경희대학교 의과대학·의학전문대학원

Radiologic Dx of GI Tract

Dong Ho LEE, M.D.

Department of Diagnostic

Radiology

Kyung Hee University Medical

Center

• Simple abdomen

• Barium study

• US

• CT

• MRI

Simple abdomen view

SB obstruction Pneumoperitoneu m

Esophageal cancer

• Squamous cell carcinoma

• Type

Esophageal cancer

• Staging

Esophageal leiomyoma

• Most common benign tumor

• Location

– Distal third 60% – Middle third 30% – Proximal third 10%

• Sharply outlined, discrete intraluminal

mass

• Right or obtuse angle with esophageal

wall

Reflux esophagitis

• Decreased lower esophageal

sphincter pressure

• Gastroesophageal reflux

• Radiologic findings

– Abnormal motility

– Mucosal nodularity

– Ulceration

– Thickened fold

Barrett esophagus

• Long-standing GE reflux and reflux

esophagitis

• Progressive columnar metaplasia of

distal esophagus

• Radiologic findings

– Midesophageal stricture

– High ulcer

– Sliding hiatal hernia

– GE reflux

Barrett esophagus

Benign gastric ulcer

Ulcer crater

Benign gastric ulcer

• Converging mucosal fold toward

ulcer

• Profile view

– Hampton’s line

– Ulcer collar

– Ulcer mound

EGC

EGC IIa

AGC

AGC

DDx of benign & malignant

ulcer

Benign Malignant Ulcer edge regular, round irregular

Depth deep,

penetrating shallow Site lesser curvature anywhere Radiating fold spokelike obliterated Profile view Hampton’s line

ulcer collar ulcer mound

Carman’s meniscus

Gastric submucosal tumor

• Benign GIST

• Malignant GIST

• Lymphoma

GIST

Benign Malignan

Duodenal ulcer

• Benign

Intestinal tuberculosis

• Inflammatory disease of terminal ileum

and colon by Mycobacterium tuberculosis

• Radiologic findings

– Fold thickening

– Transverse ulcer

– Inflammatory spasm

– Accelerated transit time

– Cecal retraction

– Shortening of A-colon

– Stricture

Intestinal tuberculosis

Cecal retraction _{Transverse ulcer}

A-colon shortening Symmetric involvement

Crohn’s disease

• Crohn(1932)

• Inflammatory disease

of terminal ileum

with insidious onset,

weakness, fever and

non-bloody diarrhea,

distinguished from

intestinal

Crohn’s disease

Crohn’s disease

Deep ulcer _Fissure

Crohn’s disease

Fistula Skip lesion

Multiple

involvement

Important findings of Crohn’s

disease

• Aphthous ulcer

• Segmental involvement

• Skip lesion

• Deep,

longitudinal ulcer

• Asymmetric

involvement

• Cobblestone

CT enterography of Crohn’s

disease

Ulcerative colitis

• Wilks(1859)

• Inflammation of colon

affected by discharge

of mucus and blood

• After death, whole

internal surface

presented vascular,

soft, red surface with

mucus

Ulcerative colitis

• Radiologic findings

– Mucosal granule

– Crypt abscess

– Collar button ulcer

– Loss of haustration

– Inflammatory pseudopolyp

– Continuous involvement

Ulcerative colitis

Crypt

Ischemic colitis

• Occlusion of mesenteric vessel

• Thumb-printing appearance by

submucosal hematoma

Acute appendicitis

• Radiologic findings

– Localized paralytic ileus in RLQ – Cecal spasm or fluid level

– Blurring of Rt. properitoneal fat line

– Indistinctness of Rt. psoas shadow

– Scoliosis and concavity to Rt. side

Acute appendicitis

• US and CT findings

Acute appendicitis

Colonic diverticulosis

• Herniation of mucosa (submucosa)

through muscle layer

• False diverticulum

Colonic diverticulitis

• Associated inflammation with

diverticuli

• Inflammatory spasm

• Wall Thickening

Colonic polyp

• Adenoma

• Located at rectum &

S-colon

• Sessile or

Malignant polyp

• Size over 1-1.5 cm

• Irregular surface

• Base indentation

• Short, thick pedicle

• Rapid growth

Colon cancer

Infiltration Mass Apple core appearanc e

Colon cancer

Rectal cancer

Rectal cancer

• Staging