ExpertDDx: Abdomen and Pelvis. Edition No. 3

Table of Contents

SECTION 1: PERITONEUM AND

MESENTERY

GENERIC IMAGING PATTERNS

4 Mesenteric or Omental Mass (Solid)

Siva P. Raman, MD

10 Mesenteric or Omental Mass (Cystic)

Siva P. Raman, MD

14 Fat-Containing Lesion, Peritoneal Cavity

Siva P. Raman, MD

18 Mesenteric Lymphadenopathy

Siva P. Raman, MD

22 Abdominal Calcifications

Siva P. Raman, MD

28 Pneumoperitoneum

Siva P. Raman, MD

32 Hemoperitoneum

Siva P. Raman, MD

36 Misty (Infiltrated) Mesentery

Siva P. Raman, MD

MODALITY-SPECIFIC IMAGING FINDINGS

COMPUTED TOMOGRAPHY

42 High-Attenuation (Hyperdense) Ascites

Siva P. Raman, MD

SECTION 2: ABDOMINAL WALL

ANATOMICALLY BASED DIFFERENTIALS

48 Abdominal Wall Mass

Siva P. Raman, MD

52 Mass in Iliopsoas Compartment

Siva P. Raman, MD

54 Groin Mass

Siva P. Raman, MD

58 Elevated or Deformed Hemidiaphragm

Siva P. Raman, MD

60 Defect in Abdominal Wall (Hernia)

Siva P. Raman, MD

SECTION 3: ESOPHAGUS

GENERIC IMAGING PATTERNS

66 Intraluminal Mass, Esophagus

Atif Zaheer, MD and Michael P. Federle, MD, FACR

68 Extrinsic Mass, Esophagus

Atif Zaheer, MD and Michael P. Federle, MD, FACR

72 Lesion at Pharyngoesophageal Junction

Atif Zaheer, MD and Michael P. Federle, MD, FACR

74 Esophageal Ulceration

Atif Zaheer, MD and Michael P. Federle, MD, FACR

76 Mucosal Nodularity, Esophagus

Atif Zaheer, MD and Michael P. Federle, MD, FACR

78 Esophageal Strictures

Atif Zaheer, MD and Michael P. Federle, MD, FACR

80 Dilated Esophagus

Atif Zaheer, MD and Michael P. Federle, MD, FACR

82 Esophageal Outpouchings (Diverticula)

Atif Zaheer, MD and Michael P. Federle, MD, FACR

84 Esophageal Dysmotility

Atif Zaheer, MD and Michael P. Federle, MD, FACR

CLINICALLY BASED DIFFERENTIALS

86 Odynophagia

Atif Zaheer, MD and Michael P. Federle, MD, FACR

SECTION 4: STOMACH

GENERIC IMAGING PATTERNS

90 Gastric Mass Lesions

Atif Zaheer, MD and Michael P. Federle, MD, FACR

96 Intramural Mass, Stomach

Atif Zaheer, MD and Michael P. Federle, MD, FACR

98 Target or Bull's-Eye Lesions, Stomach

Atif Zaheer, MD and Michael P. Federle, MD, FACR

100 Gastric Ulceration (Without Mass)

Atif Zaheer, MD and Michael P. Federle, MD, FACR

102 Intrathoracic Stomach

Atif Zaheer, MD and Michael P. Federle, MD, FACR

104 Thickened Gastric Folds

Atif Zaheer, MD and Michael P. Federle, MD, FACR

110 Gastric Dilation or Outlet Obstruction

Atif Zaheer, MD and Michael P. Federle, MD, FACR

114 Linitis Plastica, Limited Distensibility

Atif Zaheer, MD and Michael P. Federle, MD, FACR

CLINICALLY BASED DIFFERENTIALS

118 Epigastric Pain

Atif Zaheer, MD and Michael P. Federle, MD, FACR

124 Left Upper Quadrant Mass

Atif Zaheer, MD and Michael P. Federle, MD, FACR

SECTION 5: DUODENUM

GENERIC IMAGING PATTERNS

130 Duodenal Mass

Atif Zaheer, MD and Michael P. Federle, MD, FACR

136 Dilated Duodenum

Atif Zaheer, MD and Michael P. Federle, MD, FACR

138 Thickened Duodenal Folds

Atif Zaheer, MD and Michael P. Federle, MD, FACR

SECTION 6: SMALL INTESTINE

GENERIC IMAGING PATTERNS

142 Multiple Masses or Filling Defects, Small Bowel

Atif Zaheer, MD and Michael P. Federle, MD, FACR

144 Cluster of Dilated Small Bowel

Atif Zaheer, MD and Michael P. Federle, MD, FACR

146 Aneurysmal Dilation of Small Bowel Lumen

