Mayo Clinic Gastrointestinal Imaging Review by C. Daniel Johnson and Grant D. Schmit


295a25d76dac974-261x361.jpg Author C. Daniel Johnson and Grant D. Schmit
Isbn 9780849397950
File size 30.6MB
Year 2005
Pages 752
Language English
File format PDF
Category medicine



 

Mayo Clinic Gastrointestinal Imaging Review Mayo Clinic Gastrointestinal Imaging Review C. Daniel Johnson, M.D. Grant D. Schmit, M.D. MAYO CLINIC SCIENTIFIC PRESS AND INFORMA HEALTHCARE USA, INC. ISBN 0-8493-9795-2 The triple-shield Mayo logo and the words MAYO, MAYO CLINIC, and MAYO CLINIC SCIENTIFIC PRESS are marks of Mayo Foundation for Medical Education and Research. ©2005 by Mayo Foundation for Medical Education and Research. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the prior written consent of the copyright holder, except for brief quotations embodied in critical articles and reviews. Inquiries should be addressed to Mayo Clinic, 200 First Street SW, Rochester, MN 55905. For order inquiries, contact: Informa Healthcare, Kentucky Distribution Center, 7625 Empire Drive, Florence, Kentucky 41041 www.informahealthcare.com. Catalog record is available from the Library of Congress Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the contents of the publication. This book should not be relied on apart from the advice of a qualified health care provider. The authors, editors, and publisher have exerted efforts to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulation, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care providers to ascertain the FDA status of each drug or device planned for use in their clinical practice. About the Cover O ne of the fun parts of writing this book was dressing it up with a unique cover. We were delighted to learn that Mayo Clinic Scientific Press encouraged our participation in the design of the cover. We wanted the cover not only to represent the contents of the book but also to make a personal statement. Knowing of our interest in abstract art, Karen Barrie, art director for the book, provided several examples of abstract art in a warm color palette. The magnificent paintings by Wassily Kandinsky stood out as the model for our project. Our own abstract line drawings and our favorite Kandinsky paintings were shown to Jim Rownd, a Mayo Clinic illustrator. Jim took our vision and created the cover illustration. We see the cover as analogous to radiographic images—also abstract to many viewers, understood only with a knowledge of anatomy, radiography, and pathology. Our hope is that the interrelated beauty of the components of the gastrointestinal tract is depicted in the illustration. The individual components are placed on the title pages of their respective chapters. We are most grateful to both Karen Barrie and Jim Rownd for their artistic guidance and talents. We also appreciate the freedom given to our team at Mayo Clinic to create the book of our choice. We hope you enjoy it. C. Daniel Johnson, M.D. Grant D. Schmit, M.D. v Preface T he purpose of writing this book was to provide an atlas of common abnormalities that affect the gastrointestinal tract. Emphasis was placed on providing images large enough to study and minimal text including core information about the cases and disease processes. The book is not intended to be an inclusive source of diseases and their many manifestations. Rather, the most important disease processes affecting the gastrointestinal tract and their most common presentations are included. Only a few selected pediatric cases are included to provide a comparison with adult disease processes. Readers are directed to other textbooks for a comprehensive review of pediatric gastrointestinal disorders. The content of the book is directed primarily to residents in training, particularly those studying for board examinations. Practicing radiologists wanting to review the spectrum of abnormalities affecting the gastrointestinal tract will find the book to be an efficient review. This book should be considered a new book when compared with Alimentary Tract Imaging: A Teaching File, authored by me (C.D.J.) more than a decade ago. Although some of the cases used in the earlier book also are used in this text, there are substantial differences. Additions include many new cases and also chapters on the liver, biliary system, pancreas, spleen, and mesentery and peritoneum. The book includes images obtained with state-of-theart technology, such as computed tomographic colonography and enterography, ultrasonography, and magnetic resonance (including magnetic resonance cholangiopancreatography). The format for case presentation has been standardized to description of the radiographic findings, pertinent differential diagnoses, diagnosis, and discussion. The format is designed to allow the reader to review each case without knowing the diagnosis. Students are urged to commit themselves to the findings, differential diagnoses, and then diagnosis for each case before reading the answer. They can then obtain additional information from the discussion. Numerous summary tables synthesize information and provide key points and case references. The illustrations, drawn by David A. Factor, a medical illustrator at Mayo Clinic, provide a composite of the key diseases discussed in each chapter. We hope these illustrations assist the reader in learning key differential considerations. Selected readings and references are not included—an acknowledgment that readers