Tag Archive | gastrointestinal

QUIZ CASE: 40yo male with abdominal pain and vomiting. Click…

QUIZ CASE: 40yo male with abdominal pain and vomiting. Click here to ENTER QUIZ MODE where there are axial and coronal image stacks to scroll through, 4 study questions and 3 annotated images. HINT: Not appendicitis! This previous blog post may also be helpful ūüôā

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Caput medusae – a clinical and radiological sign seen in…

Caput medusae – a clinical and radiological sign seen in severe¬†portal hypertension. It describes distended and engorged paraumbilical veins radiating from the umbilicus across the abdominal wall to join systemic veins creating¬†portal-systemic anastomoses. The appearance is reminiscent of Medusa, a gorgon of Greek mythology, who was encountered and defeated by Perseus. Pictured is ‚ÄėMedusa‚Äô by Caravaggio painted in 1595. ¬†

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Comb sign¬†– seen in active¬†Crohn‚Äôs disease. It describes…

Comb sign Рseen in active Crohn’s disease. It describes prominent mesenteric vessels extending towards inflamed segments of small bowel like the teeth of a comb. The appearance is due to a combination of vascular distension and mesenteric fibrofatty proliferation. It can be seen on both CT and MRI.

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Lead pipe sign – describes the rigid and featureless appearance…

Lead pipe sign Рdescribes the rigid and featureless appearance of the colon in chronic ulcerative colitis. The sign is due to a complete loss of haustral markings and usually a degree of uniform luminal narrowing due to chronic bowel wall thickening. It is classically described on barium enema studies however it is also often seen with CT, MRI and plain radiography. 

CLEUDO summary: ULCERATIVE COLITIS in the COLON with the LEAD PIPE 

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Double duct sign – simultaneous dilatation of the common bile…

Double duct sign Рsimultaneous dilatation of the common bile duct (red arrow) and pancreatic duct (yellow arrow). The two most common causes of the double duct sign are carcinoma of the head of the pancreas and duodenal ampullary tumours (blue arrow). Because the causative tumours are often small, recognition of the sign can be critical to making a diagnosis. It may be observed on almost all imaging modalities including MRI, CT, ultrasound and ERCP. 

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Hypertrophic pyloric stenosis¬†– classically presents as…

Hypertrophic pyloric stenosis Рclassically presents as non-bilious projectile vomiting during the second month of life. Ultrasound is excellent for first line assessment with the pylorus considered hypertrophied if it exceeds 15mm in length and 3mm or more in thickness (from lumen to outer edge). The stomach will usually be distended with fluid and at no time during the scan will the pylorus open. The cervix sign (left image), antral nipple sign and target sign are commonly described in pyloric stenosis but really they are of little relevance compared to direct muscle measurements. 

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Appendicitis on ultrasound – the¬†first step is to identify the…

Appendicitis on ultrasound Рthe first step is to identify the appendix (unfortunately not always possible) by finding a blind-ending tubular structure arising from the base of the caecum. The sonographic signs of appendicitis are then as follows:

  • dilated appendix > 6mm¬†outer diameter (left image)
  • noncompressible
  • distinct appendiceal wall layers due to oedema (left image)
  • target appearance (axial section)
  • appendicolith¬†– an echogenic focus with posterior shadowing
  • periappendiceal fluid collection (right image)
  • echogenic and prominent periappendiceal and pericaecal fat
  • surrounding hypervascularity on colour Doppler (centre image)

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Intussusception – ultrasound is extremely sensitive in detecting…

Intussusception – ultrasound is extremely sensitive in detecting intestinal intussusception and several different sonographic ‚Äėsigns‚Äô are described.

When bowel telescopes into itself concentric rings are seen creating the target sign (left image) also known as the doughnut sign. The appearance is not only due to three bowel walls paralleling each other, but is also due to each wall itself demonstrating the normal striation of echogenic mucosa, hypoechoic submucosa and echogenic muscularis. 

When a large portion of mesenteric fat is incorporated within the intussusception then an additional echogenic crescent may be seen creating the crescent within a doughnut sign. 

Finally, the combination of intussusception and adjacent enlarged mesenteric lymph nodes may simulate the appearance of a kidney creating the pseudokidney sign (right image) where hypoechoic lymph nodes appear like renal medullary pyramids.

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Apple core sign – describes a short¬†segment¬†irregular…

Apple core sign – describes a short¬†segment¬†irregular circumferential stricture of the large bowel that has abrupt ‚Äúshouldered‚ÄĚ margins resembling an apple core. The appearance is classically described on contrast enema studies and is almost always due to a stenosing annular colon carcinoma. The same term has also been used for the circumferential erosion of the femoral neck seen in synovial osteochondromatosis.

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Whirlpool sign – seen when bowel rotates around its mesentery…

Whirlpool sign Рseen when bowel rotates around its mesentery with the vessels and collapsed bowel creating the whirls. It is found in a number of settings including malrotation complicated by midgut volvulus and caecal volvulus (as above). In midgut volvulus the swirl is counter-clockwise on CT (as if viewed from below) and clockwise on US and is analogous to the corkscrew sign seen on barium studies.

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