Atif Zaheer, MD and Michael P. Federle, MD, FACR

148 Stenosis, Terminal Ileum

Atif Zaheer, MD and Michael P. Federle, MD, FACR

150 Segmental or Diffuse Small Bowel Wall Thickening

Atif Zaheer, MD and Michael P. Federle, MD, FACR

156 Pneumatosis of Small Intestine or Colon

Atif Zaheer, MD and Michael P. Federle, MD, FACR

CLINICALLY BASED DIFFERENTIALS

160 Occult GI Bleeding

Atif Zaheer, MD and Michael P. Federle, MD, FACR

164 Small Bowel Obstruction

Atif Zaheer, MD and Michael P. Federle, MD, FACR

SECTION 7: COLON

GENERIC IMAGING PATTERNS

172 Solitary Colonic Filling Defect

Atif Zaheer, MD and Michael P. Federle, MD, FACR

174 Multiple Colonic Filling Defects

Atif Zaheer, MD and Michael P. Federle, MD, FACR

176 Mass or Inflammation of Ileocecal Area

Atif Zaheer, MD and Michael P. Federle, MD, FACR

182 Colonic Ileus or Dilation

Atif Zaheer, MD and Michael P. Federle, MD, FACR

186 Toxic Megacolon

Atif Zaheer, MD and Michael P. Federle, MD, FACR

188 Rectal or Colonic Fistula

Atif Zaheer, MD and Michael P. Federle, MD, FACR

194 Segmental Colonic Narrowing

Atif Zaheer, MD and Michael P. Federle, MD, FACR

198 Colonic Thumbprinting

Atif Zaheer, MD and Michael P. Federle, MD, FACR

200 Colonic Wall Thickening

Atif Zaheer, MD and Michael P. Federle, MD, FACR

206 Smooth Ahaustral Colon

Atif Zaheer, MD and Michael P. Federle, MD, FACR

CLINICALLY BASED DIFFERENTIALS

208 Acute Right Lower Quadrant Pain

Atif Zaheer, MD and Michael P. Federle, MD, FACR

214 Acute Left Lower Quadrant Pain

Atif Zaheer, MD and Michael P. Federle, MD, FACR

SECTION 8: SPLEEN

GENERIC IMAGING PATTERNS

222 Splenomegaly

Siva P. Raman, MD

226 Multiple Splenic Calcifications

Siva P. Raman, MD

228 Solid Splenic Mass or Masses

Siva P. Raman, MD

230 Cystic Splenic Mass

Siva P. Raman, MD

MODALITY-SPECIFIC IMAGING FINDINGS

COMPUTED TOMOGRAPHY

232 Diffuse Increased Attenuation, Spleen

Siva P. Raman, MD

SECTION 9: LIVER

GENERIC IMAGING PATTERNS

236 Liver Mass With Central or Eccentric Scar

Atif Zaheer, MD and Michael P. Federle, MD, FACR

240 Focal Liver Lesion With Hemorrhage

Atif Zaheer, MD and Michael P. Federle, MD, FACR

244 Liver "Mass" With Capsular Retraction

Atif Zaheer, MD and Michael P. Federle, MD, FACR

246 Fat-Containing Liver Mass

Atif Zaheer, MD and Michael P. Federle, MD, FACR

248 Cystic Hepatic Mass

Atif Zaheer, MD and Michael P. Federle, MD, FACR

252 Focal Hypervascular Liver Lesion

Atif Zaheer, MD and Michael P. Federle, MD, FACR

258 Liver Mass With Mosaic Enhancement

Atif Zaheer, MD

262 Mosaic or Patchy Hepatogram

Atif Zaheer, MD and Michael P. Federle, MD, FACR

266 Hepatic Calcifications

Atif Zaheer, MD and Michael P. Federle, MD, FACR

270 Liver Lesion Containing Gas

Atif Zaheer, MD and Michael P. Federle, MD, FACR

274 Portal Venous Gas

Atif Zaheer, MD and Michael P. Federle, MD, FACR

276 Widened Hepatic Fissures

Atif Zaheer, MD and Michael P. Federle, MD, FACR

278 Dysmorphic Liver With Abnormal Bile Ducts

Atif Zaheer, MD and Michael P. Federle, MD, FACR

282 Focal Hyperperfusion Abnormality (THAD or THID)

Atif Zaheer, MD and Michael P. Federle, MD, FACR

MODALITY-SPECIFIC IMAGING FINDINGS

MAGNETIC RESONANCE IMAGING

288 Multiple Hypodense Liver Lesions

Atif Zaheer, MD and Michael P. Federle, MD, FACR

294 Multiple Hypointense Liver Lesions (T2WI)

