CT HÌNH ẢNH BỤNG (CT SLIDE)

Nam 28 tuổi với đau HC(P) Đại tràng lên Khối cạnh ĐT kèm nhiểm Thậm nhiễm quanh ĐT Viêm ruột thừa lạc chổ Brief review of Epiploic Appendagitis Rare inflammatory and ischemic condition Results from torsion or spontaneous venous thrombosis of one of the appendices epiploicae → ischemia or infarction of the appendix epiploica & localized inflammation Sudden, severe, focal abdominal pain, mimic other conditions such as appendicitis Can be managed conservatively CT: 1- 4-cm, oval, fatty pericolic lesion with surrounding mesenteric inflammation Adjacent cecal wall thickening and compression Rarely, a central high-attenuation "dot" within the inflamed appendage; corresponds to the thrombosed vein (17) Diffuse largeB-cell lymphoma Brief review of round solid mesenteric masses Malignant solid tumors have a tendency to be located near root of mesentery benign solid tumors in periphery near bowel! Metastases especially from colon, ovary (most frequent neoplasm of mesentery) Lymphoma Leiomyosarcoma (more frequent than leiomyoma) Neural tumor (neurofibroma, ganglioneuroma) Lipoma (uncommon), lipomatosis, liposarcoma Fibrous histiocytoma Hemangioma Desmoid tumor (most common primary) Figure(s) 60/M Chief complaint: jaundice, fever and chill *not hach *day Gallbladder carcinoma Brief review of gallbladder carcinoma Most common biliary cancer Associated with: (1) Gallstones in 64 - 98% Gallbladder carcinoma occurs in only 1% of all patients with gallstones! (2) Porcelain gallbladder (in - 60%) (3) Inflammatory bowel disease (predominantly ulcerative colitis) (4) Familial polyposis coli (5) Chronic cholecystitis Growth types: replacement of gallbladder by mass (37 - 70%) focal / diffuse asymmetric irregular thickening of GB wall (15 47%) polypoid / fungating intraluminal mass with wide base (14 - 25%) Differential diagnosis see note below Figure(s) 45/M Chief complaint: general weakness Addison disease caused by adrenal tuberculosis Brief review of addison disease = Primary adrenal insufficiency 90% of adrenal cortex must be destroyed! Cause: Idiopathic adrenal atrophy (60 - 70%): likely autoimmune disorder Granulomatous disease: tuberculosis, sarcoidosis Fungal infection: histoplasmosis, blastomycosis, coccidioidomycosis Adrenal hemorrhage: anticoagulation therapy, bleeding, coagulation disorders, sepsis, shock Bilateral metastatic disease (rare) Diminutive glands (in idiopathic atrophy + chronic inflammation) Enlarged glands (acute inflammation, acute hemorrhage, metastasis These are images from contrast-enhanced abdomen CT There is a large, round mass between the right hepatic lobe and the duodenum The mass is well encapsulated Majority of the mass shows fat attenuation and geographic or tread-like areas with soft tissue attenuation are scattered between them The duodenum and the pancreas are displaced by the mass but look clearly separated from the mass What are the differential diagnoses? AnswerMyxoid liposarcoma Brief review of myxoid liposarcoma most common type of liposarcoma varying degrees of mucinous + fibrous tissue + relatively little lipid intermediate differentiation CT solid pattern: inhomogeneous poorly marginated infiltrating mass mixed pattern: focal fatty areas + areas of higher density pseudocystic pattern: water-density mass calcifications in up to 12% DDx: malignant fibrous histiocytoma, leiomyosarcoma, desmoid tumor M/40 chief complaint: jaundice PTC 10 34/M Chief complaint: palpable abdominal mass 31 Malignant gastrointestinal stromal tumor (GIST) of duodenum Brief review of malignant GIST of small bowel Location: duodenum (26%), jejunum (34%), ileum (40%) usually >6 cm in size nodularmass: intraluminal, intraluminal pedunculated, intramural, chiefly extrinsic mucosa may be stretched + ulcerated may show central ulcer pit / fistula communicating with a large necrotic center intussusception 32 28/F Chief complaint: jaundice CT ERCP 33 Polypoid hilar cholangiocarcinoma Brief review of extrahepatic cholangiocarcinoma Location: left / right hepatic duct in - 13% confluence of hepatic ducts (Klatskin tumor) in 10 - 26% common hepatic duct in 14 - 37% proximal CBD in 15 - 30%, distal CBD in 30 50%, cystic duct in 6% Growth pattern: (1) Obstructive type (70 - 85%) U- / V-shaped obstruction with nipple, rattail, smooth / irregular termination (2) Stenotic type (10 - 25%) strictured rigid lumen with irregular margins + prestenotic dilatation (3) Polypoid / papillary type (5 6%) intraluminal filling defect with irregular margins 34 30/M Chief complaint: abdominal distension Figure(s) These are images from contrast-enhanced CT There is a large cystic mass in the abdomen It has homogeneous water attenuation