Learning objectives

Objectives

The goal of this educational exhibit is to review the imaging appearance of bariatric surgery including Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy.

Radiologic findings of complications for these procedures will be demonstrated with key teaching points highlighted.

Background

Obesity is an epidemic in the United States and around the world. It is a second leading cause of preventable death in US (after smoking) with more than 300,000 deaths annually.

Bariatric surgery is the most invasive form of therapy for obesity and is ideally reserved for patients who fail to lose weight with diet, exercise, and behavioral modification.

Imaging findings OR Procedure findings

Complications of bariatric surgery include: Leak, anastomotic narrowing/stricture, marginal ulcers, jejunal ischemia, small bowel obstruction, internal hernia, intussusception, staple line dehiscence, gastric strictures, gastric dilation, gastroesophageal reflux.

Conclusion

In conclusion, one must be familiar with post-operative anatomy and identify all components of the surgery. Scout images must be reviewed and if a leak is suspected water-soluble contrast should be given initially. CT parameters may need to optimized in obese patients to improve image quality.

Objectives

To review various rare liver masses and their imaging features.

Background

The differential diagnosis for liver masses is wide. Rare livers masses do occur with some degree of frequency. While these rare liver masses often cannot be diagnosed with certainty based on imaging alone due to their nonspecific imaging features, some imaging characteristics can aid in narrowing the differential diagnosis of uncommon liver masses.

Imaging findings OR Procedure findings

The following pathology-proven entities will be reviewed:

1. Primary liver neoplasms

- Benign:

* Angiomyolipoma

* Epithelioid angiomyolipoma

* Lipoma

* Ciliated hepatic foregut cyst

* Diffuse hepatic hemangiomatosis

* Hepatic small vessel neoplasm of uncertain malignant potential

- Malignant:

* Combined hepatocellular carcinoma-cholangiocarcinoma

* Angiosarcoma

* Adenosquamous carcinoma

* Epitheliod hemangioendothelioma

2. Unusual metastases

* Liposarcoma

* Spindle cell sarcoma

* Acute lymphoblastic leukemia

* Aggressive B cell lymphoma

* Plasmacytoma

* Multiple myeloma

3. Inflammatory

* Benign necrotic granulomas

* IgG4 inflammatory pseudotumor

* Solitary fibrous tumor

* Mass-forming:

- Xanthogranulomatous cholangitis

- Vascular malformation

- Sarcoidosis

- Eosinophilic cholangiopathy

- Acute hepatocyte collapse

Conclusion

Rare liver masses do occur and often cannot be diagnosed on imaging. The purpose of this study is to review various unusual liver masses and imaging clues to their diagnosis.

Objectives

1. Review the normal cross-sectional and imaging appearance of abdominopelvic nodal groups.

2. Review size and morphologic criteria for abdominopelvic lymphadenopathy.

3. llustrate normal structures that can be misinterpreted as lymphadenopathy.

4. Highlight ancillary imaging and clinical clues associated with benign abdominopelvic lymphadenopathy.

5. Innumerate myriad causes of benign abdominopelvic lymphadenopathy and illustrate case examples on CT and MRI.

Background

1. When lymphadenopathy is detected on imaging, the key question facing the radiologist is whether it is due to a malignant or benign cause.

2. The radiologist plays a critical role in determining if further evaluation is indicated to diagnose malignancy, if further management of infection or inflammatory disease is indicated, or if findings are of no clinical significance.

3. Correlation with pertinent clinical history and laboratories can provide clues to benign lymphadenopathy.

4. When prior imaging confirms long-standing lymphadenopathy, benign lymphadenopathy can be considered.

Imaging findings OR Procedure findings

Causes of Benign Abdominopelvic Lymphadenopathy:

-Liver Disease

-Hemosiderosis

-Mesenteric Adenitis

-Infection

-Tuberculosis

-Appendicitis

-Colitis

-Crohn’s Disease

-Mesenteric Panniculitis

-Castleman Disease

-Whipple Disease

-Sarcoidosis

-Mastocytosis

-Autoimmune Disease

-Kikuchi-Fujimoto Disease

-Rosai Dorfman Disease

-Amyloidosis

-Gaucher’s Disease

-Drugs

Conclusion

1. The radiologist plays a major role in guiding management of lymphadenopathy, so understanding the etiologies and clinical settings in which benign lymphadenopathy is present can aid radiologic confidence of benign disease and avoid unnecessary work-up.

2. The unique imaging features of tuberculous lymphadenopathy greatly aids its diagnosis.

3. When lymphadenopathy is of indeterminate nature, short-term imaging follow-up may be an alternative to immediate biopsy.

Objectives

To review various rare liver masses and their imaging features.

Background

The differential diagnosis for liver masses is wide. Rare livers masses do occur with some degree of frequency. While these rare liver masses often cannot be diagnosed with certainty based on imaging alone due to their nonspecific imaging features, some imaging characteristics can aid in narrowing the differential diagnosis of uncommon liver masses.

Imaging findings OR Procedure findings

The following pathology-proven entities will be reviewed:

1. Primary liver neoplasms

- Benign:

* Angiomyolipoma

* Epithelioid angiomyolipoma

* Lipoma

* Ciliated hepatic foregut cyst

* Diffuse hepatic hemangiomatosis

* Hepatic small vessel neoplasm of uncertain malignant potential

- Malignant:

* Combined hepatocellular carcinoma-cholangiocarcinoma

* Angiosarcoma

* Adenosquamous carcinoma

* Epitheliod hemangioendothelioma

2. Unusual metastases

* Liposarcoma

* Spindle cell sarcoma

* Acute lymphoblastic leukemia

* Aggressive B cell lymphoma

* Plasmacytoma

* Multiple myeloma

3. Inflammatory

* Benign necrotic granulomas

* IgG4 inflammatory pseudotumor

* Solitary fibrous tumor

* Mass-forming:

- Xanthogranulomatous cholangitis

- Vascular malformation

- Sarcoidosis

- Eosinophilic cholangiopathy

- Acute hepatocyte collapse

Conclusion

Rare liver masses do occur and often cannot be diagnosed on imaging. The purpose of this study is to review various unusual liver masses and imaging clues to their diagnosis.

Learning objectives