GI Differentials

 

 

 

 

 

ABNORMALITIES OF STRIATED MUSCLE AND THE UPPER ESOPHAGEAL SPHINCTER

ABNORMALITIES OF SMOOTH MUSCLE AND INNERVATION OF THE BODY OF THE ESOPHAGUS

Failure of Relaxation of the Lower Esophageal Sphincter (Achalasia Pattern)

TERTIARY CONTRACTIONS

Extrinsic Compression on the Cervical Esophagus

External Compression on the Thoracic Esophagus

Esophageal Ulceration

Esophageal Narrowing

Esophageal Filling Defects

Esophageal Diverticula

Esophageal Varices

Esophagorespiratory Fistulas

Double-Barrel Esophagus

Diffuse Finely Nodular Lesions of the Esophagus

Elevation of the diaphragm

Diaphragmatic Hernias

Superficial Gastric Erosions

Narrowing of the Stomach (Linitis Plastica Pattern)

Thickening of the Gastric Folds

Filling Defects in the Stomach

Filling Defects in the Gastric Remnant

Gastric Outlet Obstruction

Gastric Dilatation Without Outlet Obstruction

Intrinsic and Extrinsic Masses of the Fundus

Widening of the Retrogastric Space

Gas in the Wall of the Stomach

Simultaneous Involvement of the Gastric Antrum and Duodenal Bulb

Postbulbar Ulceration of the Duodenum

Thickening of the Doudenal Folds

Widening of the Duodenal Sweep

Extrisic Compression on the Duodenum

Duodenal Filling Defects

Duodenal Narrowing and Obstruction

Duodenal Dilatation (Superior Mesenteric Artery Syndrome)

Causes of Small Bowel Obstruction

Adynamic Ileus

Adynamic Ileus Simulating Mechanical Obstruction

Dilatation With Normal Folds

Dilatation With Thickened Mucosal Folds

Regular thickening of Small Bowel Folds

Generalized, Irregular, Distorted Small Bowel Folds

Solitary Filling Defects in the Jejunum and Ileum

Multiple Filling Defects in the Small Bowel

Sand-like Lucencies

Thickened Small Bowel Folds with Concomitant Involvement of the Stomach

Separation of the Bowel Loops

Small Bowel Diverticula and Pseudodiverticula

Abnormalities of the Ileocecal Valve

Filling Defects in the Cecum

Coned Cecum

Ulcerative Lesions of the Colon

Single Filling Defects in the Colon

Multiple Filling Defects in the Colon

Causes of large Bowel Obstruction

Toxic Megacolon

Thumbprinting of the Colon

Double Tracking in the Sigmoid Colon

Enlargement of the Retrorectal Space

Filling Defects in an Opacified Gallbladder

Filling Defects in the Bile Ducts

Bile Duct Narrowing and Obstruction

Cystic Dilatation of the Bile Ducts

Enlargement of the Papilla of Vater

Gas in the Biliary System (Pancreaticobiliary Reflux)

Gas in the Portal Veins

Bullís-Eye Lesions in the Gastrointestinal Tract

Non-Diaphragmatic Hernias

Gas in the Bowel Wall (Pneumatosis Intestinalis)

Pneumoperitoneum

Extraluminal Gas in the Upper Quadrants

Causes of Enteric-Enteric Fistulas

Causes of Internal Fistulas

Causes of External Gastrointestinal Fistulas

Calcification in the Liver

Calcification in the Spleen

Calcification in the Pancreas

Calcification in the Gallbladder/Bile Duct

Calcification in the Alimentary Tract

Calcification in the Kidney

Ureteral Calcification

Calcification in the Bladder/UrethralUrachus

Calcification in the Male Genital Tract

Calcification in the Female Genital Tract

Adrenal Calcification

Retroperitoneal Calcification

Generalized Abdominal Calcification

Calcification in Vascular Structures

Abdominal Wall Calcification

Skeletal/Ligamentous Calcification

Miscellaneous Calcification

Thickened Gallbladder Wall

Local Anechoic masses of the Liver

Complex or Solid Masses in the Liver

Shadowing Lesions in the Liver

Generalized Abnormal Echogenicity of the Liver

Focal Decreased Attenuation Liver Masses on CT

Hyperenhancing Liver Lesions in the Arterial Phase

Hyperenhancing liver lesions in the portal vein and/or equilibrium phases

Generalized Abnormal Attentuation of the Liver

Magnetic Resonance Imaging of Liver Disease

Decreased Attentuation Masses in the Spleen

 

 

 

 

 

 

 

 

 

ABNORMALITIES OF STRIATED MUSCLE AND THE UPPER ESOPHAGEAL SPHINCTER (CRICOPHARYNGEAL ACHALASIA)

 

Disease Entities

Normal variant

Minor, nonspecific neuromuscular dysfunction Total laryngectomy (pseudodefect)

Radiation therapy

Primary muscle disorders

Myasthenia gravis

Myotonic dystrophy

Polymyositis

Dermatomyositis

Amyotrophic lateral sclerosis

Steroid myopathy

Thyrotoxic myopathy

Oculopharyngeal myopathy

Primary neural disorders

Peripheral or cranial nerve palsy Cerebrovascular disease affecting the brain stem High unilateral cervical vagotomy

Bulbar poliomyelitis

Syringomyelia

Huntington's chorea

Familial dysautonomia (Riley-Day syndrome) Multiple sclerosis

Diphtheria

Tetanus

 


ABNORMALITIES OF SMOOTH MUSCLE AND INNERVATION OF THE BODY OF THE ESOPHAGUS

 

Disease Entities

Scleroderma

Other connective tissue disorders

Systemic lupus erythematosus

Rheumatoid arthritis

Polymyositis

Dermatomyositis

Disorders of myenteric plexus

†††† Achalasia

Chagas' disease

Metastases

Esophagitis

Corrosive

Reflux

Infectious

Radiation-induced

 

Alcoholic neuropathy

Diabetic neuropathy

Presbyesophagus

Anticholinergic medication

Myxedema

Amyloidosis

Muscular dystrophy

 


Failure of Relaxation of the Lower Esophageal Sphincter (Achalasia Pattern)

Achalasia

Chagas' disease

Central and peripheral neuropathy

††††† Cerebrovascular accident

††††† Postvagotomy syndrome

††††† Diabetes mellitus

††††† Chronic idiopathic intestinal pseudo-obstruction

††††† Amyloidosis

†††† Malignant lesions

Destruction of myenteric plexus

Metastases to mid-brain vagal nuclei

Direct involvement of vagus nerve

Stricture secondary to reflux esophagitis

 


TERTIARY CONTRACTIONS

 

Presbyesophagus

Diffuse esophageal spasm

Esophageal inflammation

Reflux esophagitis

Ingestion of corrosive agents

Infectious esophagitis (e.g., candidiasis)

