Objectives

•Assess the sensitivity of the non-enhanced CT in detecting non urological pathologies.

•To identify the important non urological findings in patients presented with symptoms of renal colic and negative CT KUB for renal stone.

•How many of these findings are overlooked by radiologist and not reported.

Background

•Renal and ureteral stones are a common problem.

•Patients may present with the classic symptoms of renal colic and hematuria. Others may be asymptomatic or having vague abdominal/ flank pain and nausea.

• A non-enhanced KUB CT imaging is the modality of choice (+/- US ) to diagnosis and guide treatment in these patients.

In a retrospective study we assess all CT sacn done for renal stone over a period of 5 months in our hospital (January to May 2019).

Patients with positive KUB stone or who have urological infectious/ neoplastic findings on CT scan were excluded.

only 64 cases included in the study.

Imaging findings OR Procedure findings

A) Abnormal Bony findings

B) Bowel pathology

C) Abnormal mesenteric findings

D) Suspicious Malignant findings of the Study

Conclusion

•Most of the non urological findings in patients who were scanned to rule out stone was related to lumbar spine, mesenteric and bowel pathologies .

•A misleading clinical history with lack of contrast enhancement play an important rule in diversion the radiologist attention.

•More than half of the cases was not optimally reported and overlooked which hinders a proper treatment and good outcome.

•Error traps need to be uncovered and highlighted , in order to prevent repetition of the same mistakes.

Objectives

• To review spectrum of abdominal complication associated with fishbone perforation utilizing abdomen CT scan.

• To discuss management and treatment options.

Background

•Fishbone is the most common accidentally ingested gastrointestinal foreign body.

•It can cause diagnostic challenges both clinically and radiologically as most patients don’t recall ingestion of the fishbone.

•In few cases, it can be seen as incidental findings on CT done for other reason.

•It can be mistaken for other inflammatory conditions or neoplastic process causing a diagnostic dilemma and unnecessaryinvestigations.

•The most common sites of perforation in :

Esophagus : cricopharyngeus muscle (C5/C6 )

Stomach : lesser curvature

Small bowel : ileum

Large bowel: rectosigmoid junction

Imaging findings OR Procedure findings

case 1

•54 y/o female presented with nonspecific abdominal pain.

•CT show 3.5 cm linear hyperdense fishbone penetrated the gastric pylorus into the hepatic fissure.

•Thrombophlebitis of the intrahepatic portal veins. No abscess or pneumoperitoneum.

Conclusion

•In most cases, the fishbone can pass through the gastrointestinal tract uneventfully.

•Perforated fishbone can be a diagnostic challenge.

•The use of CT is very helpful in elicit the cause of the patient pain, site of the fishbone perforation and associated complications.

•Radiologist need high index of suspicion especially in a high-risk patient with unexplained inflammatory abdominal changes.

Objectives

•Review uncommon benign and malignant hepatic lesions in clinical practice.

•To identify and describe the main imaging features that may aid in diagnosis.

Background

• Imaging features can overlap between benign and malignant lesion.

• MRI is more sensitive in lesion detection, multiplicity and characterizing composition (fat, hemosiderin ) with utility of diffusion weighted sequence and hepatobiliary agent that can be very useful to narrow the differential diagnosis.

• Presence of cirrhosis is significant risk factor for hepatocellular carcinoma which can be atypical and hard to diagnose in some cases.

Imaging findings OR Procedure findings

Dscussing the following:

Benign

•Intrahepatic splenosis

•Hydatid disease

•Nodular infiltrative hepatic steatosis

•Necrotic hepatic granuloma (TB)

Malignant

•Primary hepatic NET

•Primary hepatic Leiomyosarcoma

•Hepatic Angiosarcoma

•Fat-containing HCC mistaken for AML

•Exophytic HCC simulating retroperitoneal mass

•Fibrolamellar HCC

•Hemangioendothelioma

Necrotizing epithelioid granulomas

•Necrotizing granuloma is usually caused by Mycobacterium tuberculosis.

•It usually occurs in the lung.

•The extrapulmonary sites commonly include lymph node, pleura, and joints, although any organ may be involved.

•Hepatic granuloma mostly caused by Tuberculosis (TB), sarcoidosis, and hisplasmotosis

•CT: predominantly hypovascular with progressive centripetal enhancement. Liver is not cirrhotic. No capsule retraction orbiliary dilatation.

•MRI: intermediately bright on T2WI with a lobulated thick low T2 component.

•Serum quantifiron was positive =(TB).

Conclusion

•The radiologist should be familiar with variable etiologies that can cause focal hepatic lesions.

•Certain imaging features associated with relevant clinical and biochemical information can aid toward the rightdiagnosis.

•Infection (TB and hydatid), intrahepatic splenosis and infiltrative hepatic steatosis can mimic neoplasm.

• Hepatocellular carcinoma with macroscopic fat shouldn't be mistaken for angiomyolipoma especially if the hepatitis serology is positive.

