f infected mesh and status post ventral hernia repair, 28, 28f–29f status post ventral hernia repair, 25, 25f–27f umbilical, 55, 56f–58f ventral, 18 diagnosis, 18 risk factors, 18 Hiatal hernia classification of, 6, 7f diagnosis, signs and symptoms of, sliding CT findings, plain film findings, upper GI series findings, 8, 9f, 10f treatment, 6–7 Hinchey classification, of diverticular disease, 197 Honda sign, 398 Horseshoe kidney, 277 CT findings, 277, 278f, 279f MRI findings, 277 plain film findings, 277 US findings, 277 LWBK1240-Ind-p455-468.indd 460 I Ileus causes, 171 diagnosis, 171 management, 171 plain film findings, 172, 172f, 173f signs and symptoms, 171 treatment, 171 Iliac artery aneurysm, 281, 435 CT findings, 435, 436f, 437f diagnosis, 435 management, 435 signs and symptoms, 435 treatment, 435 Incisional hernias, 18 See also Hernias abdominal, 19, 19f–21f with acutely incarcerated bowel, 22, 22f–24f diagnosis, 18 flank, 30, 30f–31f risk factors, 18 Inguinal hernia, 42 See also Hernias bilateral radiology, 42, 43f–46f direct, 42 incarcerated, 47, 48f–50f indirect, 42 Intraductal mucinous papillary neoplasm (IMPN), 152 Intraparenchymal hemorrhage, 315 See also Traumatic brain injury Intussusception, 187 in adult population, 187 CT findings, 189, 189f–191f diagnosis, 188 management, 188 in pediatric population, 187 plain film findings, 188 signs and symptoms, 188 treatment for adults, 188 for pediatric patients, 188 J Jefferson fracture, 332 See also Cervical spine injuries (C-spine) Juvenile polyposis syndrome, 217 23/07/13 9:26 PM Index 461 K Kasabach–Merritt syndrome, 118 Kidney, 375 L Laparoscopic cystogastrostomy, for pseudocyst treatment, 147 Leiomyomas, Liver abscess, 115, 116f–117f amebic abscess, 118 CT findings, 118 ultrasound, 118 Lymphoma, treatment, 61 M McBurney point, 244 Meckel diverticulum, 185 CT findings, 186, 186f–187f diagnosis, 185 management, 185 plain film findings, 186 signs and symptoms, 185 in adults, 185 in pediatric population, 185 treatment, 185 Mesenteric ischemia CT findings, 193, 193f–195f diagnosis, 192 etiologies, 192 management, 192 plain film findings, 192 signs and symptoms, 192 treatment, 192 Metronidazole, in amebic abscess treatment, 115 Morgagni hernia See also Diaphragmatic hernia CT findings, 32 plain film findings, 32, 33f–37f Mucinous cystic neoplasms (MCN), 152 Mucosa-associated lymph tissue (MALT), 61 Murphy sign, 92 Mycotic aneurysm, 443 CT findings, 444, 445f–450f diagnosis, 443 risk factors, 443 LWBK1240-Ind-p455-468.indd 461 signs and symptoms, 443 treatment, 444 N National Emergency X-Radiography Utilization Study (NEXUS), 318 Needle thoracotomy, in tension pneumothorax treatment, 340 Nissen fundoplication, O Obturator sign, 244 Ogilvie’s syndrome, 239 CT findings, 240, 240f–242f diagnosis, 239 management, 239 plain film findings, 240, 240f–242f signs and symptoms, 239 treatment, 239 Omental fat, 47 P Pancreas, cystic diseases of, 151 clinical presentation, 151 hypodense lesion CT findings, 152, 153f–154f plain film findings, 152 invasive pancreatic tumor CT findings, 158, 158f, 159f pancreatic cystic lesions, 152 pancreatic tumor CT findings, 155, 156f, 157f MRI findings, 155 plain film findings, 155 US findings, 155 risk factors, 151 Pancreatic cystic lesions, 152 intraductal mucinous papillary neoplasm, 152 mucinous cystic neoplasms, 152 serous cystadenoma, 152 Pancreatic pseudocyst, 146 Pancreatic tumors, 151 clinical presentation, 151 head of the pancreas CT findings, 155, 156f, 157f MRI findings, 155 plain film findings, 155 US findings, 155 23/07/13 9:26 PM 462 Index Pancreatic tumors (continued) hypodense lesion CT findings, 152, 153f–154f plain film findings, 152 invasive CT findings, 158, 158f, 159f location of, 151 pancreatic cystic lesions, 152 risk factors, 151 Pancreatitis, acute, 141 causes, 141 complications, 142 diagnosis, 141–142 etiologies, 141 with necrosis CT findings, 145, 145f, 146f signs and symptoms, 141 with surrounding fluid CT findings, 143, 144f MRCP findings, 143 plain film findings, 143 US findings, 143 treatment, 