Metastatic Spread via the Peritoneal Ligaments

The major ligamentous attachments of the upper abdomen include the lesser omentum, the gastrosplenic ligament, and the splenorenal ligament. The lesser omentum is subdivided into the gastrohepatic ligament and the he-patoduodenal ligament. In the embryo, the gastrosplenic ligament gives rise to the gastrocolic ligament (also known as the greater omentum) and the transverse meso-colon. The gastrohepatic ligament can be recognized on computed tomography (CT) scanning as a fatty plane, which joins...

Urinary Tract Infection Acute Pyelonephritis

Acute pyelonephritis is usually an ascending infection spread from the bladder, and is seen predominately in females. Rarely, the source of infection is hematogenous bacteremia. Diagnosis is usually made on clinical grounds and with urine analysis. Imaging may be needed to detect complications or sequela of pyelonephritis. When clinical pyelonephritis persists for greater than three days after antibiotic therapy has been initiated, then imaging is recommended. CT is the imaging technique of...

Bladder Cancer Staging

Local tumor extension, the degree of lymph node and distant metastases, and histologic tumor type largely determine treatment and prognosis. Therefore, exact staging is imperative. To determine local tumor extension (T), presence of lymph node (N) and distant metastases (M), the International Union against Cancer proposed a uniform clinical staging method (Table 1). In this table, a correlation is also presented between the TNM-system and MRI-findings. Patients with superficial tumors, i.e.,...

MR Imaging

MR imaging of the prostate is still in an exploratory phase and is not yet advocated as a routine staging procedure. Prostate MR imaging should be performed in centers where at least 25-50 patients per year are examined and the results can be compared with histology, preferably whole mount specimen 12 . Currently, the major clinical indication for MR imaging is detection of ECE, SVI, nodal and bone marrow metastases, which are contraindications for radical prostatectomy 13 . Prostate cancer is...

The Uterus Malignant Conditions Cervical Cancer

Patients with cervical cancer are staged according to the classification of the International Federation of Gynecology and Obstetrics FIGO Table 1 . Unfortu nately, FIGO staging is based primarily on clinical exam neither cross-sectional imaging, nor lymph node status is routine , and staging errors of 15-24 for patients with Stage IB disease and 45-58 for patients with Stages IIA and IIB disease have been reported 19, 20 . MRI is the best single modality for the pre-operative staging of...

Cystic Dilatation of Intrahepatic Bile Ducts

Similar to extrahepatic duct dilatation, a mechanical biliary obstruction is the most common cause of intrahep-atic bile duct dilatation. Intrahepatic biliary dilatation in mechanical obstruction is generally tubular and lacks focal stricture formation. Caroli disease, recurrent pyogenic cholangitis, polycystic liver disease, primary sclerosing cholangitis, choledochal cyst, and peribiliary cysts should be included in the differential diagnosis of cystic intrahepatic biliary dilatation. Caroli...

Perianal Fistulas

Perianal fistulas primarily occur as the result of fistulous disease originating in the anal glands near the anal crypts cryptoglandular hypothesis , or in patients with Crohn's disease 13 . Infection of the anal glands may result in abscess formation. It is a relatively common condition with a prevalence of approximately 0.01 , predominantly affecting young adults. The tracks may have a simple superficial course, or may have a complicated course. The complicated tracks may be intersphincteric...

Normal Radiological Anatomy of the Adrenal Glands

The adrenal glands are enclosed within the perinephric fascia and are usually surrounded by a sufficient amount of fat for identification on computed tomography CT or magnetic resonance imaging MRI . The right adrenal gland lies immediately posterior to the inferior vena cava IVC . The left adrenal gland lies anteromedial to the upper pole of the left kidney and posterior to the pancreas and splenic vessels. The shape of the adrenals can vary, depending on the orientation of the gland and the...

Diverticulitis

Diverticulitis Magnetic Resonance

It is estimated that 10-25 of individuals with diverticu-losis will suffer from episodes of peridiverticular inflammation during their lifetime. In the United States, this complication accounts for approximately 200,000 hospi-talizations and a health care expenditure of four billion dollars annually. Among patients who are hospitalized, 10-20 require emergency operations. Inflammatory change in the pericolic fat Fig. 4 is the hallmark of diverticulitis on CT, and is seen in 98 of cases. The...

Rectal Cancer Diagnostic Workup

Total Mesorectal Excision

Adenocarcinoma is the most common rectal malignancy. The diagnosis is usually histologically established prior to imaging. Cross-sectional imaging is used to stage the tumor. The treatment of rectal cancer depends on the extent of disease and has changed substantially over the last decade. EUS and MRI are important in the management of these patients. T2-weighted sequences are pivotal in MRI of rectal cancer. These provide optimal contrast between the rectal wall and surrounding fat and organs....

Axr Malrotation

Necrotizing Enterocolitis

The cervix after LEEP procedure, mimicking a cystic lesion. Notice the cystic area on the sagittal transvaginal sonogram Pitfalls as the Result of Implantation of Tissue and Prosthesis Whenever postoperative radiation therapy is contemplated in the pelvis, one of the limiting factors in its optimization is the low level of radiation tolerance of the small intestine 10 . Omental fat, synthetic absorbable mesh, or occasionally breast implant have been used during surgery to lift the small...

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Sigmoid Colon Walled Off Perforation

A 74-year-old man with known diabetes mellitus presents with acute abdominal pain in the right upper quadrant. a Plain abdominal radiograph shows a fluid-gas level in the distended gallbladder and gas in the gallbladder wall open arrow . b MDCT depicts the dilated gallbladder with intramural gas open arrow , indicative of emphysematous cholecystitis. In addition, extraluminal extramural gas is present due to walled-off gallbladder perforation arrow . Hydronephrosis and parenchymal...

Cmv Esophagitis

Esophagram Stab

A Incomplete relaxation of pharyngoesophageal sphincter b May be normal at beginning of examination c Often combined overlap syndromes a Incomplete relaxation of pharyngoesophageal sphincter b May be normal at beginning of examination c Often combined overlap syndromes with a pulse rate of 12 to 15 pps can be used, which exposes the patient to less radiation. During the entire bolus passage through the esophagus, the patient should not swallow, as this would immediately interrupt peristalsis....