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
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8 Scholz AJR 189: , 2007
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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
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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
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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
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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?
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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
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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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