142 Pancreatitis, chronic, 143 Papilla of Vater, 142 Paraesophageal hernia See also Hernias CT findings, 10, 11f–14f upper GI series findings, 10, 11f–14f Parastomal hernia, CT findings of, 51, 52f–54f See also Hernias Pelvic fractures, 397, 399f–407f CT findings, 398 pelvic ring fractures, 397 plain film findings, 397–398 pubic rami fractures, 397 scintigraphy findings, 398 Pelvic ring fractures, 397 See also Pelvic fractures Peptic ulcer disease and gastric outlet obstruction, 72 Johnson classification of, 79 (see also Duodenal ulcer) Perirectal abscess classification, 235 diagnosis, 235 horseshoe abscess CT findings, 238 MRI findings, 238, 238f LWBK1240-Ind-p455-468.indd 462 perirectal abscess CT/MRI findings, 235, 236f–237f signs and symptoms, 235 treatment, 235 Peutz–Jeghers syndrome, 189, 217 Pigmented stones, 92 Pneumatosis intestinalis, 178 adult, 183f–185f CT findings, 179, 183f–185f diagnosis, 178 management, 178 pediatric, 180f–182f plain film findings, 179, 180f–182f treatment, 178 Pneumobilia, 135 CT findings, 129, 129f–130f etiology, 128 ultrasound, 128 Pneumothorax, 339 See also Thoracic trauma and hemothorax, 339 treatment, 339 Polypropylene (PP), 25 Polytetrafluoroethylene (PTFE), 25 Popliteal aneurysm, 438 CT findings, 438, 439f–442f diagnosis, 438 management, 438 signs and symptoms, 438 treatment, 438 Portal vein thrombosis, CT findings of, 137, 138f–140f Pseudocyst, 146 clinical presentation, 147 complications, 147 CT findings, 148, 148f–150f defined, 146 diagnosis, 147 treatment, 147 Pseudo-obstruction, acute colonic, 239 Psoas sign, 244 Pubic rami fractures, 397 See also Pelvic fractures Pulmonary contusion, 348 See also Thoracic trauma Pyloric stenosis, 76 clinical presentation, 76 CT findings, 77 23/07/13 9:26 PM Index 463 diagnosis, 76 treatment, 76 upper GI findings, 76 US findings, 77, 77f–78f Pyogenic abscess, 114 chest x-ray, 117 CT findings, 117 occurrence, 114 signs and symptoms, 114 treatment, 114 types, 114 ultrasound, 117 R Ranson criteria, 141 Renal cell carcinoma (RCC), 270 clinical presentation, 270 CT findings, 271, 272f, 273f diagnosis, 270 MRI findings, 271 occurrence, 270 plain film findings, 270 risk factors, 270 treatment, 270 Renal cyst, 265 Bosniak classification for, 266 CT findings, 266–267, 267f–269f diagnosis, 265 MRI findings, 267 signs and symptoms, 265 treatment, 265 US findings, 266 Reynolds pentad, 92 Rigler’s sign, 80 Rovsing sign, 244 S Sacral ala fractures, 397 See also Pelvic fractures Serous cystadenoma, 152 See also Pancreatic cystic lesions Skull fractures, 301 See also Traumatic brain injury Small bowel obstruction cause, 161 CT findings, 162, 163f–170f diagnosis, 161 etiologies, 161 LWBK1240-Ind-p455-468.indd 463 management, 162 plain film findings, 162, 163f–170f signs and symptoms, 161 treatment, 162 Small Bowel Enterocutaneous Fistula CT findings, 174, 175f–177f defined, 173 diagnosis, 174 management, 174 plain film findings, 174 signs and symptoms, 174 treatment, 174 Solid organ injury scale, 350 See also Abdominal trauma Spinal injuries, 316–317 Spleen, 364 Splenic artery aneurysm, 281 CT findings, 282, 282f–287f diagnosis, 281 management, 281 plain film findings, 282 risk factors, 281 signs and symptoms, 281 treatment, 281 Splenic cyst, 287 CT findings, 288, 289f–292f diagnosis, 288 management, 288 MRI findings, 288 plain film findings, 288, 289f–292f signs and symptoms, 287 treatment, 288 types, 287 US findings, 288, 289f–292f Splenic infarction, 293 CT findings, 293, 294f, 295f diagnosis, 293 etiologies, 293 MRI findings, 293 occurrence, 293 signs and symptoms, 293 treatment, 293 US findings, 293 Splenomegaly 296 CT findings, 296, 297f–299f defined, 296 etiologies, 296 role, 296 Squamous cell carcinoma, 23/07/13 9:26 PM 464 Index Stones, pigmented, 92 Subarachnoid hemorrhage (SAH) CT findings, 309, 310f–312f MRI findings, 309 Subdural hematoma, CT findings of, 304, 305f–307f Subfalcine herniation, 312 See also Brain herniation Superior mesenteric artery (SMA), 151 Superior mesenteric vein (SMV), 151 T Tension pneumothorax, 340 See