Objectives

•Assess the sensitivity of the non-enhanced CT in detecting non urological pathologies.

•To identify the important non urological findings in patients presented with symptoms of renal colic and negative CT KUB for renal stone.

•How many of these findings are overlooked by radiologist and not reported.

Background

•Renal and ureteral stones are a common problem.

•Patients may present with the classic symptoms of renal colic and hematuria. Others may be asymptomatic or having vague abdominal/ flank pain and nausea.

• A non-enhanced KUB CT imaging is the modality of choice (+/- US ) to diagnosis and guide treatment in these patients.

In a retrospective study we assess all CT sacn done for renal stone over a period of 5 months in our hospital (January to May 2019).

Patients with positive KUB stone or who have urological infectious/ neoplastic findings on CT scan were excluded.

only 64 cases included in the study.

Imaging findings OR Procedure findings

A) Abnormal Bony findings

B) Bowel pathology

C) Abnormal mesenteric findings

D) Suspicious Malignant findings of the Study

Conclusion

•Most of the non urological findings in patients who were scanned to rule out stone was related to lumbar spine, mesenteric and bowel pathologies .

•A misleading clinical history with lack of contrast enhancement play an important rule in diversion the radiologist attention.

•More than half of the cases was not optimally reported and overlooked which hinders a proper treatment and good outcome.

•Error traps need to be uncovered and highlighted , in order to prevent repetition of the same mistakes.

Objectives

• To review spectrum of abdominal complication associated with fishbone perforation utilizing abdomen CT scan.

• To discuss management and treatment options.

Background

•Fishbone is the most common accidentally ingested gastrointestinal foreign body.

•It can cause diagnostic challenges both clinically and radiologically as most patients don’t recall ingestion of the fishbone.

•In few cases, it can be seen as incidental findings on CT done for other reason.

•It can be mistaken for other inflammatory conditions or neoplastic process causing a diagnostic dilemma and unnecessaryinvestigations.

•The most common sites of perforation in :

Esophagus : cricopharyngeus muscle (C5/C6 )

Stomach : lesser curvature

Small bowel : ileum

Large bowel: rectosigmoid junction

Imaging findings OR Procedure findings

case 1

•54 y/o female presented with nonspecific abdominal pain.

•CT show 3.5 cm linear hyperdense fishbone penetrated the gastric pylorus into the hepatic fissure.

•Thrombophlebitis of the intrahepatic portal veins. No abscess or pneumoperitoneum.

Conclusion

•In most cases, the fishbone can pass through the gastrointestinal tract uneventfully.

•Perforated fishbone can be a diagnostic challenge.

•The use of CT is very helpful in elicit the cause of the patient pain, site of the fishbone perforation and associated complications.

•Radiologist need high index of suspicion especially in a high-risk patient with unexplained inflammatory abdominal changes.

Objectives

•Review uncommon benign and malignant hepatic lesions in clinical practice.

•To identify and describe the main imaging features that may aid in diagnosis.

Background

• Imaging features can overlap between benign and malignant lesion.

• MRI is more sensitive in lesion detection, multiplicity and characterizing composition (fat, hemosiderin ) with utility of diffusion weighted sequence and hepatobiliary agent that can be very useful to narrow the differential diagnosis.

• Presence of cirrhosis is significant risk factor for hepatocellular carcinoma which can be atypical and hard to diagnose in some cases.

Imaging findings OR Procedure findings

Dscussing the following:

Benign

•Intrahepatic splenosis

•Hydatid disease

•Nodular infiltrative hepatic steatosis

•Necrotic hepatic granuloma (TB)

Malignant

•Primary hepatic NET

•Primary hepatic Leiomyosarcoma

•Hepatic Angiosarcoma

•Fat-containing HCC mistaken for AML

•Exophytic HCC simulating retroperitoneal mass

•Fibrolamellar HCC

•Hemangioendothelioma

Necrotizing epithelioid granulomas

•Necrotizing granuloma is usually caused by Mycobacterium tuberculosis.

•It usually occurs in the lung.

•The extrapulmonary sites commonly include lymph node, pleura, and joints, although any organ may be involved.

•Hepatic granuloma mostly caused by Tuberculosis (TB), sarcoidosis, and hisplasmotosis

•CT: predominantly hypovascular with progressive centripetal enhancement. Liver is not cirrhotic. No capsule retraction orbiliary dilatation.

•MRI: intermediately bright on T2WI with a lobulated thick low T2 component.

•Serum quantifiron was positive =(TB).

Conclusion

•The radiologist should be familiar with variable etiologies that can cause focal hepatic lesions.

•Certain imaging features associated with relevant clinical and biochemical information can aid toward the rightdiagnosis.

•Infection (TB and hydatid), intrahepatic splenosis and infiltrative hepatic steatosis can mimic neoplasm.

• Hepatocellular carcinoma with macroscopic fat shouldn't be mistaken for angiomyolipoma especially if the hepatitis serology is positive.