Radiation injury

Nutcracker esophagus

Hyperactive achalasia

Neuromuscular disorders (e.g., diabetes mellitus) Obstruction of the cardia

Malignant lesion

Distal esophageal stricture

Benign lesion

Postsurgical repair of hiatal hernia

 


Extrinsic Compression on the Cervical Esophagus

Cricopharyngeus muscle

Pharyngeal venous plexus (postcricoid impression) Esophageal web

Anterior marginal osteophyte

Anterior herniation of intervertebral disk

Thyroid enlargement

Parathyroid enlargement

Ectopic gastric mucosa

Narrow thoracic inlet

Lymph node enlargement

Soft-tissue lesions

Abscess

Hematoma

Spinal lesions

Neoplasm

Inflammatory

 


External Compression on the Thoracic Esophagus

 

Normal structures

Aortic knob

Left main stem bronchus

Left inferior pulmonary vein/confluence of left

††††††††††††††† pulmonary veins

†††† Right inferior supra-azygous recess

Vascular abnormalities

Aortic lesions

Right aortic arch

Cervical aortic arch

Double aortic arch

Coarctation of the aorta

Aortic aneurysm/tortuosity

Nonaortic lesions

Aberrant right subclavian artery

Aberrant left pulmonary artery

Anomalous pulmonary venous return

††††††† (type III)

Persistent truncus arteriosus

††††††††††††††† Cardiac enlargement

†††† Left atrium

†††† Left ventricle

Pericardia I lesion

Effusion

Tumor

Cyst

Mediastinal mass

Tumor

Duplication cyst

Pulmonary mass

††† Tumor

Bronchogenic cyst

Lymph node enlargement

Thoracic osteophyte

Paraesophageal hernia

Apical pleuropulmonary fibrosis (pseudoimpression)

 


Esophageal Ulceration

Reflux esophagitis

Hiatal hernia

Vomiting secondary to intraabdominal disease Chalasia of infancy

Pregnancy

Scleroderma

Medication

Surgery

Barrett's esophagus

Infectious/granulomatous disorders

Candidiasis

Herpes

Cytomegalovirus

Tuberculosis

Human immunodeficiency virus (HIV) Crohn's disease

Syphilis

Histoplasmosis

Actinomycosis

Staphylococcus infection

Acute alcoholic esophagitis

Eosinophilic esophagitis

Beh_et's syndrome

Epidermolysis bullosa

Benign mucous membrane pemphigoid Nasogastric intubation

Malignant lesions

Carcinoma

Lymphoma

Metastases

Corrosive esophagitis

Radiation injury

Drug-induced esophagitis

Potassium chloride tablets

Tetracycline

Emepronium bromide

Quinidine

††† Ascorbic acid

††† Ferrous sulfate

Sclerotherapy of esophageal varices

Intramural pseudodiverticulosis

 


ESOPHAGEAL NARROWING

 

Congenital conditions

Esophageal web

Lower esophageal ring (Schatzki's ring)

Cartilaginous esophageal ring

Congenital stricture

Neoplastic lesions

Carcinoma of the esophagus

Carcinoma of the stomach

Direct spread from adjacent malignancy

Hematogenous/lymphangitic metastases

Lymphoma

Benign tumors

Reflux esophagitis

Corrosive esophagitis

Barrett's esophagus

Postsurgical stricture (e.g., after hiatal hernia repair, gastric surgery)

Postnasogastric intubation stricture

Infectious/inflammatory esophagitis

†††† Candidiasis

Drug-induced esophagitis

Crohn's disease

Eosinophilic esophagitis

Behcet's syndrome

Chronic granulomatous disease of childhood

Radiation injury

Epidermolysis bullosa

Benign mucous membrane pemphigoid

Graft versus host disease (GVHD)

Sclerotherapy of esophageal varices

Motility disorders

Achalasia pattern

Esophageal spasm

Intramural esophageal pseudodiverticulosis

Mallory-Weiss syndrome

 

 

 


Esophageal Filling Defects

Neoplastic lesions

Benign tumors

Spindle cell tumor (e.g., leiomyoma)

Fibrovascular polyp

Squamous papilloma

Inflammatory esophagogastric polyp

Adenomatous polyp

Tumors of intermediate malignant potential

††††††††††††††††††††††††††††††† Villous adenoma

Malignant tumors

Carcinoma of the esophagus

Gastric carcinoma with upward extension Metastases

Leiomyosarcoma

Spindle cell squamous carcinoma

Melanoma

Lymphoma/leukemia

Kaposi's sarcoma

Verrucous squamous cell carcinoma

Lymph node enlargement (extrinsic lesions)

Malignant lesion

Granulomatous process

††† Infectious/granulomatous/inflammatory esophagitis

Candidiasis

Herpes esophagitis

Reflux esophagitis

Crohn's disease

Eosinophilic esophagitis

Varices

Duplication cyst

Foreign bodies/air bubbles

Intramural hematoma

Hirsute esophagus

Prolapsed gastric folds

 


Esophageal Diverticula

Cervical diverticula

Zenker's (pharyngoesophageal)

Traction (from surgery, infection)

Lateral

Midesophageal diverticula

Traction (interbronchial)

Pulsion (interaorticobronchial)

Epiphrenic diverticula

Intramural esophageal pseudodiverticulosis

Intraluminal diverticula

 


Esophageal Varices

Portal hypertension Hepatic cirrhosis

Carcinoma of the pancreas

Pancreatitis

Retroperitoneal inflammatory disease

High-viscosity, slow-flow states

(e.g., polycythemia)

Noncirrhotic liver disease

Metastatic carcinoma

Carcinoma of the liver

Congestive heart failure

Idiopathic

Superior vena cava obstruction

Mediastinal tumors (e.g., bronchogenic

carcinoma)

Chronic fibrosing mediastinitis

Retrosternal goiter

Thymoma

 


Esophagorespiratory Fistulas

Congenital disorders

Malignancies

Carcinoma of the esophagus

†††††† Carcinoma of the lung

†††† Trauma

Instrumentation

Surgery

Foreign body

Corrosive esophagitis

Inflammatory disease

Tuberculosis

Syphilis

Histoplasmosis Actinomycosis

Crohn's disease

Behcet's syndrome

Perforated diverticulum

Pulmonary sequestration or cyst

Spontaneous esophageal rupture

 


Double-Barrel Esophagus

Dissecting intramural hematoma

Emetogenic injury

Trauma

Instrumentation

Ingestion of a foreign body

Spontaneous (bleeding diathesis)

Intramural abscess

Intraluminal diverticulum

Esophageal duplication

 


Diffuse Finely Nodular Lesions of the Esophagus

Glycogenic acanthosis

Esophagitis

Reflux

Corrosive

Radiation-induced

Candidal

Herpes

Barrett's

Tuberculous

Superficial spreading esophageal carcinoma

Acanthosis nigricans

Leukoplakia

Hirsute esophagus

Bullous pemphigoid

Ectopic sebaceous glands

Papillomatosis

Lymphoma

Multiple hamartoma syndrome (Cowden's disease)

 