Atif Zaheer, MD and Michael P. Federle, MD, FACR

298 Hyperintense Liver Lesions (T1WI)

Atif Zaheer, MD and Michael P. Federle, MD, FACR

304 Liver Lesion With Capsule or Halo on MR

Atif Zaheer, MD and Michael P. Federle, MD, FACR

COMPUTED TOMOGRAPHY

308 Focal Hyperdense Hepatic Mass on Nonenhanced CT

Atif Zaheer, MD and Michael P. Federle, MD, FACR

312 Periportal Lucency or Edema

Atif Zaheer, MD and Michael P. Federle, MD, FACR

318 Widespread Low Attenuation Within Liver

Atif Zaheer, MD and Michael P. Federle, MD, FACR

ULTRASOUND

322 Focal Hepatic Echogenic Lesion ? Acoustic

Shadowing

Atif Zaheer, MD, Gregory E. Antonio, MD, DRANZCR,

FHKCR, and Eric K. H. Liu, PhD, RDMS

328 Hyperechoic Liver, Diffuse

Atif Zaheer, MD, Gregory E. Antonio, MD, DRANZCR,

FHKCR, and Eric K. H. Liu, PhD, RDMS

330 Hepatomegaly

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

334 Diffuse Liver Disease

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

336 Cystic Liver Lesion

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

340 Hypoechoic Liver Mass

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

344 Echogenic Liver Mass

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

348 Target Lesions in Liver

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

350 Multiple Hepatic Masses

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

354 Hepatic Mass With Central Scar

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

356 Periportal Lesion

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

360 Irregular Hepatic Surface

Aya Kamaya, MD, FSRU, FSAR

362 Portal Vein Abnormality

Hee Sun Park, MD, PhD and Aya Kamaya, MD, FSRU, FSAR

SECTION 10: GALLBLADDER

GENERIC IMAGING PATTERNS

366 Distended Gallbladder

Siva P. Raman, MD

368 Gas in Bile Ducts or Gallbladder

Siva P. Raman, MD

372 Focal Gallbladder Wall Thickening

Siva P. Raman, MD

374 Diffuse Gallbladder Wall Thickening

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

MODALITY-SPECIFIC IMAGING FINDINGS

COMPUTED TOMOGRAPHY

378 High-Attenuation (Hyperdense) Bile in Gallbladder

Siva P. Raman, MD

ULTRASOUND

380 Hyperechoic Gallbladder Wall

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

382 Echogenic Material in Gallbladder

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

384 Dilated Gallbladder

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

388 Intrahepatic and Extrahepatic Duct Dilatation

L. Nayeli Morimoto, MD and Aya Kamaya, MD, FSRU,

FSAR

CLINICALLY BASED DIFFERENTIALS

390 Right Upper Quadrant Pain

Siva P. Raman, MD

SECTION 11: BILIARY TRACT

GENERIC IMAGING PATTERNS

398 Dilated Common Bile Duct

Siva P. Raman, MD

404 Asymmetric Dilation of Intrahepatic Bile Ducts

Siva P. Raman, MD

408 Biliary Strictures, Multiple

Siva P. Raman, MD

MODALITY-SPECIFIC IMAGING FINDINGS

MAGNETIC RESONANCE IMAGING

412 Hypointense Lesion in Biliary Tree (MRCP)

Siva P. Raman, MD

SECTION 12: PANCREAS

GENERIC IMAGING PATTERNS

416 Hypovascular Pancreatic Mass

Siva P. Raman, MD

422 Hypervascular Pancreatic Mass

Siva P. Raman, MD

426 Cystic Pancreatic Mass

Siva P. Raman, MD

432 Atrophy or Fatty Replacement of Pancreas

Siva P. Raman, MD

434 Dilated Pancreatic Duct

Siva P. Raman, MD

438 Infiltration of Peripancreatic Fat Planes