and well demarcation The mass push the left kidney and small bowels to right side Which anatomical space did the mass35 arise from? What are Lymphangioma Brief review of lymphangioma Congenital malformation of lymphatic vessels Pathology usually multiloculated large thin-walled cystic mass with chylous / serous / hemorrhagic fluid contents Location: mesentery, proximal bowel dilatation (in partial bowel obstruction) US: multiseptated cystic mass with lobules fluid anechoic / with internal echoes / sedimentation CT: cystic mass with contents of water- to fat-density MR: serous contents: hypointense on T1WI + hyperintense on T2WI hemorrhage / fat: hyperintense on T1WI + T2WI Treatment: surgery (difficult due to intimate attachment to bowel wall) 36 42/M Figure(s) Chief complaint: frequency past medical history: total gastrectomy due to stomach cancer years ago 37 Isolated bladder metastasis from stomach cancer Brief review of Isolated bladder metastases from stomach cancer Extremely rare Focal or diffuse thickening of the bladder wall on CT Differential diagnoses Cystitis Bladder cancer Tuberculosis 38 F/65 Chief complaint: known systemic lupus erythematosus patient These are images from contrast-enhanced CT There is an abnormal vessel connecting right hepatic vein to middle hepatic vein More inferiorly the accessory right inferior hepatic vein which is not seen normally, is seen to be drained into the IVC What 39 are the possible causes? Budd-chiari syndrome with veno-veno collateral due to idiopathic occlusion of right hepatic vein Brief review of Budd-chiari syndrome Definition: global / segmental obstruction of hepatic venous outflow Causes: A idiopathic B thrombosis: Hypercoagulable state, Injury to vessel wall C nonthrombotic obstruction: Tumor growth into IVC / hepatic veins, Membranous obstruction of suprahepatic IVC, Right atrial tumor, Constrictive pericarditis, Right heart failure communications between right / middle hepatic vein and inferior right hepatic vein enlarged inferior right hepatic vein hypertrophy of caudate lobe hypodensity in atrophic areas / periphery with inversion of portal blood flow patchy enhancement with normal portal blood flow narrowing / obstruction of intrahepatic IVC 40 M/33 Chief complaint: received hormonal (steroid) therapy for aplastic anemia 41 Hepatic adenomas Brief review of hepatic adenoma Radiologic-pathologic correlation Rich in fat Hyperechoic mass: ultrasound Hypodense mass: CT Hyperintense mass: MR No stroma, internal Anechoic, potentially cystic mass: ultrasound hemorrhage Hyperdense area: CT Hyperintense area: T1-weighted image (MR) Peripheral “feeders” Peripheral enhancement: angiography Kupffer cells Sulfur colloid uptake, SPIO uptake Hepatocytes, no ductule IDA uptake, no excretion Associated with: oral contraceptives, steroids, pregnancy, diabetes mellitus, glycogen storage disease 42 M/82 Chief complaint : frequent watery diarrhea and abdomen distension Past medical history: being under long term antibiotics due to aspiration pneumonia These are images from contrastenhanced CT scan Diffuse, circumferential wall thickening of the rectum and the sigmoid colon is demonstrated Thickened colonic wall looks having three layers on CT and these layers are clearly seen throughout the rectum and sigmoid colon Mucosal layer which is well enhanced is clearly seen in contrast 43 with edematous submucosal layer Pseudomembranous colitis Brief review of pseudomembranous colitis Cause: overgrowth of Gram-positive Clostridium difficile Predisposed: (a) complication of antibiotic therapy, some chemotherapeutic agents (b) following surgery / renal transplantation / irradiation (c) shock, uremia (d) proximal to large bowel obstruction (d) debilitating diseases: lymphosarcoma, leukemia (e) immunosuppressive therapy with actinomycin D Location: rectum (95%); confined to right + transverse colon (5 - 27%) CT colonic wall thickening of - 22 mm smooth circumferential thickening (44%) accordion pattern nodular thickening homogeneous enhancement due to hyperemia pericolonic 44 stranding ascites                      45 ... Remittent incomplete obstruction + bacterial superinfection Multiple crescent- / stiletto-shaped filling defects within bile ducts Complication (1) Bile duct obstruction (conglomerate of worms... desquamation of epithelial bile duct lining with adenomatous proliferation of ducts + thickening of duct walls (inflammation, necrosis, fibrosis) (b) bacterial superinfection with formation of liver... 26% common hepatic duct in 14 - 37% proximal CBD in 15 - 30%, distal CBD in 30 50%, cystic duct in 6% Growth pattern: (1) Obstructive type (70 - 85%) U- / V-shaped obstruction with nipple, rattail,