TOP 10 LIST OF INCIDENTAL GI PET PEEVES ON MDCT

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1 TOP 10 LIST OF INCIDENTAL GI PET PEEVES ON MDCT Richard M. Gore, MD North Shore University Medical Center University of Chicago Evanston, Illinois SCBT/MR 2011 Washington, DC October 23, :30-4:40

2 NO DISCLOSURES

3 TOP 10 LIST 6. TRANSIENT INTUSSUSCEPTION 7. SMALL BOWEL FECES SIGN 8. APPENDIX > 6mm 9. ILEOCECAL VALVE 10. SUBMUCOSAL FAT

4 10. SUBMUCOSAL FAT

5 WHITE GRAY TARGET WATER TARGET FAT GAS

6 OBESE PATIENT CHRONIC UC CHRONIC CD CHEMOTHERAPY CELIAC DISEASE TARGET FAT

7

8 Scholz AJR 189: , 2007

9

10 FAT HALO SIGN IN PTS WITHOUT GI DISEASE 100 consecutive ER stone protocol exams 21% had fat halo sign 4% TI, 28% asc, 34% transverse, 36% desc, 14% sigmoid, 10% rectum Correlated with body habitus Harisinghani MG AJR 181: , 2003

11 10. SUBMUCOSAL FAT In patient without a history of IBD this likely relates to the patient s body habitus In the OP with belly discomfort with duodenal and proximal jejunal fat: suggest celiac disease In patients with acute symptoms suggest acute and chronic IBD TI involvement alone query Crohn s disease

12 9. ILEOCECAL VALVE

13

14

15 ILEOCECAL VALVE: NORMAL APPEARANCE Smooth contour 85% Lobulated contour 15% Mild 69% Moderate 23% Marked 8% El-Amin Radiology 227: 52-58, 2003

16 ILEOCECAL VALVE: CT COLONOGRAPHY Labial (slit like opening): 76% Papillary (dome shaped): 21% Lipomatous: 3% Regge Abd Imaging: 30: 20-25, 2005

17 ILEOCECAL VALVE: CT COLONOGRAPHY Labial Papillary Lipomatous

18 ILEOCECAL VALVE: CT COLONOGRAPHY Labial Papillary Lipomatous

19 ILEOCECAL VALVE: CT COLONOGRAPHY Labial Papillary Lipomatous

20 ILEOCECAL VALVE: CT COLONOGRAPHY Complete visualization, supine: 82% Complete visualization, prone: 62% At least partial visualization: 94% Regge Abd Imaging: 30: 20-25, 2005

21 8. SUCCULENT APPENDIX

22 NORMAL CALIBER OF THE APPENDIX

23 THE SUCCULENT APPENDIX Appendiceal diameter in the asymptomatic patient is often >6 mm

24 THE SUCCULENT APPENDIX

25 THE SUCCULENT APPENDIX Appendiceal fluid depth > 2.6 mm is indicative of appendicitis Moteki AJR 188: , 2007

26 WHEN EVALUATING AN APPENDIX

27 7. SMALL BOWEL FECES SIGN

28 SB FECES SIGN Obstruction Undigested food Secondary bacterial overgrowth Water absorption proximal to an obstruction

29

30 SB FECES SIGN Obstruction Undigested food Secondary bacterial overgrowth Water absorption proximal to an obstruction If the cecum is stool filled, no obstructive symptoms, be dismissive

31 6. TRANSIENT INTUSSUSCEPTION

32

33

34 TRANSIENT INTUSSUSCEPTION Proximal jejunal location No obstruction No small bowel symptoms No lead point < 3.5 cm Don t investigate*

35 TOP 10 LIST 1. THICK GE JUNCTION? 2. THICK ANTRUM? 3. THICK ESOPHAGUS? 4. THICK SMALL BOWEL? 5. THICK COLORECTUM?

36 IS THE GUT WALL REALLY THICK?

37

38

39

40

41

42 MESENTERY LYMPH NODES BOWEL WALL

43 MESENTERY LYMPH NODES 1- IGNORE 2- F/U 3- PURSUE BOWEL WALL

44 DDx CHEST DISCOMFORT PE MI Aortic dissection Pericarditis Pleurisy GERD

45

46 ESOPHAGEAL WALL THICKNESS AT VARIOUS LEVELS: Nl vs Esophagitis AORTIC ARCH CARINA SUP PULM VEIN GEJ AVERAGE SD CONTROLS ESOPHAGITI S Berkovich, Levine, Miller AJR 175: , 2000

47 ESOPHAGEAL WALL THICKNESS: NORMAL vs ESOPHAGITIS Mural thickening 5mm in 55% esophagitis Target sign in 17% esophagitis 5 mm was a useful threshold for determining esophageal wall thickening in patients with esophagitis 4% controls had 5 mm thick wall 42% controls had 3 mm thick wall Berkovich, Levine, Miller AJR 175: , 2000

48

49

50

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52 THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus

53 THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus

54 THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus

55 THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus

56 THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus

57 THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus

58 TOP 10 LIST 1. THICK GE JUNCTION? 2. THICK ANTRUM? 3. THICK ESOPHAGUS? 4. THICK SMALL BOWEL? 5. THICK COLORECTUM?

59 THANK YOU

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