Various Appearance of Portal Hypertension ~ To be continued

Spenoadrenorenal shunt

MRI feature of white matter disease

Brain atrophy
Involved symmetericity
Myelin abnormality
Brainstem & cerebellar involvement
Contrast enhancement
Malformation
Dynamic imaging pattern

Pseudomyxoma peritonei

Ruptured mucocele with foreign body peritonitis
Male: cystadenocarcinoma of appendix
Female: cystadenocarcinoma of ovary

*Thickening of peritoneal + omental sufaces
*Omental cake
*Posterior fixation of bowel loops and mesentery
*Voluminous septated/loculated pseudoascites
*Several thin-walled cystic masses of different size throughout abdominal cavity
*Scalloped contour of liver and splenic margins
Annular / semicircular calcifications

GIST

Esophageal GIST

Gastric GIST

Hiatal hernia

Sliding hernia (axial type): 95%
- GEJ is aboe the diaphragm
- Reflux is more likely with larger hernias
- May be reducible in erect position
Paraesophageal hernia
- GEJ is in its normal position
- Part of the fundus is herniated above the diaphragm through esophageal hiatus and lies to the side of the esophagus
- Not reflux
- More prone to mechanical complications
- Usually nonreducible

*Gastric folds aboe diaphragm
*B line above diaphragm
*Schatzki's ring above diaphragm

%Esophagitis
%Duodenal ulcers

Gastric Volvulus

Gastric volvulus
- Mesenteroaxial type: from lesser to greater curve
- Organoaxial type: from cardia to pylorus
Cause
- Diaphragmatic defect
- Intestinal malrotation
- Wandering spleen
-Absence of gastrophrenic ligament and gastrosplenic ligament
Resolve spontaneously sometimes.

*Organoaxial vovulus*

Complication of subtotal gastrectomy

Esophageal Symptoms

Delayed Gastric Emptying

Recurrent Ulcers

Carcinoma

Afferent Loop Syndrome

Diarrhea

Weight Loss and Malabsorption

Anemia

Cholelithiasis

Dumping syndrome : early and late

Pharynx, anatomy and disease

Lateral pharyngeal pouch: At the level of valleculae
Superior - hyoid bone, middle constrictor muscle
Posterior - stylopharyngeus muscle, superior cornu of the thyroid cartilage
Anterior - thyrohyoid muscle and membrane
5% aspiration
Lateral pharyngeal diverticula: from tonsillar fossa or region of the thyrohyoid membrane
Persistent pouches or saccular collections of the region of the thyrohyoid membrane
Zenker's Diverticulum
Killian-Jamieson Pouches and Diverticula
Webs
Inflammatory disorder
Benign tumor
Malignant tumor

Von Hippel-Lindau Disorder

•Autosomal dominant disorder (Chroosome 3) with 1/35000-1/40000 incidence in America
•Most attacked in 2nd to 3rd decades
•M:F is about 1:1
Diagnostic Criteria
•> 1 hemangioblastoma of CNS
•1 hemangioblastoma + visceral manifestation
•1 manifestation + family history

Subclassification by NIH

•Type I: Renal + pancreatic cysts, high risk for RCC, no pheochromocytoma
•Type IIA: Pheochromocytoma, pancreatic islet cell tumor
•Type IIB: Pheochromocytoma + renal + pancreatic disease

Angiomatous lesions

- Retinal hemangioblastomas -> Von Hippel tumor
- CNS hemangioblastomas -> Lindau tumor
- Endolymphatic sac tumors
- Renal cell carcinoma - Pancreatic cysts and tumors
- Pheochromocytomas
- Epididymal cystadenomas

Groove pancreatitis

a form of segmental pancreatitis affecting the head of the pancreas, is localized within the "groove" between pancreas head, duodenum, and common bile duct. Differentiation between groove pancreatitis and pancreatic head carcinoma is often difficult.

Impact of protein plug over Santorini's duct may be the cause of groove pancreatitis

Image: a mass was detected in the head of the pancreas that involved the duodenum. Dynamic CT demonstrated a poorly enhancing lesion extending between the pancreatic head and the duodenum.

Squamous cell carcinoma

30% of lung cancer
Related to smoking
65% found in main, lobar, or segmental bronchi
Endobronchial mass
Bronchial obstruction
Infiltration of bronchial wall
Local invasion
Hilar mass
Atelectasis and consolidation common
30% solitary nodule or mass
Central necrosis and cavitation relatively common
Metastasis late
Relatively good prognosis

Right middle lobe syndrome

Most in child
Chronic inflammation
Congential heart disease
Asthma
Cystic fibrosis
Bronchopulmonary dysplasia
Obstructive lesion

Cause repeated pneumonia

Atelectasis

cause: tumor (most SCC), TB, sarcoidosis, Post operative atelectasis. Large left atrium.
Types:
Resorption - Obstruction
Relaxation - Passive, Pleural effusion, pneumothroax
Adhesive - ARDS (decrease in surfatant production)
Cicatricial - Lung fibrosis
ex. right middle lobe syndrome
Discoid atelectasis: Emoblus, Penumonia, Inadequate inspiration Carcinoma
Segmental atelectasis
Sign
Double lesion sign - RUL and RML collapse
Shifting granuloma sign
Golden's S sign - RUL
Juxtaphrenic peak - UL
Luftsichel sign - LUL - Apical cap
Falt waist sign - LLL
Comet-tail sign - Rounded
Rounded atelectasis - Posterior lower lobe. often free pleural effusion with inflammation