Elevation of the diaphragm

 

Eventration of the diaphragm

Paralysis of the diaphragm

Surgical damage to the phrenic nerve

Tumors

†††††† Bronchogenic carcinoma

†††††† Metastatic malignancy

††† Neurologic disorders

Myelitis

Encephalitis

Herpes zoster

Poliomyelitis

Tetanus antitoxin

Diphtheria

Trauma

Wounds/accidents

Brachial plexus block

Birth injury

Mechanical causes

Substernal thyroid

Aortic aneurysm

Infections

Tuberculosis

Pneumonia

Empyema

Adhesive pleurisy

Idiopathic

Increased intraabdominal volume

†† Ascites

Obesity

Pregnancy

Infradiaphragmatic abdominal infection

Subphrenic abscess

Hepatic abscess

Cholecystitis

Pancreatitis

Peritonitis

Intraabdominal masses

Cyst

Tumor

Aortic aneurysm

Supradiaphragmatic pulmonary processes

†††† Chest wall injury

Atelectasis

Pulmonary embolus

Infrapulmonic effusion (pseudodiaphragmatic contour)

 


Diaphragmatic Hernias

Hiatal

Paraesophageal

Foramen of Morgagni

Foramen of Bochdalek

Traumatic

Intrapericardial

 


Superficial Gastric Erosions

Alcohol

Anti-inflammatory agents (e.g., aspirin, steroids)

Analgesics

Crohn's disease

Herpetic gastritis

Syphilitic gastritis

Cytomegalovirus gastritis

Candidiasis

Idiopathic

 


Narrowing of the Stomach (Linitis Plastica Pattern)

Malignant neoplasms

Carcinoma

Lymphoma (Hodgkin's disease)

Kaposi's sarcoma

Metastases

Direct extension from carcinoma of the

pancreas and transverse colon

Omental cakes

Hematogenous metastases (e.g., carcinoma of

the breast)

Gastric ulcer disease

Granulomatous infiltration

Crohn's disease

Sarcoidosis

Syphilis

Tuberculosis

Histoplasmosis

Actinomycosis

Eosinophilic gastritis

Polyarteritis nodosa

Other gastritis

††††† Infections

Phlegmonous gastritis

Helicobacter pylori

Strongyloidiasis

Cytomegalovirus

Toxoplasmosis

Corrosive agents

Gastric radiation

Gastric freezing

††††††††† Iron intoxication

†††††††† Hepatic arterial infusion chemotherapy

†††††††† Stenosing antral gastritis

Amyloidosis

Intramural gastric hematoma

Extrinsic masses impressing stomach

Gastric restrictive surgery for morbid obesity

Perigastric adhesions

 

I

 


Thickening of the Gastric Folds

Normal variant

Gastritis

Alcoholic

Hypertrophic

Antral

Corrosive

Helicobacter pylori

Other infections

Postirradiation

Postfreezing

Peptic ulcer disease

Zollinger-Ellison syndrome

Menetrier's disease

Lymphoma

MALT lymphoma

Carcinoma

Varices

Antral vascular ectasia

††† Portal hypertensive gastropathy

Infiltrative processes

Eosinophilic gastritis

Crohn's disease

Sarcoidosis

Tuberculosis

Syphilis

Amyloidosis

Adjacent pancreatic disease

Acute pancreatitis

Extension of carcinoma of the pancreas

 


Filling Defects in the Stomach

Areae gastricae

Neoplasms

†††††††††††† Benign tumors

††††††† Hyperplastic polyp

Adenomatous polyp

Hamartoma

Peutz-Jeghers syndrome

Cowden's disease

Juvenile polyposis

Ruvalcaba-Myhre-Smith syndrome

†††††††††††† Spindle cell tumor

Tumors of variable malignant potential

†††††††††††† Villous adenoma

††† Carcinoid tumor

††††††† Malignant tumors

††††††† Carcinoma

††††††† Lymphoma

††††††† Metastases

††††††† Sarcoma

††††††† Plasmacytoma

Extrinsic cystic or inflammatory masses

Ectopic pancreas

Thickened folds simulating nodules Menetrier's disease

Gastric varices

Crohn's disease

Sarcoidosis

Tuberculosis

††††† Eosinophilic gastritis

Hypertrophied antral-pyloric fold

Bezoar

Foreign body

Blood clots/intramural hematoma

Peptic ulcer (surrounding edematous mass;

incisura)

Double pylorus

Inflammatory fibroid polyp

Arterial impression

Gastric duplication cyst

MALT lymphoma

Intragastric gallstone

Tumefactive extramedullary hematopoiesis

Amyloidoma

Candidiasis

Gastric intramural pseudocyst

Postoperative defect

Suture granuloma

††††† Fundoplication

Jejunogastric intussusception

Gastric varices

Anisakis larva

Prolapsed esophageal mucosa

 


Filling Defects in the Gastric Remnant

Surgical deformity

Suture granuloma

Bezoar

Carcinoma

††††††† Gastric stump carcinoma

††††††† Recurrent carcinoma

Gastric stump lymphoma

Hyperplastic polyps and bile (alkaline) reflux

gastritis

Jejunogastric intussusception

 


Gastric Outlet Obstruction

†††† Peptic ulcer disease

Duodenal

Pyloric channel

Antral

Tumors

††††††††††† Malignant

Antral carcinoma

Carcinoma of the head of the pancreas

Other malignant tumors causing duodenal obstruction

Lymphoma

Primary scirrhous carcinoma of the pyloric

channel

Benign

Inflammatory disorders

Crohn's disease

Pancreatitis

Cholecystitis

Corrosive stricture

Radiation injury

Sarcoidosis

Syphilis

Tuberculosis

Amyloidosis

Congenital disorders

Antral mucosal diaphragm

Duodenal diaphragm

Gastric or duodenal duplication

Annular pancreas

Miscellaneous disorders

Gastric volvulus

Hypertrophic pyloric stenosis

Gastric bezoar

Prolapsed antral mucosa

Prior surgery

 


Gastric Dilatation Without Outlet Obstruction

 

Postabdominal surgery

Abdominal trauma

Ruptured spleen

Fractures

Retroperitoneal hematoma

Urinary tract injury

†† Severe pain

Renal colic

Biliary colic

Migraine headaches

†† Infection and inflammation Peritonitis

Pancreatitis

Appendicitis

Subphrenic abscess

Septicemia

†† Immobilization

Body plaster cast

Paraplegia

Postoperative state

Diabetes mellitus

Neurologic abnormalities

Brain tumor

Bulbar poliomyelitis

Vagotomy

Tabes dorsalis

††† Muscular abnormalities

†††††††† Scleroderma

†††††††† Polymyositis/dermatomyositis

†††††††† Muscular dystrophy

†††† Drug-induced disorders

††††††††† Atropine or atropine-like drugs

††††††††† Morphine

†††† Ganglionic blocking agents

†††† Electrolyte/acid-base imbalance

††††††††† Diabetic ketoacidosis

††††††††† Hypercalcemia

††††††††† Hypocalcemia

†††† Hypokalemia

Hepatic coma

Uremia

Myxedema

Lead poisoning

Porphyria

Emotional distress

 


