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Gastrointestinal Imaging Highlights

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Gastroesophageal Reflux Disease (GERD)

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Thickened esophageal folds, mucosal hyperenhancement, hiatal hernia may co-exist on imaging studies.

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Volvulus

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'Bird’s beak' sign on barium enema at the site of torsion, 'whirl sign' of twisted mesentery on CT, distended loop of bowel with air-fluid levels.

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Cholelithiasis (Gallstones)

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Echogenic foci within the gallbladder with posterior shadowing on US, may see calcified gallstones on CT, cholesterol stones often invisible on CT.

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Liver Metastases

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Hypodense lesions on CT during portal venous phase, 'target' sign on MRI with contrast, may present with elevated liver enzymes.

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Small Bowel - Normal Anatomy

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Valvulae conniventes extend across the entire lumen, wall thickness <3mm on CT, uniform enhancement on CT with contrast.

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Diverticular Disease

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Outpouchings of colonic wall on CT or barium enemas, thickening of adjacent colonic wall, inflammation may lead to 'fat stranding' on CT.

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Hemangioma

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Hyperechoic on US, peripheral nodular enhancement with centripetal fill-in on CT, high T2 signal on MRI.

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Esophagus - Normal Anatomy

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Continuous luminal structure, wall thickness <3mm on CT, mucosal folds visible on barium swallow.

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Crohn's Disease

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'String sign' on barium studies, 'cobblestone' mucosal pattern, skip lesions with asymmetric bowel wall thickening and enhancement.

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Esophageal Varices

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Serpiginous enhancing structures within esophageal wall on contrast-enhanced CT, distended veins on barium swallow, may see red wale marks on endoscopy.

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Gastric Cancer

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Irregular or nodular gastric wall thickening, linitis plastica appearance with diffuse wall thickening, enhancing mass may be present.

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Pancreatitis

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Diffuse or focal enlargement of the pancreas, decreased attenuation on CT, peripancreatic fluid collections.

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Celiac Disease

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Dilatation of small bowel loops, 'stack of coins' or 'accordion sign' due to thickened folds, decreased mucosal enhancement.

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Colon Cancer

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Apple-core lesion on barium enema, asymmetric wall thickening with shouldering, mass effect or obstruction on CT.

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Small Bowel Obstruction

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Dilated loops of bowel with air-fluid levels, 'string of pearls' sign due to trapped gas, transition point seen on CT.

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Hepatocellular Carcinoma (HCC)

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Arterial phase hyperenhancement with washout in venous phase, capsule appearance on contrast-enhanced studies, may see vascular invasion.

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Gastric Ulcer

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Mucosal defect with barium pooling, CT may show wall thickening or edema, enhancement of ulcer margins.

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Cholecystitis

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Gallbladder wall thickening >3mm, pericholecystic fluid, Murphy's sign elicitable on ultrasound.

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Appendicitis

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Dilated appendix >6mm, peri-appendiceal fat stranding, presence of an appendicolith on CT.

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Pancreatic Adenocarcinoma

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Hypoattenuating mass in the pancreas, dilatation of the pancreatic duct (double duct sign), atrophy of distal pancreas.

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Inflammatory Bowel Disease - Ulcerative Colitis

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Continuous colonic mucosal abnormality, 'lead pipe' sign on barium enema, loss of haustral pattern on imaging.

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Hernia

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Presence of bowel loops or omentum within hernial sac, disruption of the abdominal wall, associated with fat stranding if strangulated.

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Colon - Normal Anatomy

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Haustral fold pattern, mean diameter <6cm for the cecum and <3cm for the sigmoid, wall thickness <5mm on CT when distended.

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Intussusception

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'Target sign' or 'donut sign' on US and CT, telescoping of the bowel segments visualized, lead point may be identified.

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Ischemic Bowel

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Bowel wall thickening and hypoenhancement, pneumatosis (air within the bowel wall), portal venous gas on imaging.

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Gastrointestinal Stromal Tumor (GIST)

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Enhancing, exophytic soft tissue mass, can present with central ulceration or necrosis, usually well-circumscribed.

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Achalasia

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Dilated esophagus with air-fluid levels, 'bird-beak' tapering on barium swallow, absent peristalsis on manometry.

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Stomach - Normal Anatomy

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Rugae visible on barium studies with distention, gastric wall thickness <5mm on CT when distended, enhancement pattern uniform.

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Peptic Ulcer Disease

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Radiolucent area with halo of edema on barium swallow, thickened gastric folds on endoscopy, penetration into adjacent organs on CT.

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