Siva P. Raman, MD

444 Pancreatic Calcifications

Siva P. Raman, MD

MODALITY-SPECIFIC IMAGING FINDINGS

ULTRASOUND

448 Cystic Pancreatic Lesion

Fauzia Vandermeer, MD

452 Solid Pancreatic Lesion

Fauzia Vandermeer, MD

456 Pancreatic Duct Dilatation

Fauzia Vandermeer, MD

SECTION 13: RETROPERITONEUM

GENERIC IMAGING PATTERNS

460 Retroperitoneal Mass, Cystic

Matthew T. Heller, MD, FSAR

466 Retroperitoneal Mass, Soft Tissue Density

Matthew T. Heller, MD, FSAR

472 Retroperitoneal Mass, Fat Containing

Matthew T. Heller, MD, FSAR

474 Retroperitoneal Hemorrhage

Matthew T. Heller, MD, FSAR

SECTION 14: ADRENAL

GENERIC IMAGING PATTERNS

478 Adrenal Mass

Mitchell Tublin, MD

SECTION 15: KIDNEY

GENERIC IMAGING PATTERNS

486 Solid Renal Mass

Mitchell Tublin, MD

490 Cystic Renal Mass

Mitchell Tublin, MD

494 Bilateral Renal Cysts

Alessandro Furlan, MD

498 Infiltrative Renal Lesions

Ghaneh Fananapazir, MD

502 Perirenal and Subcapsular Mass Lesions

Matthew T. Heller, MD, FSAR

506 Renal Cortical Nephrocalcinosis

Matthew T. Heller, MD, FSAR

508 Medullary Nephrocalcinosis

Matthew T. Heller, MD, FSAR

510 Perirenal Hemorrhage

Amir A. Borhani, MD

514 Fat-Containing Renal Mass

Alessandro Furlan, MD

518 Calcified Small Lesion in Kidney

Alessandro Furlan, MD

522 Renal Sinus Lesion

Amir A. Borhani, MD

528 Gas in or Around Kidney

Alessandro Furlan, MD

530 Delayed or Persistent Nephrogram

Amir A. Borhani, MD

534 Wedge-Shaped or Striated Nephrogram

Alessandro Furlan, MD

MODALITY-SPECIFIC IMAGING FINDINGS

ULTRASOUND

538 Enlarged Kidney

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

542 Small Kidney

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

546 Hypoechoic Kidney

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

550 Hyperechoic Kidney

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

554 Renal Pseudotumor

Jade Wong-You-Cheong, MBChB, MRCP, FRCR, FSRU,

FSAR

556 Dilated Renal Pelvis

Narendra Shet, MD

560 Hyperechoic Renal Mass

Mitchell Tublin, MD

SECTION 16: COLLECTING SYSTEM

568 Dilated Renal Calices

Alessandro Furlan, MD

572 Radiolucent Filling Defect, Renal Pelvis

Amir A. Borhani, MD

SECTION 17: URETER

GENERIC IMAGING PATTERNS

576 Ureteral Filling Defect or Stricture

Amir A. Borhani, MD

580 Cystic Dilation of Distal Ureter

Amir A. Borhani, MD

SECTION 18: BLADDER

GENERIC IMAGING PATTERNS

584 Filling Defect in Urinary Bladder

Amir A. Borhani, MD

590 Urinary Bladder Outpouching

Amir A. Borhani, MD

592 Gas Within Urinary Bladder

Amir A. Borhani, MD

594 Abnormal Bladder Wall

Ashish P. Wasnik, MD, FSAR

SECTION 19: URETHRA

GENERIC IMAGING PATTERNS

600 Urethral Stricture

Matthew T. Heller, MD, FSAR

SECTION 20: SCROTUM

GENERIC IMAGING PATTERNS

604 Intratesticular Mass

Mitchell Tublin, MD

608 Testicular Cystic Lesions

Mitchell Tublin, MD

610 Extratesticular Cystic Mass

Mitchell Tublin, MD

612 Extratesticular Solid Mass

Mitchell Tublin, MD

614 Diffuse Testicular Enlargement

Shweta Bhatt, MD

616 Decreased Testicular Size

Shweta Bhatt, MD

618 Testicular Calcifications

Shweta Bhatt, MD

SECTION 21: PROSTATE AND SEMINAL

VESICLES

GENERIC IMAGING PATTERNS

622 Focal Lesion in Prostate

Alessandro Furlan, MD

626 Enlarged Prostate

Katherine To'o, MD

SECTION 22: FEMALE PELVIS