Intrinsic and Extrinsic Masses of the Fundus

 

Neoplasms

†††††††† Primary malignancies of the stomach

††††††††††† Carcinoma

††††††† Lymphoma

††††††† Leiomyosarcoma

Extragastric malignancies

†††††††† Carcinoma of the body or tail of the pancreas

†††††††† Carcinoma of the splenic flexure of the colon

†††††††† Tumors of adjacent organs (liver, adrenal, kidney)

†††††††† Lymphoma or metastases to adjacent lymph nodes

Benign tumors of the stomach

††††††† Spindle cell tumor

††††††† Adenoma

††† Extrinsic pressure by normal or enlarged structures

††††††††††† Liver

†††††† Spleen

Splenic flexure

Kidney

Aorta

Heart

Cardiac aneurysm

Intrinsic benign gastric lesions

††† Esophagogastric herniation/reduced hiatal hernia

Gastric varices

Giant rugal folds

Postoperative deformities (e.g., Nissen fundoplication, splenectomy)

Regenerated splenosis

Subphrenic abscess

Gastric diverticulum

Hematoma

 


Widening of the Retrogastric Space

Generalized widening without a discrete mass

Obesity

Previous surgery

Ascites

Gross hepatomegaly

Hernias involving the omentum Emphysema

Discrete retrogastric masses

††††††††††††† Pancreatic masses

†††††††††††††††††† Carcinoma

†††††††††††† Pseudocysts

†††††††††††††††††† Pancreatitis

†††††††††††††††††† Cystadenoma

Retroperitoneal masses Neoplasms

Lymph node enlargement Abscesses

Hematoma

Masses on the posterior wall of thestomach

Aortic aneurysm

Choledochal cyst

 


Gas in the Wall of the Stomach

 

Emphysematous gastritis

Corrosive gastritis

Severe necrotizing gastroenteritis

Ischemia

Recent gastroduodenal surgery

Peptic ulcer with intramural perforation

Gastric outlet obstruction (e.g., malignancy, volvulus)

††††††††††††††† Traumatic emphysema of the stomach

††† Gastroscopy

Esophagoscopy

Gastric pneumatosis

Bullus ruptured into the esophageal wall

Respiratory therapy (positive pressure)

 


Simultaneous Involvement of the Gastric Antrum and Duodenal Bulb

Malignant lesions

Lymphoma

Carcinoma

Peptic ulcer disease

Crohn's disease

Tuberculosis

Strongyloidiasis

Eosinophilic gastroenteritis

 


Postbulbar Ulceration of the Duodenum

Peptic ulcer disease

Zollinger-Ellison syndrome

Benign tumors

Malignant tumors

Primary duodenal malignancy

Metastatic malignancy

Contiguous invasion (pancreas, right colon,

right kidney, gallbladder)

Invasion from lymph node metastases

††††††† Hematogenous metastases (melanoma)

Crohn's disease

Tuberculosis

Aorticoduodenal fistula

Lesions simulating ulceration

Ectopic pancreas

Duodenal diverticulum

 


Thickening of the Doudenal Folds

Inflammatory disorders

Peptic ulcer disease

Brunner's gland hyperplasia

Zollinger-Ellison syndrome

Duodenitis

Pancreatitis

Cholecystitis

Uremia (chronic dialysis)

Crohn's disease

Tuberculosis

Parasitic infestation (giardiasis,

strongyloidiasis) AIDS-related infections

Nontropical sprue

†† Neoplastic disorders

Lymphoma

Metastases to peri pancreatic lymph

††††††† nodes

AIDS-related malignancy

Diffuse infiltrative disorders

†††††† Whipple's disease

Amyloidosis

Mastocytosis

Eosinophilic enteritis

Intestinal lymphangiectasia

Vascular disorders

Duodenal varices

Mesenteric arterial collaterals Intramural hemorrhage

Chronic duodenal congestion Cystic fibrosis (mucoviscidosis)

 


Widening of the Duodenal Sweep

Normal variant

Pancreatic lesions

Pancreatitis

Pancreatic pseudocyst

Pancreatic cancer

Metastatic replacement of the pancreas

Cystadenoma/cystadenocarcinoma

Lymph node enlargement

Metastases

Lymphoma

Inflammation

Cystic lymphangioma of the mesentery

Mesenteric arterial collaterals

Retroperitoneal masses (tumors, cysts)

Aortic aneurysm

Choledochal cyst

 


Extrisic Compression on the Duodenum

Bile ducts

Normal impression

Enlargement

Choledochal cyst

Gallbladder

Normal impression

Enlargement

††††††††† Hydrops

††††††††† Courvoisier phenomenon

Carcinoma

Pericholecystic abscess

Liver

Generalized hepatomegaly (especially

††††††† enlargement of the caudate lobe)

Cyst

Tumor

Lymphadenopathy in the periportal region

Right kidney

††† Enlargement due to bifid collecting

††††††††††† system/hydronephrosis

††† Multiple cysts/polycystic disease

††† Hypernephroma

†††††† Mass effect

†††††† Direct invasion of duodenum

Right adrenal

Enlargement (Addison's disease)

Carcinoma

Pancreas

Annular pancreas

Carcinoma (wrapped around the duodenum)

Postbulbar ulcer (lateral incisura appearance)

Colon

Duodenocolic apposition Carcinoma of the hepatic flexure

Vascular structures

Duodenal varices

Mesenteric arterial collaterals

Aortic aneurysm

Intramural or mesenteric hematoma

 

 

 


 

Duodenal Filling Defects

Pseudotumors

Gallbladder impression

Acute ulcer mound

Blood clot

Foreign body (fruit pit, gallstone)

Stitch abscess

Gas-filled duodenal diverticulum

Flexure defect

Nonneoplastic masses

Brunner's gland hyperplasia

Benign lymphoid hyperplasia

Heterotopic gastric mucosa

Nonerosive duodenitis

Sprue

Ectopic pancreas

Prolapsed antral mucosa

Enlarged papilla

Choledochocele

Duplication cyst

Pancreatic pseudocyst

Duodenal varices/mesenteric arterial

collaterals

Anomalous vessel

Intramural hematoma

Adjacent abscess

Benign tumors

Adenomatous polyp

Leiomyoma

Lipoma

Hamartoma (Peutz-Jeghers syndrome)

Neurogenic tumors

Cavernous lymphangioma

Prolapsed/intussuscepted antral polyp

Brunner's gland adenoma

Tumors with variable malignant potential

††† Villous adenoma

Carcinoid tumor

Malignant tumors

Adenocarcinoma

Ampullary carcinoma

Sarcoma

Lymphoma

Metastases

Kaposi's sarcoma

 