also Thoracic trauma Thoracic aortic aneurysm, 416 ascending CT findings, 417, 418f, 419f defined, 416 descending CT findings, 420, 421f–423f plain film findings, 429, 421f–423f etiology, 416 false aneurysm, 416 signs and symptoms, 416 treatment, 417 true aneurysm, 416 Thoracic trauma chest tube placement plain film findings, 347, 347f chest wall trauma, 344 clavicle fracture plain film findings, 346, 346f diaphragmatic injury with pneumothorax CT findings, 340, 341f–343f plain film findings, 340 early deaths, etiology of, 339 flail chest, 344 pleural space hemothorax, 339 pneumothorax, 339 tension pneumothorax, 340 pulmonary contusion, 348 rib fracture CT findings, 344 plain film findings, 344, 345f vascular injury, 348 LWBK1240-Ind-p455-468.indd 464 Total parenteral nutrition (TPN), 171 Toupet fundoplication, Trauma, abdominal, 349 bladder, 390–391 bladder rupture CT findings, 392, 392f, 393f cystography findings, 391 plain film findings, 391 CT findings, 351, 351f–363f duodenum, 390 extraperitoneal bladder rupture, 394f–397f kidney, 375 CT findings, 375, 376f–389f liver, 349 pancreas, 390 retroperitoneal hematoma, 390 solid organ injury scale, 349 spleen, 364 CT findings, 365, 366f–374f US findings, 365 Trauma, thoracic chest tube placement plain film findings, 347, 347f chest wall trauma, 344 clavicle fracture plain film findings, 346, 346f diaphragmatic injury with pneumothorax CT findings, 340, 341f–343f plain film findings, 340 early deaths, etiology of, 339 flail chest, 344 pleural space hemothorax, 339 pneumothorax, 339 tension pneumothorax, 340 pulmonary contusion, 344 rib fracture CT findings, 344 plain film findings, 344, 345f vascular injury, 348 Traumatic brain injury, 301 brain herniation CT findings, 312, 313f–315f diffuse axonal Injury, 315 diffuse cerebral edema, subdural hematoma with CT findings, 308, 308f 23/07/13 9:26 PM Index 465 epidural hematoma, 303 CT findings, 302, 303f intraparenchymal hemorrhage, 315 skull fractures, 301 subarachnoid hemorrhage CT findings, 309, 310f–312f MRI findings, 309 subdural hematoma, 304 CT findings, 304, 305f–307f Trousseau sign, 151 Tube thoracostomy, in pneumothorax treatment, 339 Turcot syndrome, 217 U Ultrasound (US) findings acute cholecystitis, 94, 95f acute pancreatitis, with surrounding fluid, 143 amebic abscess, 118 appendicitis, 245 with appendicolith, 252 with fat stranding, 249 choledocholithiasis, 110 cholelithiasis, 96, 97f–98f diverticulitis, 204 emphysematous gallbladder, 102, 102f–103f gallbladder calcification, 107 hepatocellular carcinoma, 128, 130f–132f horseshoe kidney, 277 pancreas, cystic diseases of pancreatic tumor, 155 pneumobilia, 135 pyloric stenosis, 77, 77f–78f pyogenic abscess, 117 renal cyst, 265 ruptured appendix with abscess, 260 LWBK1240-Ind-p455-468.indd 465 spleen, 364 splenic cyst, 287, 289f–292f infarction, 293 Wilms tumor, 274 Umbilical hernia, CT findings of, 55, 56f–58f See also Hernias V Vascular injury, 348 See also Thoracic trauma Volvulus, 222 causes, 222 cecal CT findings, 230, 231f–234f plain film findings, 230 diagnosis, 223 sigmoid CT findings, 223, 224f–230f plain film findings, 223, 224f–230f signs and symptoms, 222 treatment, 223 cecal, 223 sigmoid, 223 W WAGR syndrome, 274 Wilms tumor, 274 CT findings, 274, 275f, 276f MRI findings, 275 plain film findings, 274 symptoms, 274 treatment, 274 US findings, 274 workup, 274 Z Zollinger–Ellison syndrome, 78 23/07/13 9:26 PM ... LWBK 124 0-Ch10_p265 -28 0.indd 26 7 24 /07/13 6: 52 PM 26 8 Imaging for Surgical Disease E F B G A Renal cyst H H FIGURE 10.1 B LWBK 124 0-Ch10_p265 -28 0.indd 26 8 23 /07/13 9 :20 PM Chapter 10 Kidney 26 9... FIGURE 10 .2 A LWBK 124 0-Ch10_p265 -28 0.indd 27 2 23 /07/13 9 :20 PM Chapter 10 Kidney 27 3 H G I A D III–defined heterogeneously enhancing mass C F FIGURE 10 .2 B LWBK 124 0-Ch10_p265 -28 0.indd 27 3 23 /07/13... LWBK 124 0-Ch09_p244 -26 4.indd 25 2 23 /07/13 9:19 PM Chapter 9 Appendix 25 3 C B D A Inflamed, dilated appendix containing gas FIGURE 9.3 B LWBK 124 0-Ch09_p244 -26 4.indd 25 3 23 /07/13 9:19 PM 25 4 Imaging