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Gastrointestinal Imaging Highlights
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Esophagus - Normal Anatomy
Continuous luminal structure, wall thickness <3mm on CT, mucosal folds visible on barium swallow.
Esophageal Varices
Serpiginous enhancing structures within esophageal wall on contrast-enhanced CT, distended veins on barium swallow, may see red wale marks on endoscopy.
Achalasia
Dilated esophagus with air-fluid levels, 'bird-beak' tapering on barium swallow, absent peristalsis on manometry.
Gastroesophageal Reflux Disease (GERD)
Thickened esophageal folds, mucosal hyperenhancement, hiatal hernia may co-exist on imaging studies.
Stomach - Normal Anatomy
Rugae visible on barium studies with distention, gastric wall thickness <5mm on CT when distended, enhancement pattern uniform.
Gastric Ulcer
Mucosal defect with barium pooling, CT may show wall thickening or edema, enhancement of ulcer margins.
Gastric Cancer
Irregular or nodular gastric wall thickening, linitis plastica appearance with diffuse wall thickening, enhancing mass may be present.
Peptic Ulcer Disease
Radiolucent area with halo of edema on barium swallow, thickened gastric folds on endoscopy, penetration into adjacent organs on CT.
Small Bowel - Normal Anatomy
Valvulae conniventes extend across the entire lumen, wall thickness <3mm on CT, uniform enhancement on CT with contrast.
Small Bowel Obstruction
Dilated loops of bowel with air-fluid levels, 'string of pearls' sign due to trapped gas, transition point seen on CT.
Crohn's Disease
'String sign' on barium studies, 'cobblestone' mucosal pattern, skip lesions with asymmetric bowel wall thickening and enhancement.
Intussusception
'Target sign' or 'donut sign' on US and CT, telescoping of the bowel segments visualized, lead point may be identified.
Celiac Disease
Dilatation of small bowel loops, 'stack of coins' or 'accordion sign' due to thickened folds, decreased mucosal enhancement.
Colon - Normal Anatomy
Haustral fold pattern, mean diameter <6cm for the cecum and <3cm for the sigmoid, wall thickness <5mm on CT when distended.
Colon Cancer
Apple-core lesion on barium enema, asymmetric wall thickening with shouldering, mass effect or obstruction on CT.
Diverticular Disease
Outpouchings of colonic wall on CT or barium enemas, thickening of adjacent colonic wall, inflammation may lead to 'fat stranding' on CT.
Inflammatory Bowel Disease - Ulcerative Colitis
Continuous colonic mucosal abnormality, 'lead pipe' sign on barium enema, loss of haustral pattern on imaging.
Appendicitis
Dilated appendix >6mm, peri-appendiceal fat stranding, presence of an appendicolith on CT.
Volvulus
'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.
Hernia
Presence of bowel loops or omentum within hernial sac, disruption of the abdominal wall, associated with fat stranding if strangulated.
Ischemic Bowel
Bowel wall thickening and hypoenhancement, pneumatosis (air within the bowel wall), portal venous gas on imaging.
Gastrointestinal Stromal Tumor (GIST)
Enhancing, exophytic soft tissue mass, can present with central ulceration or necrosis, usually well-circumscribed.
Liver Metastases
Hypodense lesions on CT during portal venous phase, 'target' sign on MRI with contrast, may present with elevated liver enzymes.
Hemangioma
Hyperechoic on US, peripheral nodular enhancement with centripetal fill-in on CT, high T2 signal on MRI.
Hepatocellular Carcinoma (HCC)
Arterial phase hyperenhancement with washout in venous phase, capsule appearance on contrast-enhanced studies, may see vascular invasion.
Cholelithiasis (Gallstones)
Echogenic foci within the gallbladder with posterior shadowing on US, may see calcified gallstones on CT, cholesterol stones often invisible on CT.
Cholecystitis
Gallbladder wall thickening >3mm, pericholecystic fluid, Murphy's sign elicitable on ultrasound.
Pancreatitis
Diffuse or focal enlargement of the pancreas, decreased attenuation on CT, peripancreatic fluid collections.
Pancreatic Adenocarcinoma
Hypoattenuating mass in the pancreas, dilatation of the pancreatic duct (double duct sign), atrophy of distal pancreas.
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