Duodenal Narrowing and Obstruction

Congenital obstruction

Duodenal atresia

Annular pancreas

Duodenal diaphragm (web)

Intraluminal diverticulum

Midgut volvulus

Extrinsic bands (Ladd's)

Duodenal duplication cyst

Inflammatory disorders of the duodenum Postbulbar ulcer

Crohn's disease

Tuberculosis

Strongyloidiasis

Nontropical sprue

Inflammatory disorders of the pancreas Acute pancreatitis

Chronic pancreatitis

Pseudocyst of the pancreas

Malignancies

Primary pancreatic lesions

Primary duodenal lesions

Metastatic lesions

Intramural duodenal hematoma

Intraluminal duodenal diverticulum

Aorticoduodenal fistula

Radiation injury

Preduodenal portal vein

Superior mesenteric artery syndrome

 


Duodenal Dilatation (Superior Mesenteric Artery Syndrome)

 

Normal variant

Congenital small vascular angle or childhood growth spurt

Prolonged bed rest in supine position

Body cast syndrome

Whole-body burns

Surgery

Loss of retroperitoneal fat

Multiple pregnancies with loss of muscle tone

Decreased duodenal peristalsis

Smooth muscle or neuromuscular junction

†††††††††††††††††† dysfunction

†††††††††† Scleroderma

†††††††††† Dermatomyositis/systemic lupus

†††††††††††††††††† erythematosus

†††††††††† Aganglionosis

†††††††††† Chagas' disease

††††† Vagus or splanchnic nerve dysfunction

†††††††††† Surgical or chemical vagotomy

†††††††††† Neuropathy (diabetes, porphyria, thiamine

†††††††††††††††††† deficiency)

Inflammatory disorders

Pancreatitis

Cholecystitis

Peptic ulcer disease

Trauma

Altered emotional states

Thickening of the bowel wall or root

†††††††††††††††††† of the mesentery

††††† Crohn's disease

Tuberculous enteritis

Pancreatitis

Peptic ulcer disease

Strongyloidiasis

Metastatic lesions

Exaggerated lumbar lordosis

Abdominal aortic aneurysm

Aorticoduodenal fistula

Chronic idiopathic intestinal pseudo-obstruction

 


Causes of Small Bowel Obstruction

Extrinsic bowel lesions

Adhesions

Previous surgery

Previous peritonitis

Hernias

External

Internal

Extrinsic masses

Neoplasm

Abscess

Volvulus

Congenital bands

Luminal occlusion

Tumor

Gallstone

Enterolith

Foreign body

Bezoar

Intestinal tube balloon

Intussusception

Meconium ileus

Intrinsic lesions of the bowel wall

Strictures

Neoplastic

Inflammatory

Chemical

Anastomotic

Radiation-induced

Amyloid

Vascular insufficiency

Arterial occlusion

Venous occlusion

†††† Congenital atresia or stenosis

†††††††††† Jejunal

†††††† Ileal

Segmental dilatation of the ileum

 


Adynamic Ileus

Surgical procedure

Peritonitis

Medication

Electrolyte imbalance

Metabolic disorder

Abdominal trauma

Retroperitoneal hemorrhage

Gram-negative sepsis/shock

Renal or ureteral calculus

Acute chest disease (pneumonia, myocardial

††††††††††††††† infarction, congestive heart failure)

Mesenteric vascular occlusion

Myotonic muscular dystrophy

 


Adynamic Ileus Simulating Mechanical Obstruction

Chronic idiopathic intestinal pseudo-obstruction

Pelvic surgery

Urinary retention

Pancreatitis

Acute intermittent porphyria

Ceroidosis

Neonatal adynamic ileus

†††† Systemic

†††† Chemical/hormonal

†††† Abdominal

 


Dilatation With Normal Folds

Mechanical obstruction

Adynamic ileus

Vagotomy (surgical or chemical)

Sprue

Lymphoma

Connective tissue disease

††††† Scleroderma

††††† Dermatomyositis

Diabetes with hypokalemia

Lactase deficiency

Vascular insufficiency

Mesenteric ischemia

Systemic lupus erythematosus

Amyloidosis

Chronic idiopathic intestinal pseudo-obstruction

Chagas' disease

 


Dilatation With Thickened Mucosal Folds

Zollinger-Ellison syndrome

Vascular insufficiency states

Diseases affecting the bowel wall and

mesentery

Metastases

Crohn's disease

Tuberculosis

Radiation enteritis

Infectious enteritis

Amyloidosis

Lymphoma

Abetalipoproteinemia

Hypoalbuminemia

 


Regular thickening of Small Bowel Folds

Hemorrhage into the bowel wall

Anticoagulant therapy

Ischemic bowel disease or infarction

Vasculitis

Connective tissue diseases

Thromboangiitis obliterans (Buerger's disease)

Henoch-Schonlein syndrome

††††† Hemophilia

††††† Idiopathic thrombocytopenic purpura

††††† Trauma

††††† Coagulation defects secondary to other diseases

Hypoprothrombinemia

Leukemia

Multiple myeloma

Lymphoma

Metastatic carcinoma

flypofibrinogenemia/circulating anticoagulants/

††††††††††††††† fibrinolytic system activation

Intestinal edema

††††† Hypoproteinemia

††† Cirrhosis

Nephrotic syndrome

Protein-losing enteropathy

†††† Lymphatic blockage

†††††††††† Tumor infiltration

Lymphangiitis secondary to radiation damage

Fibrosis of the mesentery

†††††††† Angioneurotic edema

†† Intestinal lymphangiectasia

††††† Primary

††††† Secondary

Abetalipoproteinemia

Eosinophilic enteritis

Amyloid vasculitis Xanthomatosis

Pneumatosis intestinalis

 


Generalized, Irregular, Distorted Small Bowel Folds

Whipple's disease

Giardiasis

Lymphoma

Amyloidosis

Eosinophilic enteritis

Lymphangiectasia

Crohn's disease

Tuberculosis

Histoplasmosis

Mastocytosis

Strongyloidiasis

Yersinia enterocolitiea

Typhoid fever

Other infections

Campylobaeter jejuni

Shigella

Escherichia coli

Anisakiasis

Cryptosporidium

†††††† Mycobacterium avium-intraeellulare (MAC)

Alpha chain disease

Abetalipoproteinemia

 


Solitary Filling Defects in the Jejunum and Ileum

 

Benign neoplasms

Leiomyoma

Adenoma

Lipoma

Hemangioma

Neurofibroma

Peutz-Jeghers hamartoma

Fibroma/lymphangioma/teratoma

Malignant neoplasms

Adenocarcinoma

Lymphoma

Leiomyosarcoma

Metastases

Neoplasms with variable malignant potential

Carcinoid tumor

Gallstone ileus

Inflammatory fibroid polyp

Endometrioma

Pseudotumors

Parasitic (ascariasis, strongyloidiasis)

†††† Inflammatory

Duplication cyst

Heterotopic gastric mucosa

Small bowel varix

Inverted Meckel's diverticulum

Blood clot

Foreign body/bezoar/pill

 