of this book are likely looking for an efficient single-source review. C. Daniel Johnson, M.D. Grant D. Schmit, M.D. vii Acknowledgments I am deeply indebted to the many members of the Department of Radiology at Mayo Clinic who provided cases for the book. I have had many mentors and assistants who made this project possible. My training in radiology was highly influenced by distinguished radiologists, including Harley C. Carlson, David H. Stephens, Robert L. MacCarty, Reed P. Rice, William M. Thompson, and Igor Laufer. I am grateful for the training, mentorship, encouragement, and help from all of them. My colleague, Grant D. Schmit, the coauthor of this book, provided enthusiasm and help with obtaining cases, balancing content, and providing insight into formats and charts and key editorial assistance. He has been delightful to work with, and I hope this experience has cemented our collegial bonds and friendship. Debora L. Shreve performed a herculean job in typing and organizing the contents of the book. Without her dedication and skills, the book could not have been written. The Section of Scientific Publications and Media Support Services at Mayo Clinic worked tirelessly to provide the product that Grant and I envisioned. Roberta Schwartz was the lead project organizer, LeAnn Stee editor, Dianne Kemp editorial assistant, Karen Barrie art director, David Factor medical illustrator, and John Hedlund proofreader. Each one served a critical role in book production. I am grateful to them all. Most importantly, I thank my dear wife, Therese, for her encouragement to tackle another book. As always, she provided me unselfish support for a project that took me away from family and home activities. I also thank my daughter, Kristina, for her support. Time was not always available to do things together that would have been most fun. I hope that my academic pursuits, such as book writing, will inspire her to activities that are professionally rewarding and enjoyable. I hope readers find the book an efficient way to learn the myriad and fascinating ways of the gastrointestinal tract. C. Daniel Johnson, M.D. In addition to those persons already acknowledged, I thank my wife, Chris, and my sons, Collin and Cameron, for their support and the sacrifice that allowed me to be involved in writing this book. I also thank my friend and mentor, C. Daniel Johnson, for including me in such an educational and rewarding project at this early stage in my academic career. Grant D. Schmit, M.D. viii Author Affiliations C. Daniel Johnson, M.D. Consultant, Department of Radiology, Mayo Clinic Professor of Radiology, Mayo Clinic College of Medicine Rochester, Minnesota Grant D. Schmit, M.D. Senior Associate Consultant, Department of Radiology, Mayo Clinic Instructor in Radiology, Mayo Clinic College of Medicine Rochester, Minnesota ix Table of Contents Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Duodenum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135 Small Bowel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179 Colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275 Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .393 Bile Ducts and Gallbladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .479 Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .553 Spleen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .633 Peritoneum and Mesentery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .667 Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .719 Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .721 Case Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .729 xi CHAPTER 1 ESOPHAGUS Inflammatory and Ulcerative Diseases . . . . . . . .Cases 1.1–1.14 Strictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Cases 1.15–1.24 Masses and Filling Defects . . . . . . . . . . . . . . . . . .Cases 1.25–1.45 Benign Tumors Malignant Tumors Nonneoplastic Diverticula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Cases 1.46–1.52 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Cases 1.53–1.67 1 Esophagus 3 CASE 1.1 Findings Double-contrast esophagram. Thickened and somewhat nodular folds are seen in the distal esophagus. Differential Diagnosis 1. Reflux esophagitis 2. Esophageal varices Diagnosis Mild reflux esophagitis Discussion Reflux esophagitis is a common indication for and finding at UGI. If fold thickening is the only finding on a triphasic esophagram, mild esophagitis commonly is found endoscopically. Folds are considered abnormal if they exceed 2 to 3 mm in diameter. Development of reflux esophagitis depends on several factors, including the acidity of the refluxed contents, the efficacy of esophageal clearance, and the frequency of reflux. These factors are particularly important in patients with Zollinger-Ellison syndrome and those with scleroderma, groups commonly affected with reflux esophagitis. Varices (cases 1.38 and 1.39) change shape with fluoroscopic observation and often have a serpentine and nodular configuration. Inflammatory and Ulcerative Diseases 4 Chapter 1 CASE 1.2 Findings Double-contrast esophagram. Linear erosions (arrow) and punctate superficial erosions (arrowhead) are present within a mildly nodular mucosal background. The esophagus is shortened, and a small hiatal hernia is present. Differential Diagnosis 1. Reflux esophagitis 2. Herpes esophagitis 3. Candida esophagitis Diagnosis Moderate reflux esophagitis Discussion Moderate esophagitis