G.I. Radiology Potpourri Mark Feldman, MD

Ovarian teratomas. A form of germ cell tumor Immature Mature, solid Mature, cystic –may containing sebum, hair, teeth(1/3)- also bones; parts of intestine, eyes, or homunculi –malignant transformation in < 2% Monodermal, highly specialized –struma ovarii,carcinoids,gastrinomas,ACTH,...

Achalasia Incomplete relaxation of the LES Normal or elevated resting LES pressure Aperistalsis in the esophageal body if rapid weight loss, short history ( 60) consider secondary or pseudo-achalasia

Diffuse esophageal spasm Non-cardiac chest pain Dysphagia or odynophagia Condition may be asymptomatic On motility tracings, spontaneous and simultaneous (tertiary) contractions are present and are often high amplitude

Dysphagia lusoria Aberrant right subclavian artery which indents and compresses esophageal wall at T4, usually from behind but in 1 in 5 cases from in front, as it courses from the descending aortic arch toward the right shoulder Anomaly is present in 0.7% of population and thus is usually asymptomatic Conservative therapy; surgery rarely used

CT showing appendicolith (open arrow) associated with an adjacent inflammatory mass (closed arrow)

SMA Syndrome Associated with rapid weight loss and more acute angle between aorta and SMA as it crosses over the duodenum just to the right of the spine (e.g., anorexia nervosa) Body casts, prolonged best rest, rapid growth in kids Treatment is weight gain, removal of cast or rarely a duodenojejunosomy

Somatostatinoma Rare usually malignant (>70%) endocrine tumor of the pancreas or duodenum Most common findings are diarrhea, gall bladder disease, weight loss, hyperglycemia, steatorrhea

Secondary Syphilis (Spirochetemia) Headache Malaise Fatigue Myalgias Rash –nearly pathognomonic –alopecia Lymphadenopathy –epitrochlear classic Mucous patches –mouth, nares, genitals Condylomata lata Osteitis Arthritis/bursitis Hepatitis Nephrosis/GMN Uveitis GASTRITISGASTRITIS

Adult Hypertrophic Pyloric Stenosis Idiopathic (i.e., no PUD or Ca on EGD) Very rare Male to female 4:1 Often family history of infantile form Symptoms similar to infantile form –nausea, mild vomiting, postprandial epigastric pain Diagnosis: upper GI or ultrasonography Rx: surgery with resection if symptomatic