Multiple Filling Defects in the Small Bowel

Multiple polyps

Peutz-Jeghers syndrome

Gardner's syndrome

Disseminated gastrointestinal polyposis

Generalized gastrointestinal juvenile

polyposis

Cronkhite-Canada syndrome

Ruvalcaba-Myhre-Smith syndrome

Simple adenomatous polyps

Hemangiomas

Leiomyomas

Lipomas

Carcinoid tumors

Neurofibromas

Metastases (especially melanoma, breast

carcinoma, lung carcinoma)

Lymphoma

Crohn's disease

Nodular lymphoid hyperplasia

Food particles, seeds, foreign bodies,

††††††††† pills

 

Parasites

Ascaris lumbricoides

Strongyloides stercoralis

Ancylostoma duodenale (hookworm)

Taenia solis (tapeworm)

Gallstones

Blood clots

Amyloidosis

Varices

Behcet's syndrome

 


Sand-like Lucencies

Macroglobulinemia

Mastocytosis

Histoplasmosis

Lymphoid hyperplasia

Intestinal lymphangiectasia

Lymphoma

Whipple's disease

Crohn's disease

Yersinia enterocolitis

Eosinophilic enteritis

Cronkhite-Canada syndrome

Alpha chain disease

Amyloidosis

Food particles/gas bubbles

Irradiation enteritis

Pancreatic glucagonoma

Protein-losing enteropathy

Small bowel ischemia

 


Thickened Small Bowel Folds with Concomitant Involvement of the Stomach

Lymphoma

Crohn's disease

Eosinophilic gastroenteritis

Zollinger-Ellison syndrome

Menetrier's disease

Gastric varices with hypoproteinemia

Amyloidosis

Whipple's disease


 

Separation of the Bowel Loops

Processes that thicken or infiltrate the bowel wall

or mesentery

Crohn's disease

Tuberculosis

Intestinal hemorrhage or mesenteric vascular

occlusion

Whipple's disease

Amyloidosis

Lymphoma.

Primary carcinoma of the small bowel Radiation-induced enteritis

Carcinoid tumor

Neurofibromatosis of the small bowel

Ascites

Hepatic cirrhosis

Peritonitis

Congestive failure/constrictive

pericarditis

Peritoneal carcinomatosis

Primary or metastatic disease of the lymphatic system

Neoplasms

Primary tumors of the peritoneum

Primary tumors of the mesentery Metastases (peritoneal

carcinomatosis)

Intraperitoneal abscess

Retractile mesenteritis

Retroperitoneal hernia

Graft versus host disease

 


Small Bowel Diverticula and Pseudodiverticula

True diverticula

Duodenal

Jejunal

Meckel's

Ileal

Pseudodiverticula

Giant duodenal ulcer

Peptic disease

Intraluminal diverticula

Scleroderma

Crohn's disease

Lymphoma

Communicating ileal duplication

 


Abnormalities of the Ileocecal Valve

Lipomatosis (fatty infiltration)

Neoplasms

††††† Benign tumors†††††††††††††††

Lipoma

Adenomatous polyp

Villous adenoma

††††† Tumors of intermediate potential

††††††††††††††† Carcinoid tumor

††††† Malignant tumors

†††††††††††††† Adenocarcinoma

†††††††††††††† Lymphoma

Inflammatory disorders

†††††††††††† Crohn's disease

†††††† Ulcerative colitis

Tuberculosis

Amebiasis

Typhoid fever

Yersinia enterocolitis

Anisakiasis

Actinomycosis

Cathartic abuse

Prolapse

Antegrade

Retrograde

Intussusception

Lymphoid hyperplasia

 


 

Filling Defects in the Cecum

Abnormalities of the appendix

Acute appendicitis/appendiceal

††††††††††††††††††††††††† abscess

Mimics of appendicitis with normal

appendix

Mesenteric adenitis

Cecal diverticulitis

Typhlitis

Crohn's disease

Inverted appendiceal stump

Mucocele

Myxoglobulosis

Intussusception

Benign neoplasms (carcinoid tumor;

††††††††††††††††††††††††† spindle cell tumor)

††† Malignant neoplasms (adenocarcinoma)

Metastases (pancreas, ovary, colon,

††††††††††††††††††††††††† stomach)

General causes of colonic filling defects

†††††††††††† Inflammatory diseases

†††††††††††† Benign and malignant primary

††††††††††††††††††††††††† neoplasms

†††††††††††† Ileocolic intussusception

††††††† Unusual abnormalities of the cecum

†††††††††††† Diverticulitis of the ileocecal area

††††††††††† Solitary benign ulcer of the cecum

††††††††††† Adherent fecalith (cystic fibrosis)

††††††††††† Endometriosis

††††††††††† Intussusception of distal ileum lesion

††††††††††† Burkitt's lymphoma

††††††††††† Cecal diaphragm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Coned Cecum

Crohn's disease

Tuberculosis

Amebiasis

Ulcerative colitis

Appendicitis

Carcinoma of the cecum

Perforated cecal diverticulum

Actinomycosis

South American blastomycosis

Anisakiasis

Typhoid fever

Yersinia enterocolitis

Cytomegalovirus

Typhlitis

 


 

Ulcerative Lesions of the Colon

 

Ulcerative colitis

Crohn's colitis

Ischemic colitis

Specific infections

†† Protozoan

†† Amebiasis

†† Schistosomiasis

†† Bacterial

††† Shigellosis

††† Salmonellosis

††† Tuberculous colitis

††† Gonorrheal proctitis

††† Staphylococcal colitis

††† Yersinia colitis

††† Campylobacter fetus colitis

††† Lymphogranuloma venereum

Fungal

Histoplasmosis

Mucormycosis

Actinomycosis

Candidiasis

Viral

Herpes simplex

Herpes zoster

Cytomegalovirus

Rotavirus

Helminthic

Strongyloidiasis

Pseudomembranous colitis

Postantibiotic colitis

Postoperative colitis

 

Uremia

Large bowel obstruction

Hypoxia

Radiation injury

Caustic colitis

Collagenous colitis

Pancreatitis

Malignancy

†††††† Primary carcinoma

†††††† Metastases

†††† Leukemic infiltration

Amyloidosis

Inorganic mercury poisoning

Behcet's syndrome

Diverticulosis/ diverticulitis

Solitary rectal ulcer syndrome

Nonspecific benign ulceration of the colon

Drug-induced colitis

Diversion colitis

Postrectal biopsy

 


Chronic or healing stage of an ulcerating

colitis

Ulcerative colitis

Crohn's colitis

Ischemic colitis

Specific infections

†††† Protozoan

††††††† Amebiasis

††††††† Schistosomiasis

Bacterial

Bacillary dysentery

Tuberculosis

Gonorrheal proctitis

††††††† Lymphogranuloma venereum

Fungal

Viral

Anorectal giant condyloma acuminatum

Herpes zoster

Cytomegalovirus

Helminthic

Strongyloidiasis

Radiation injury

Cathartic colon

Caustic colitis

Solitary rectal ulcer syndrome

Nonspecific benign ulcer of the colon

†††††† Malignant lesions

Primary adenocarcinoma

"Apple-core"

