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CT Abdomen Case based presentation dr.damodhar, drdamodhar, sugery, ct scan
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CASE BASED PRESENTATION
HOW TO READ CT ABDOMEN
Case I
28 year-old male with abdominal pain
Focal nodular hyperplasia
Focal nodular hyperplasia (FNH) is a benign tumor-like mass of the liver, second only to haemangiomas in frequency
FNH is most frequently found in young to middle aged adults, with a strong female predilection. 10 - 20% occur in men
CT
- On non contrast scanning the lesion is usually hypo- or isodense, but may appear hyperdense if the rest of the liver is fatty. A hypodense central scar can be seen in up to 60% of lesions over 3 cm in size .
- FNH demonstrates bright arterial contrast enhancement except for the central scar which remains hypodense .
- In the portal venous phase the lesion becomes iso dense to liver.
- The scar demonstrates enhancement on delayed scans in up to 80% of cases
CASE II
History
young-age female patient with abdominal pain
Superior mesenteric artery syndrome
Compression of 3rd portion of duodenum between the aorta and superior mesenteric artery (SMA)
Females more affected than males
Most often in older children, adolescents
Some doubt the true existence of the syndrome
Pathophysiology
Narrowing of angle between SMA and aorta
SMA usually forms an angle of 45 degrees with the aorta
Clinical findings
Epigastric pain ,Nausea and Repetitive vomiting
Abdominal cramping
Typically findings are worst in supine position and may be relived by changing to the prone or left lateral decubitus positions
Imaging findings
Usually requires upper GI or CT of abdomen for diagnosis
Megaduodenum
Pronounced dilatation of 1st and 2nd portion of duodenum and frequently stomach
Best seen in supine position
Compression of duodenum between aorta and SMA
CASE III
History
A middle-aged female presents with abdominal pain and swelling
Omental and peritoneal calcified metastatic disease from bilateral ovarian serous cystadenocarcinomas. Left hydronephrosis indicates distal ureteric encasement
Omental Cake
An omental cake refers to infiltration of the omental fat by material of soft-tissue density. The most common causes are metastases from ovary, stomach or colon.
Tuberculous peritonitis may also give this appearance.
CASE IV
42 year-old female with abdominal pain
Ulcerative colitis with colonic mass
CASE V
Diabetic patient with right iliac fossa pain
Emphysematous cholecysitis
Occurs more often in men
As opposed to gallbladder disease in general which occurs more often in women
Mostly elderly patients (>60) with diabetes
Gas may occur in the wall and/or the lumen
May spread to pericholecystic tissue
Rarely, gas may escape into the bile ducts
CT findings of (non-complicated) cholecystitis
Most common is gallbladder wall thickening >3mm, and
Cholelithiasis
Increased density of bile (>20 H)
Loss of clear definition of gallbladder wall
Pericholecystic fluid such as a halo of edema
Case VI
History
60-year old male with non-specific pain
Mesenteric lipodystrophy ( stage II sclerosing mesentritis )
Sclerosing mesentritis is a rare idiopathic disorder characterised by chronic non-specific inflammation involving the adipose tissue of the bowel mesentery
The disease is said to pass through 3 stages, although some authors believe these to be separate entities :
1- mesenteric panniculitis: inflammatory reaction
2-mesenteric lipodystrophy: degeneration of mesenteric fat
3- retractile mesenteritis: fibrosis, which may be associated with distortion or lymphatic obstruction
CT
- CT features are somewhat dependent on the main tissue component and include a well-demarcated or ill-defined mesenteric mass like lesion with misty attenuation, soft-tissue attenuation, or both.
- The mesentery demonstrates positive mass effect and may have a ground glass opacity. Typically the traversing mesenteric vessels and soft tissue nodules have a spared fat halo (this has sometimes been referred to as the fat ring sign) . Its orientation is aligned with the root of the jejunal mesentery. Punctate / coarse calcifications as well as small lymph nodes (usually <5 mm) may be present within the region