Hepatobiliary & Genitourinary Spring 2013 RT 91 PATHOLOGY 1.

Hepatobiliary & Genitourinary

Spring 2013

RT 91 PATHOLOGY

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Hepatobiliary System

• Comprised of:

– Liver– Gallbladder– Biliary tree

• Pancreas shares a portion of the biliary ductal system

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Biliary System

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Biliary Tree

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Hepatobiliary

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Inflammatory Diseases

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Cirrhosis1. CT is modality of choice

1. Shrunken liver & ascites

2. X-ray not useful

3. US also used1. Demonstrates

enlargement of spleen and liver

2. Biopsies done under US

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Cirrhosis1. Chronic liver

condition liver parenchyma is destroyed & fibrous tissue is laid down1. Regenerative

nodules are formed

2. Results from alcoholism, drug abuse, autoimmune disorders, metabolic & genetic disease, hepatitis, heart problems, biliary obstruction 8

Cholelithiasis1. Most commonly

demonstrated with US

2. Most calculi are radiolucent1. 20% are calcified

enough to see on x-rays

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Cholelithiasis1. Greater incidence in people who are:

1. diabetic

2. obese

3. elderly

4. have a diet high in fats sugar and salt

5. low in fiber

2. Symptoms1. Bloating, nausea,

RUQ pain

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Cholecystitis1. Acute inflammation of the gallbladder

2. Sudden onset of pain, fever, nausea & vomiting

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Cholecystitis1. Stones may be

visible on 1. CT

2. plain films

3. US

2. X-rays appear as radiopaque stones

1. Have thickened walls surrounding gallbladder

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Pancreatitis1. Primary Modalities:

1. CT and US

2. Secondary:1. Endoscopy & MRI

3. CT demonstrates an enlargement of the gland

4. Pancreas has a shaggy irregular contour

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Pancreatitis1. Inflammation of

pancreas

2. Causes include:1. alcoholism

2. obstruction of ampulla of vater by gallstone or tumor

3. Can be chronic or acute1. Chronic causes

irreversible change to the pancreatic function

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Neoplastic Diseases

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Hemangioma1. Increased echogenicity

may be demonstrated in US

2. US can assess shape and size of tumor

3. NM using labeled blood cells that are attracted to the tumor

4. CT & MRI with contrast demonstrates peripheral enhancement

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Hemangioma

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Most common tumor of the liver

Well circumscribed

CAN range from microscopic to 20 cm

More common in women than men

It is a benign neoplasm

Metastatic Liver Disease1. US is most

commonly used to screen

2. CT & MRI all accurate diagnosis

3. Liver biopsy under US provides definitive diagnosis

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Metastatic Liver Disease

1. Much more common than primary carcinoma of the liver

2. It is a common site for metastases from primary sites1. Colon2. Pancreas3. Stomach4. Lung5. breast

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Pancreatic Cancer

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CT is the best method of imaging the pancreas

Sonography is used to evaluate the biliary tree

Pancreatic Cancer

1. 5th leading cause of cancer death in the U.S.

2. Prognosis is poor1. 2% survival rate

3. Signs & symptoms are nonspecific

4. Tumor is well advanced when diagnosis is made

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Carcinoma of Renal Cells

1. US reveals as a solid mass

2. CT is the most accurate for diagnosis & regional spread1. 10% have calcifications

3. MRI allows demonstration of renal anatomy & approaches accuracy of CT1. More definitive than CT if

contrast enhancement cannot be used

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MISC pathologies ofHepatobiliary System

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Biliary Stenosis

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Genitourinary System

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Urinary System

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Benign Prostatic Hyperplasia

1. Enlargement can be demonstrated on an intravenous urographic exam as a filling defect at the base of the bladder

2. CT and MRI can also identify pathology

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Benign Prostatic Hyperplasia

1. Most common benign enlargement

2. Can be diagnosed with rectal exam & PSA levels

3. Generally affects men over 50

4. Symptoms1. Difficulty starting,

stopping, & maintaining urine flow

5. Can cause urinary obstruction & UTI’s

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Congenital Anomaly

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Renal Agenesis

1. Congenital anomaly

2. Absence of one kidney & opposite kidney is enlarged

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Hypoplasia1. A underdeveloped

kidney that is smaller in size but works normally

2. Often other kidney is larger to compensate

3. Significance of this anomaly depends on the volume of functioning

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Horseshoe Kidney

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Most common fusion anomaly

Lower poles of kidney are joined

Causes a rotation anomaly on one or both sides

Kidney function is generally unimpaired

If obstruction is present surgery may be required

Horseshoe Kidney

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Kidney Malrotation

1. Incomplete or excessive rotation of the kidneys

2. No clinical significance unless it causes an obstruction

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Kidney Malrotation

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Pelvic or Ectopic Kidney

1. Kidney or kidneys are lower than normal, often in pelvic region

2. Most asymptomatic but there is an increased incidence of ureteropelvic junction obstruction

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Pelvic or Ectopic Kidney

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Double Collecting System

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Double Collecting System

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Ureterocele

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Cyst like dilatation of a ureter near its opening into the bladder

X-ray demonstrates a filling defect of the bladder

US demonstrates a cyst

Urteterocele

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Bladder Diverticula

• Con occur congenitally or caused by chronic bladder obstruction and infection

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Polycystic Kidney

1. US demonstrates renal & hepatic cysts

2. IVU show bilateral enlargement of the kidneys, calyceal stretching & distortion (poorly visualized outlines)

3. CT demonstrates a moth eaten appearance

4. CT & US can detect before conventional x-rays

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Polycystic Kidney1. Congenital disease2. Cysts enlarge as pt

ages

3. Enlargement destroys normal tissues

4. It is the cause of 10% of end-stage renal disease

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Inflammatory Diseases

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Pyelonephritis1. Can be

demonstrated on a CT and US

2. IVU will often look normal in a acute attack

3. Interstitial edema causes less visualization of collecting structures

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Pyelonephritis1. Bacterial infection of the calyces and renal pelvis

2. Stagnation or obstruction of urine flow causes an infection

3. People with recurrent UTI’s have more of a chance of getting this

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Cystitis

1. Inflammation and congestion of the bladder mucosa

2. Cystography may demonstrate backflow of bladder into ureters

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Urinary System Calcifications

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Staghorn Calculus1. LG calculus that

assumes shape of pelvicaliceal junction

2. Most visible on x-ray, IVU or retrograde pyelogram

3. CT’s bone study is the modality of choice

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Staghorn Calculus

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Ureter Stone

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Bladder Stones

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Bladder Calculi

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Renal Stones

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Renal Stone

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Degenerative Diseases

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Hydronephrosis

1. IVU is largely replaced by CT

2. CT allows diagnosis 90% of the time

3. US is initial modality of choice because it does not require contrast 58

Neoplastic Diseases

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Wilms Tumor

•Malignant renal tumor

•1 in every 13,500 births

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Tumor (Wilm’s)

1. CT is modality of choice to assessing extent & spread of tumor1. Largely replaced IVU

2. US differentiates between cystic and solid masses

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Carcinoma of the Bladder

1. IVU or cystogram may demonstrate filling defect of bladder

2. Cystoscopy is method of choice1. Diagnosis is made via

biopsy or resection

3. US, MRI & CT stage the disease once diagnosis is made

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Carcinoma of the Bladder

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Ureter Stenosis

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Ureteral Stent

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Renal Stent

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Vesicoureteral Reflux

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Vesicoureteral Reflux

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