Scirrhous

Metastases

Direct invasion

Intraperitoneal seeding

Hematogenous spread

Lymphangitic spread

Carcinoma developing in an ulcerating colitis

†††† Ulcerative colitis

Crohn's colitis

Sigmoid carcinoma after

†††††† ureterosigmoidostomy

Kaposi's sarcoma

Carcinoid tumor

Lymphoma

Diverticulitis

Miscellaneous disorders

Pancreatitis

Amyloidosis

Endometriosis

Pelvic lipomatosis

Retractile mesenteritis

Adhesive bands

Typhlitis

Cystic fibrosis

Narrowing at the site of surgical anastomosis

Suppositories

 


Single Filling Defects in the Colon

 

Neoplastic disorders

††††††† Benign tumors

Hyperplastic polyp

Adenomatous polyp

Hamartoma

Peutz-Jeghers polyp

Juvenile polyp

Villous adenoma

Villoglandular polyp

Spindle cell tumor (lipoma, leiomyoma, fibroma,

††††† neurofibroma, cystic lymphangioma)

††††††† Traumatic neuroma

Tumors of intermediate potential

††† Carcinoid tumor

Malignant tumors

Carcinoma

Sarcoma

Metastases

Lymphoma

Extramedullary plasmacytoma

Inflammatory disorders

Ameboma

Crohn's colitis

Giant inflammatory pseudopolyp

Schistosomiasis (polypoid granuloma)

Tuberculosis

Ascaris /umbricoides (bolus of worms)

Anisakiasis

Mucormycoma

Periappendiceal abscess

Diverticular abscess

††† Inverted colonic diverticulum

††† Nonspecific benign ulceration

††† Inflammatory fibroid polyp

††† Foreign-body perforation and abscess

†††††††† (chicken bone)

Miscellaneous disorders

Fecal impaction

Endometrioma

Intussusception

Foreign body

Gallstone

Hypertrophied anal papilla

Pseudotumors

†††††† Adhesions

†††††† Superimposed sacral foramen

Amyloidosis

Suture granuloma

Colitis cystic a profunda

Solitary rectal ulcer syndrome

Bezoar

 


Multiple Filling Defects in the Colon

 

Neoplasms

Multiple adenomatous polyps

Intestinal polyposis

syndromes

Familial polyposis

Gardner's syndrome

Peutz-Jeghers syndrome

Turcot's syndrome

Juvenile polyposis coli

Generalized gastrointestinal

juvenile polyposis

Cronkhite-Canada syndrome

Neurocrest and colonic tumors

Ruvalcaba-Myhre-Smith

syndrome

Multiple juvenile polyps

Multiple adenocarcinomas

Metastases

Lymphoma

Leukemic infiltration

Neurofibromatosis

Lipomatosis

Hemangiomas

Multiple hamartoma syndrome

(Cowden's disease)

Inflammatory diseases

Ulcerative colitis

Crohn's colitis

Ischemic colitis

Amebiasis

Schistosomiasis

Trichuriasis

Strongyloidiasis

Cytomegalovirus colitis

Yersinia colitis

Pseudomembranous colitis

Diversion colitis

Artifacts

Feces

Air bubbles

Oil droplets

Mucous strands

Ingested foreign bodies

Miscellaneous disorders Hemorrhoids

Diverticula

Pneumatosis intestinalis

Colitis cystica profunda

Nodular lymphoid hyperplasia

Lymphoid follicular pattern

Cystic fibrosis

Submucosal edema pattern

††††† Colonic urticaria

††††† Herpes zoster!

††††† Yersinia

††††† Ischemia

††††† Colonic obstruction

Ulcerative pseudopolyps proximal

to an obstruction

Endometriosis

Malacoplakia

Colonic varices

Amyloidosis

 


Causes of large Bowel Obstruction

Malignant lesions

Inflammatory strictures

Diverticulitis

Inflammatory bowel disease

Infectious granulomatous disease

Parasitic disease

Ischemia

Extrinsic bowel lesions

Volvulus

Hernias

Neoplasms/abscesses/distended bladder

†††††††††††† Endometriosis

Fecal impaction

Intussusception

Aganglionosis of the colon (Hirschsprung's disease)

Imperforate anus

Meconium plug syndrome

Adhesions

Retractile mesenteritis

Bezoar

Colonic pseudo-obstruction

 


Toxic Megacolon

 

Ulcerative colitis

Crohn's colitis

Ischemic colitis

Amebic colitis

Bacillary dysentery

Typhoid fever

Cholera

Strongyloidiasis

Campylobacter colitis

Pseudomembranous colitis

Behcet's syndrome

 


Thumbprinting of the Colon

†††† Ischemic colitis

Occlusive vascular disease

Hemorrhage into the bowel wall (bleeding

diathesis, anticoagulants)

†††††† Traumatic intramural hematoma

Ulcerative colitis

Crohn's colitis

Infectious colitis

Amebiasis

Schistosomiasis

Strongyloidiasis

Anisakiasis

††††††† Cytomegalovirus

Pseudomembranous colitis

Malignant lesions

†††††† Lymphoma

†††††† Metastases

Endometriosis

Amyloidosis

Pneumatosis intestinalis

Diverticulosis/ diverticulitis

Hereditary angioneurotic edema

Typhlitis

Retractile mesenteritis

Hemolytic-uremic syndrome

 


 

 


Double Tracking in the Sigmoid Colon

Diverticulitis

Crohnís Disease

Carcinoma of the colon


Enlargement of the Retrorectal Space

 

Normal variant

Inflammatory conditions

Ulcerative colitis

Crohn's disease

Infectious proctitis

Tuberculosis

Amebiasis

Lymphogranuloma venereum

Radiation proctitis

Ischemic colitis

Presacral abscess

Diverticulitis

Perforated appendix

Idiopathic proctosigmoiditis

Tumors

††††††††† Developmental cysts

Dermoid cyst

Duplication cyst

††††††††††††††† Postanal (tail gut) cyst

Lipoma and hemangioendothelioma

Primary rectal tumors Adenocarcinoma

Lymphoma

Sarcoma

Cloacogenic carcinoma

Secondary rectal tumors (contiguous

spread)

Prostate

Bladder

Ovary

Uterus

Neurogenic tumors

Chordoma

Neurofibroma

Schwannoma

Primary sacral tumors

Osteogenic sarcoma

Chondrosarcoma

Giant cell tumor

Metastases to the sacrum

Teratoma

Anterior sacral meningocele

Multiple myeloma and solitary plasmacytoma

Miscellaneous lesions

Inguinal hernias containing segments of colon

Amyloidosis

Pelvic lipomatosis

Cushing's disease

Inferior vena cava obstruction

Postsurgical lesions (partial sigmoid resection)

