Notes from Friday Live Stream with Vikas Shah on Abdominal CT Pitfalls

Jul 30, 2024

Notes from Friday Live Stream with Vikas Shah

Introduction by Sally Ayessa

  • Host: Sally Ayessa
  • Event: Free Friday live stream; also available to watch on replay on YouTube.
  • Conference: Radiopedia 2024, upcoming virtual conference in July.
    • Access to conference included with an all-access pass.
    • Free access for individuals from 125 low and middle-income countries.
    • Tiered and concession rates for ticket purchases available.
  • New Content for 2024:
    • Anatomy review sets explaining key imaging anatomy concepts.
    • On-call case sets covering important findings in emergency situations.

Lecture Introduction by Vikas Shah

  • Speaker: Vikas Shah, abdominal radiologist from the UK, known as "The X-Ray Doctor".
  • Topic: Top 10 pitfalls in abdominal CT.

Top 10 Pitfalls in Abdominal CT by Vikas Shah

1. Gastric Diverticula

  • Common Mistake: Mistaken for left adrenal lesions, especially when fluid-filled.
  • Imaging: Can be seen on Barium studies, MRI, and CT.
    • Look for gas and fluid levels in diverticulum.
    • Utilize multi-planar reformats for better identification.

2. Zebra Pattern of Splenic Enhancement

  • Appearance: Stripey pattern on arterial phase studies due to different enhancement of red and white pulp.
  • Key Point: Recognize normal enhancement vs. disease processes like splenic infarction or laceration.

3. Hepatic Pseudo-lesion

  • Cause: Seen in cases of superior vena cava obstruction; may mimic true lesions.
  • Imaging: Look for patterns of enhancement and collateral blood flow signs.

4. Focal Hepatic Steatosis

  • Differentiation: Can resemble mass lesions but has distinct imaging characteristics.
  • Technique: Utilize in-phase and opposed-phase MRI images for confirmation.

5. Renal Parapelvic Cysts

  • Confusion with: Hydronephrosis.
  • Diagnosis: Delayed phase imaging helpful; no cortical thinning in true pelvis expansion indicates parapelvic cysts.

6. Submucosal Fat in Bowel

  • Association: Sometimes seen in patients without inflammatory bowel disease.
  • Key Differential: Distinguish submucosal fat from edema to avoid unnecessary investigations.

7. Venous Pseudothrombus

  • Importance: Understanding phases of enhancement can prevent misdiagnosis.
  • Clues: Swirling appearance and lack of expansion in adjacent organs suggest pseudothrombus, not true thrombus.

8. Surgical Hemostatic Material

  • Identification: Can resemble an abscess; look for gas bubbles and reports from the surgical team about materials used.
  • Key Features: No rim enhancement typical of abscesses; geometric shapes of hemostatic material.

9. Peritoneal Tuberculosis vs. Ovarian Malignancy

  • Diagnostic Challenge: Similar imaging findings; requires clinical context to differentiate.
  • Signs: Ascites and nodular thickening in peritoneum or omentum.

10. Splenosis

  • Definition: Auto-implanted splenic tissue post-surgery or trauma, may confuse for metastases.
  • Key Differentiation: Blood supply from other arteries, not splenic artery; utilize technetium scans for confirmation.

Conclusion by Vikas Shah

  • Key takeaways from the lecture were highlighted, improving preparedness for interpreting abdominal CTs.
  • Reminder: Registration for Radiopedia 2024 is open for all interested individuals.
  • Next Stream: Look forward to the next Friday live stream in a few weeks.

Full transcript