usually is characterized by the presence of superficial erosions that may be either punctate or linear. Fold thickening and nodularity also often are findings on the mucosal-relief phase films. In patients with long-standing disease with esophageal intramural fibrosis, the esophagus shortens and pulls the stomach into an intrathoracic location. This type of “short esophagus” hiatal hernia is present in this case. Herpes esophagitis (cases 1.12 and 1.13) is usually associated with multiple discrete superficial ulcers that may be located anywhere in the esophagus. Candida esophagitis (cases 1.10 and 1.11) most often has multiple plaquelike filling defects throughout the esophagus. Inflammatory and Ulcerative Diseases Esophagus 5 CASE 1.3 CASE 1.4 Findings Case 1.3. Double-contrast esophagram. A large, flat ulcer is present in the distal esophagus (arrow) with associated diminished distensibility of the lower esophageal segment. There is also a long linear ulcer (arrowheads) with a surrounding halo of edema. Discussion Transverse folds develop as a result of a prior linear ulceration with scar formation within the longitudinal muscle layers of the distal esophagus. They usually do not span the entire esophageal lumen. Severe esophagitis usually is characterized by the presence of an ulcer crater. Typically, patients with severe esophagitis have superficial erosions and fold thickening in addition to the characteristic ulcer. Transverse folds from esophagitis should be distinguished from the folds in feline esophagus (case 1.54) because transverse folds are fixed, fewer in number, coarser, and shorter. Changes of both active and chronic disease commonly coexist (as seen in these cases). Case 1.4. Double-contrast esophagram. Mucosal nodularity, a deep ulcer, and luminal narrowing are present. Transverse folds due to chronic scarring and buckling of the mucosa also are present (arrows). Sharp spiculations are seen just superior to the deep ulcer; these are due to transverse folds seen in profile. Asymmetric scarring causes the distal deformity and narrowing. Differential Diagnosis 1. Transverse folds and severe reflux esophagitis 2. Feline esophagus 3. Carcinoma of the esophagus Diagnosis Severe reflux esophagitis Inflammatory and Ulcerative Diseases 6 Chapter 1 CASE 1.5 Findings Double-contrast esophagram. Luminal irregularity and narrowing are present in the distal esophagus with associated asymmetric sacculations. Differential Diagnosis 1. Active reflux esophagitis 2. Chronic reflux esophagitis 3. Esophageal carcinoma Discussion Chronic and active changes of reflux esophagitis often coexist. It may be impossible to exclude active ulceration or carcinoma in patients with marked deformity. Endoscopy should be recommended for patients with such problematic findings. Changes of chronic reflux esophagitis can result in scarring and considerable deformity of the esophagus. Diagnosis Chronic reflux esophagitis Inflammatory and Ulcerative Diseases Esophagus 7 CASE 1.6 CASE 1.7 Findings Case 1.6. Double-contrast esophagram. A featureless distal esophagus is present. Above the featureless zone are findings of active reflux esophagitis (mucosal granularity and superficial erosions [arrows]). Discussion It is important to recognize Barrett esophagus because the adenomatous tissue is at increased risk for malignant transformation. Some reports suggest adenocarcinoma may develop in up to 10% of affected patients. In fact, 5% to 20% of all esophageal cancers develop in Barrett mucosa. Reticular changes of Barrett esophagus are often adjacent to an esophageal stricture. The nodularity and crevices may be smaller and more delicate than in case 1.7. The mucosal nodularity associated with usual reflux esophagitis (cases 1.2, 1.3, and 1.4) without adenomatous transformation could have similar radiographic findings. The plaquelike filling defects in patients with candidiasis (cases 1.10 and 1.11) usually involve the entire esophagus and are not associated with other changes of reflux esophagitis. Case 1.7. Double-contrast esophagram. Mucosal reticularity is present in the esophagus. There is a short esophagus-type hiatal hernia. A surgically induced deformity mimics an ulcer crater. A benign-appearing stricture also is present. Differential Diagnosis 1. Barrett esophagus with active reflux esophagitis 2. Reflux esophagitis 3. Candida esophagitis Diagnosis Barrett esophagus Inflammatory and Ulcerative Diseases

Author C. Daniel Johnson and Grant D. Schmit Isbn 9780849397950 File size 30.6MB Year 2005 Pages 752 Language English File format PDF Category Medicine Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare Offering four times the amount of imaging cases offered by competing texts, this reference stands as the foremost guide to common diseases and radiographic presentations found within the gastrointestinal tract-authoritatively covering the entire range of gastrointestinal diseases to include conditions affecting the esophagus, stomach, duodenum, small bowel, colon, liver, biliary tree, gallbladder, pancreas, spleen, peritoneum, and mesentery.     Download (30.6MB) Atlas of Colonoscopy: Techniques – Diagnosis – Interventional Procedures Top 3 Differentials In Neuroradiology Mayo Clinic Gastroenterology And Hepatology Board Review, 2nd Edition Deep Brain Stimulation: Indications and Applications Case-Based Interventional Neuroradiology Load more posts

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