Fracture of the sacrum

Colitis cystica profunda

 

 


Filling Defects in an Opacified Gallbladder

Movable filling defects

Gallstones

Fixed filling defects

Cholesterolosis

Adenomyomatosis

Gallstone adherent to the gallbladder wall Inflammatory polyp

Mucosal adenoma

Glandular adenoma (adenomatous polyp)

Papillary adenoma (villous adenoma, papilloma)

Fibroadenoma

Cystadenoma

Unusual benign tumors

Neurinoma

Carcinoid

Hemangioma

Mixed tumor

Malignant tumors

Carcinoma of the gallbladder

Leiomyosarcoma

Metastases

Parasite granuloma

Metachromatic leukodystrophy

Fibroxanthogranulomatous inflammation

Intramural epithelial cyst

Pseudopolyps

Pseudodefect in the neck of the gallbladder

Congenital fold, septum, or multiseptate

gallbladder

Heterotopic gastric or pancreatic tissue

Postoperative defect of the gallbladder wall

Vascular lesion (varices, arterial

tortuosity or aneurysm)

 


Filling Defects in the Bile Ducts

Biliary calculi

Mirizzi's syndrome

Artifacts (pseudocalculi)

Contraction of the sphincter of Oddi

Air bubble

Blood clot

Right hepatic artery

Bile duct varices

Neoplasms

Malignant tumors

Cholangiocarcinoma

Ampullary carcinoma

Hepatoma

Villous adenoma

Metastases

Sarcoma botryoides

Tumor-induced mucus/floating

tumor debris

Benign tumors

Adenoma

Papilloma

Fibroma

Lipoma

Neuroma

Cystadenoma

Hamartoma

Carcinoid

Parasites

Clonorchis sinensis

Ascaris /umbricoides

Fasciola hepatica Echinococcus

Oriental cholangiohepatitis


 

 

Bile Duct Narrowing and Obstruction

 

Neoplastic lesions

††† Malignant tumors

†††††††† Carcinoma of the common bile duct

(cholangiocarcinoma)

Ampullary carcinoma

Carcinoma of the pancreas

Carcinoma of the duodenum

Carcinoma of the gallbladder

Hepatoma

Metastases to lymph nodes in the

porta hepatis

Lymphoma

Villous tumor

Tumor-induced mucus/floating

tumor debris

Benign tumors

Papilloma

Adenoma

Neurinoma of the cystic duct Granular cell tumor

Fibroma

Leiomyoma

Cystadenoma

Inflammatory disorders

Primary sclerosing cholangitis

Oriental cholangiohepatitis

Cholangiolitic hepatitis

Chronic pancreatitis

Acute pancreatitis

Duodenal ulcer disease

Papillary stenosis

Parasites

Ascaris /umbricoides

Clonorchis sinensis

Fasciola hepatica

Echinococcus granulosis

Amebiasis

Schistosomiasis

AIDS-related cholangitis

Granulomatous disease in adjacent lymph nodes

††††† Tuberculosis

Sarcoidosis

Bile duct calculi

Impacted stone in ampulla of Vater

Papillary edema secondary to recent passage

of biliary stone

Mirizzi's syndrome

Traumatic stricture

Congenital/neonatal anomalies

††††† Biliary atresia/hypoplasia

Congenital membranous diaphragm

Duodenal diverticulum

Vascular impressions

Calcified portal vein

Aortic aneurysm

Hepatic cysts (simple, polycystic)

Cirrhosis

 


Cystic Dilatation of the Bile Ducts

General bile duct dilatation (see Chapter 59)

Dilation of extrahepatic bile ducts

Choledochal cyst

Choledochocele

Hepatic duct diverticulum

Dilation of intrahepatic bile ducts

†††††††††††† Congenital anomalies

†††††††††††††††††† Caroli's disease

†††††††††††††††††† Congenital hepatic fibrosis

†††††††††††† Neoplastic disease

†††††††††††††††††† Papillomatosis

†††††††††††††††††† Epithelioma

†††††††††††† Choledocholithiasis

†††††††††††††††††† Western type

†††††††††††††††††† Oriental type

†††††††††††† Cholangitis

†††††††††††† Oriental cholangiohepatitis (recurrent pyogenic

†††††††††††††††††††††††††† cholangitis)

Secondary involvement

Benign tumors

Malignant tumors

Parasites (hydatid cysts, Clonorchis sinensis,

†††††††††††† Ascaris lumbricoides)

Liver infarcts after transcatheter embolization

†††††††††††† of hepatic artery branches

 

 

 


Enlargement of the Papilla of Vater

 

Normal variant

Papillary edema

Impacted common duct stone

Pancreatitis

Acute duodenal ulcer

Periampullary neoplasms

†††††† Carcinoma

††† Adenomatous polyp

Papillitis

Lesions simulating enlarged papilla

††††† Benign spindle cell tumor

††††† Ectopic pancreas


Gas in the Biliary System (Pancreaticobiliary Reflux)

Surgery

Sphincterotomy

Biliary-intestinal anastomosis

Choledochoduodenostomy

Cholecystoduodenostomy

Cholecystojejunostomy

Inflammatory diseases

Cholecystitis .

Recently passed common duct stone

Perforated ulcer

Pancreatitis

Diseases associated with chronic scarring

Crohn's disease

Strongyloidiasis

Clonorchis sinensis

Ascaris lumbricoides

Neoplastic infiltration

†††† Primary carcinoma of the ampulla,

†††††††††††††††††††††††††† duodenum, or pancreas

Metastatic malignancy

Emphysematous cholecystitis

Anomalous insertion of common bile duct into a

††††††††††††††††††††† duodenal diverticulum

Pseudopneumobilia

 

 

 


Gas in the Portal Veins

 

Childhood disorders

Necrotizing enterocolitis

Neonatal gastroenteritis

Erythroblastosis fetalis

Surgery for congenital intestinal

obstruction

Esophageal atresia

Duodenal atresia

Imperforate anus

†††† Umbilical venous catheterization

Adult disorders

†††† Mesenteric arterial occlusion and bowel

†††††††††††††††††† infarction

†††† Diabetes mellitus

†††† Mesenteric vein thrombosis secondary to

peritonitis

Hemorrhagic pancreatitis

Diverticulitis

Pelvic abscess

Perforated gastric ulcer

Necrotic colon cancer

Ingestion of corrosive substances

Hydrogen peroxide gastric lavage Emphysematous cholecystitis

Barium enema or colonoscopy in a patient with

†††††††††††††† inflammatory bowel disease (ulcerative or

††††††††††††††† Crohn's colitis)

Overinflation of rectal balloon catheter

Gastric emphysema

Cystic fibrosis

 


Bullís-Eye Lesions in the Gastrointestinal Tract

Metastatic melanoma

Primary neoplasms

Spindle cell tumor (benign or malignant)

Lymphoma

Carcinoid

Carcinoma

');