1. Hepatobiliary & Genitourinary
Spring 2013
RT 91 PATHOLOGY

2. Hepatobiliary System Comprised of: Liver Gallbladder Biliary tree
Pancreas shares a portion of the biliary ductal system

3. Biliary System

4. Biliary Tree

5. Hepatobiliary

6. Inflammatory Diseases

7. Cirrhosis CT is modality of choice X-ray not useful US also used
Shrunken liver & ascites
X-ray not useful
US also used
Demonstrates enlargement of spleen and liver
Biopsies done under US
Cirrhosis

8. Cirrhosis
Chronic liver condition liver parenchyma is destroyed & fibrous tissue is laid down
Regenerative nodules are formed
Results from alcoholism, drug abuse, autoimmune disorders, metabolic & genetic disease, hepatitis, heart problems, biliary obstruction

9. Cholelithiasis Most commonly demonstrated with US
Most calculi are radiolucent
20% are calcified enough to see on x-rays
Cholelithiasis

10. Cholelithiasis Symptoms Greater incidence in people who are: diabetic
obese
elderly
have a diet high in fats sugar and salt
low in fiber
Symptoms
Bloating, nausea, RUQ pain
Cholelithiasis
Women more likely than men to get it

11. Cholecystitis Acute inflammation of the gallbladder
Sudden onset of pain, fever, nausea & vomiting

12. Cholecystitis Stones may be visible onCT
plain films US
X-rays appear as radiopaque stones
Have thickened walls surrounding gallbladder
Cholecystitis

13. Pancreatitis Secondary: Primary Modalities: Endoscopy & MRI
CT and US
Secondary:
Endoscopy & MRI
CT demonstrates an enlargement of the gland
Pancreas has a shaggy irregular contour
Pancreatitis

14. Pancreatitis Inflammation of pancreas Causes include:
alcoholism
obstruction of ampulla of vater by gallstone or tumor
Can be chronic or acute
Chronic causes irreversible change to the pancreatic function
Pancreatitis

15. Neoplastic Diseases

16. Hemangioma Increased echogenicity may be demonstrated in US
US can assess shape and size of tumor
NM using labeled blood cells that are attracted to the tumor
CT & MRI with contrast demonstrates peripheral enhancement
Hemangioma

17. Hemangioma 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

18. Metastatic Liver Disease
US is most commonly used to screen
CT & MRI all accurate diagnosis
Liver biopsy under US provides definitive diagnosis

19. Metastatic Liver Disease
Much more common than primary carcinoma of the liver
It is a common site for metastases from primary sites
Colon
Pancreas
Stomach
Lung
breast

20. Pancreatic Cancer CT is the best method of imaging the pancreas
Sonography is used to evaluate the biliary tree

21. Pancreatic Cancer 5th leading cause of cancer death in the U.S.
Prognosis is poor
2% survival rate
Signs & symptoms are nonspecific
Tumor is well advanced when diagnosis is made
Pancreatic Cancer

22. Carcinoma of Renal Cells
US reveals as a solid mass
CT is the most accurate for diagnosis & regional spread
10% have calcifications
MRI allows demonstration of renal anatomy & approaches accuracy of CT
More definitive than CT if contrast enhancement cannot be used
Carcinoma of Renal Cells

23. MISC pathologies of Hepatobiliary System

24. Biliary Stenosis

25. Genitourinary System

26. Urinary System

27. Benign Prostatic Hyperplasia
Enlargement can be demonstrated on an intravenous urographic exam as a filling defect at the base of the bladder
CT and MRI can also identify pathology
Benign Prostatic Hyperplasia

28. Benign Prostatic Hyperplasia
Most common benign enlargement
Can be diagnosed with rectal exam & PSA levels
Generally affects men over 50
Symptoms
Difficulty starting, stopping, & maintaining urine flow
Can cause urinary obstruction & UTI’s

29. Congenital Anomaly

30. Renal Agenesis Congenital anomaly
Absence of one kidney & opposite kidney is enlarged

31. A underdeveloped kidney that is smaller in size but works normally
Often other kidney is larger to compensate
Significance of this anomaly depends on the volume of functioning
Hypoplasia

32. Horseshoe Kidney Kidney function is generally unimpaired
If obstruction is present surgery
may be required
Most common fusion anomaly
Lower poles of kidney are joined
Causes a rotation anomaly on
one or both sides

33. Horseshoe Kidney

34. Kidney Malrotation Incomplete or excessive rotation of the kidneys
No clinical significance unless it causes an obstruction

35. Kidney Malrotation

36. Pelvic or Ectopic Kidney
Kidney or kidneys are lower than normal, often in pelvic region
Most asymptomatic but there is an increased incidence of ureteropelvic junction obstruction

37. Pelvic or Ectopic Kidney

38. Double Collecting System

39. Double Collecting System

40. Ureterocele 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

41. Urteterocele

42. Bladder Diverticula
Con occur congenitally or caused by chronic bladder obstruction and infection

43. Polycystic Kidney US demonstrates renal & hepatic cysts
IVU show bilateral enlargement of the kidneys, calyceal stretching & distortion (poorly visualized outlines)
CT demonstrates a moth eaten appearance
CT & US can detect before conventional x-rays
Polycystic Kidney

44. Polycystic Kidney Congenital disease Cysts enlarge as pt ages
Enlargement destroys normal tissues
It is the cause of 10% of end-stage renal disease
Polycystic Kidney

45. Inflammatory Diseases

46. Pyelonephritis Can be demonstrated on a CT and US
IVU will often look normal in a acute attack
Interstitial edema causes less visualization of collecting structures
Pyelonephritis

47. Pyelonephritis Bacterial infection of the calyces and renal pelvis
Stagnation or obstruction of urine flow causes an infection
People with recurrent UTI’s have more of a chance of getting this

48. Cystitis Inflammation and congestion of the bladder mucosa
Cystography may demonstrate backflow of bladder into ureters

49. Urinary System Calcifications

50. LG calculus that assumes shape of pelvicaliceal junction
Most visible on x-ray, IVU or retrograde pyelogram
CT’s bone study is the modality of choice
Staghorn Calculus

51. Staghorn Calculus

52. Ureter Stone

53. Bladder Stones

54. Bladder Calculi

55. Renal Stones

56. Renal Stone

57. Degenerative Diseases

58. Hydronephrosis IVU is largely replaced by CT
CT allows diagnosis 90% of the time
US is initial modality of choice because it does not require contrast
Obstructive disorder that causes dilitation of the pelvix and calyces with urine.
Most common cause is a stone, but it can be congenital, from a tumor, stricture blood clot or inflammation.

59. Neoplastic Diseases

60. Malignant renal tumor 1 in every 13,500 births
Wilms Tumor
Malignant renal tumor
1 in every 13,500 births

61. Tumor (Wilm’s)
CT is modality of choice to assessing extent & spread of tumor
Largely replaced IVU
US differentiates between cystic and solid masses

62. Carcinoma of the Bladder
IVU or cystogram may demonstrate filling defect of bladder
Cystoscopy is method of choice
Diagnosis is made via biopsy or resection
US, MRI & CT stage the disease once diagnosis is made

63. Carcinoma of the Bladder

64. Ureter Stenosis

65. Ureteral Stent

66. Renal Stent

67. Vesicoureteral Reflux

68. Vesicoureteral Reflux