Radiology.Academy.Sk

Neuro Review
Appendix
Spleen
Stomach
Kidneys
Kidney
Pancreas
Pelvic congestion syndrome
Liver
Biliary
CT Abd Epiploic Appendagitis
Fractures Wrist
Wrist
Diffuse periosteal reaction
Signs in Uroradiology
Male breast
MRI Breast Indications
CT Head Cerebellar Mass
Biopsies
Diagnostic mammography
Screening mammography
Mammo Pearls
ACR Appropriateness Criteria Breast Cancer Screen
AVM types
CT Orbits
CT Abd NL
Chiari Malformations
Vesicoureteral Reflux (VUR)
Elbow
XRAY Abdominal Series

Abdomen
Cardio
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Dictation Templates
General
GU
Mammography
MSK
neuro
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Nuclear Medicine
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Bile Ducts

Runs in portal triad anterior to portal veins. Hepatic artery arises from celiac axis, travels in the hepatoduodenal ligament anterior to the portal vein and medial to the common duct → Mickey Mouse on transverse view (head = PV, ear to the patient’s left = hepatic artery, ear to the right = bile duct). Replaced R hepatic artery arises from SMA


Choledocholithiasis

Hyperechoic, sometimes shadowing, intraductal stones mostly located near the ampulla of Vater.


Intrahepatic ducts stones

Pigment stones from bacterial deconjugation of bilirubin - Recurrent pyogenic cholangitis, biliary flukes (Clonorchis sinensis, Ascaris lumbricoides)


Pneumobilia

Intrabiliary gas: brighter reflections and dirtier shadows than stones, ring-down artifact


Cholangiocarcinoma

Most common is Klatskin tumor (dilated intrahepatic ducts w/o communication)
DDx: GB cancer, HCC, Pancreatic ca, Ampullary ca.

Intraductal cholangiocarcinoma

Stricture, polypoid or diffuse sclerosing pattern; most are unresectable; US: dilated duct w/ abrupt termination


Bile duct wall thickening

Hypoechoic layer adjacent to echogenic wall.

Sclerosing cholangitis

Young men, assoc. w/ IBD especially UC, Bile duct wall thickening > 5 mm, multifocal strictures, beading in the intrahepatic ducts. Predisposition for cholangiocarcinoma, prominent nodes in the porta hepatis.
Other causes of BD wall thickening: Choledocholithiasis, AIDS (CMV or Cryptosporidium), Pancreatitis, Recurrent Pyogenic Cholangitis


Choledochal Cysts

  1. Type 1: Fusiform dilatation of the extrahepatic duct
  2. Type 2: Diverticular outpouching of the extrahepatic duct
  3. Type 3: Choledochocele
  4. Type 4: Multifocal dilatations
  5. Type 5: Caroli’s disease: multifocal saccular dilatation of the intrahepatic bile ducts with sparing of the extrahepatic ducts. Leads to hepatic fibrosis and portal HTN and variceal bleeding. Assoc. w/ medullary sponge kidneys (tubular ectasia).

Sono: cystic intrahepatic lesions w/ communication w/ bile ducts, comet tail artifacts, Central Dot Sign - dilated duct surrounds hepatic artery and PV.
DDx: Von Mayerman biliary hamartomas


Mirizzi’s Sy

Common bile duct obstruction caused by gallstone in the cystic duct or the GB neck; low inserting cystic duct; cholangiography is the gold standard