GENERIC IMAGING PATTERNS

630 Pelvic Fluid

Akram M. Shaaban, MBBCh

634 Female Lower Genital Cysts

Akram M. Shaaban, MBBCh

640 Extra-Ovarian Adnexal Mass

Maryam Rezvani, MD

CLINICALLY BASED DIFFERENTIALS

646 Acute Pelvic Pain in Non-Pregnant Women

Akram M. Shaaban, MBBCh

SECTION 23: UTERUS

GENERIC IMAGING PATTERNS

654 Enlarged Uterus

Maryam Rezvani, MD

658 Thickened Endometrium

Maryam Rezvani, MD

CLINICALLY BASED DIFFERENTIALS

664 Abnormal Uterine Bleeding

Maryam Rezvani, MD

SECTION 24: OVARY

GENERIC IMAGING PATTERNS

672 Multilocular Ovarian Cysts

Akram M. Shaaban, MBBCh

678 Unilocular Ovarian Cysts

Akram M. Shaaban, MBBCh

684 Solid Ovarian Masses

Akram M. Shaaban, MBBCh

688 Calcified Ovarian Masses

Akram M. Shaaban, MBBCh

MODALITY-SPECIFIC IMAGING FINDINGS

MAGNETIC RESONANCE IMAGING

692 Ovarian Lesions With Low T2 Signal Intensity

Akram M. Shaaban, MBBCh

Authors

Atif Zaheer Professor of Radiology, Oncology and Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Atif Zaheer has a specialty focus on CT, MR, and US of the abdomen and pelvis. He is Professor of Radiology, Oncology and Medicine at The Johns Hopkins University School of Medicine in Baltimore, Maryland. Siva P. Raman Bay Imaging Consultants, Walnut Creek, California. Dr. Siva Raman is a board-certified radiologist who gained his subspecialty expertise in thoracoabdominal imaging during a fellowship at Stanford University, and intern residency at UC Davis Medical Center. He attended Johns Hopkins University Medical School. Dr. Raman is a radiologist at Bay Imaging Consultants in Walnut Creek, California, with a subspecialty focus on thoracoabdominal imaging Bryan R. Foster Professor, Department of Radiology, Oregon Health & Science University, Portland, Oregon. Dr. Bryan Foster is a body imaging radiologist with a subspecialty focus on oncologic, hepatobiliary, pancreatic, prostate, and small bowel imaging. Dr. Foster is the director of ultrasound at OHSU and performs complex image-guided biopsies; he also performs CEUS imaging and US elastography. Dr. Foster is skilled in all facets of imaging including radiography, fluoroscopy, ultrasound, CT, and MRI. His interests include oncologic, hepatobiliary, pancreatic, prostate, and small bowel imaging. Dr. Foster has recently started performing contrast-enhanced ultrasound imaging (as the only site in Oregon) and US elastography. He is one of two radiologists that perform MRI-guided prostate biopsies (also only site in Oregon). Recently he was selected as an Honored Educator for the Radiological Society of North America. Ghaneh Fananapazir Professor of Radiology, University of California, Davis, Sacramento,, California. Dr. Ghaneh Fananapazir is a radiologist with specialization in abdominal radiology. He is Professor of Radiology at the University of California, Davis, in Sacramento, California. Fananapazir's clinical focus includes nonvascular interventional procedures, advanced US, CT and MR techniques, vascular imaging, and abdominal organ transplantation (kidney, liver, pancreas). In addition to his clinical duties, Dr. Fananapazir is passionate about medical education and research, particularly relating to kidney transplantation, and has authored textbooks and peer-reviewed research in highly impactful medical journals.