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, 2011 4:30-4:40
NO DISCLOSURES rgore@uchicago.edu
TOP 10 LIST 6. TRANSIENT INTUSSUSCEPTION 7. SMALL BOWEL FECES SIGN 8. APPENDIX > 6mm 9. ILEOCECAL VALVE 10. SUBMUCOSAL FAT
10. SUBMUCOSAL FAT
WHITE GRAY TARGET WATER TARGET FAT GAS
OBESE PATIENT CHRONIC UC CHRONIC CD CHEMOTHERAPY CELIAC DISEASE TARGET FAT
Scholz AJR 189: 786-790, 2007
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: 781-784, 2003
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
9. ILEOCECAL VALVE
ILEOCECAL VALVE: NORMAL APPEARANCE Smooth contour 85% Lobulated contour 15% Mild 69% Moderate 23% Marked 8% El-Amin Radiology 227: 52-58, 2003
ILEOCECAL VALVE: CT COLONOGRAPHY Labial (slit like opening): 76% Papillary (dome shaped): 21% Lipomatous: 3% Regge Abd Imaging: 30: 20-25, 2005
ILEOCECAL VALVE: CT COLONOGRAPHY Labial Papillary Lipomatous
ILEOCECAL VALVE: CT COLONOGRAPHY Labial Papillary Lipomatous
ILEOCECAL VALVE: CT COLONOGRAPHY Labial Papillary Lipomatous
ILEOCECAL VALVE: CT COLONOGRAPHY Complete visualization, supine: 82% Complete visualization, prone: 62% At least partial visualization: 94% Regge Abd Imaging: 30: 20-25, 2005
8. SUCCULENT APPENDIX
NORMAL CALIBER OF THE APPENDIX
THE SUCCULENT APPENDIX Appendiceal diameter in the asymptomatic patient is often >6 mm
THE SUCCULENT APPENDIX
THE SUCCULENT APPENDIX Appendiceal fluid depth > 2.6 mm is indicative of appendicitis Moteki AJR 188: 1313-1319, 2007
WHEN EVALUATING AN APPENDIX
7. SMALL BOWEL FECES SIGN
SB FECES SIGN Obstruction Undigested food Secondary bacterial overgrowth Water absorption proximal to an obstruction
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
6. TRANSIENT INTUSSUSCEPTION
TRANSIENT INTUSSUSCEPTION Proximal jejunal location No obstruction No small bowel symptoms No lead point < 3.5 cm Don t investigate*
TOP 10 LIST 1. THICK GE JUNCTION? 2. THICK ANTRUM? 3. THICK ESOPHAGUS? 4. THICK SMALL BOWEL? 5. THICK COLORECTUM?
IS THE GUT WALL REALLY THICK?
MESENTERY LYMPH NODES BOWEL WALL
MESENTERY LYMPH NODES 1- IGNORE 2- F/U 3- PURSUE BOWEL WALL
DDx CHEST DISCOMFORT PE MI Aortic dissection Pericarditis Pleurisy GERD
ESOPHAGEAL WALL THICKNESS AT VARIOUS LEVELS: Nl vs Esophagitis AORTIC ARCH CARINA SUP PULM VEIN GEJ AVERAGE SD CONTROLS 2.8 2.9 3.2 4.7 2.9 0.8 ESOPHAGITI 4.7 4.5 4.7 7.2 4.7 2.0 S Berkovich, Levine, Miller AJR 175: 1431-1434, 2000
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: 1431-1434, 2000
THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus
THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus
THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus
THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus
THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus
THE ESOPHAGUS Hiatal hernia Mural thickening of distal esophagus Reflux Increased secretions and/or foodstuffs in distal esophagus
TOP 10 LIST 1. THICK GE JUNCTION? 2. THICK ANTRUM? 3. THICK ESOPHAGUS? 4. THICK SMALL BOWEL? 5. THICK COLORECTUM?
THANK YOU rgore@uchicago.edu