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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_770_Библиотеки_им_академика_М_И_Перельмана
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J. H. Bortz et al.
Question 14
Describe the appearances in Fig.28.1n(i–iii). Does this pathology occur equally in males and females?
n(i) n(ii)
n(iii)
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Question 15
Describe the appearance in Fig.28.1o. State E classication.
o
Question 16
Describe the appearances in Fig.28.1p(i, ii).
p(i) p(ii)
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Question 17
Describe this ECF in Fig. 28.1q. State E
classication.
q
Question 18
Describe the appearance in Fig.28.1r.
r
Question 19
Describe the appearance in Fig. 28.1s. State E
classication.
s
Question 20
Describe the ECF seen on Fig. 28.1t. State E
classication.
t
Question 21
Describe the ECF seen on Fig. 28.1u. State E
classication.
u
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Question 22
Describe the ECF seen on Fig.28.1v(i) and state E classication. Figure28.1v(ii) is of another patient.
Describe the nding and state E classication.
v(i)
Question 23
Describe the ECF seen on Fig.28.1w.
w
v(ii)
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Question 24
Describe the ECFs seen on Fig.28.1x(i–iv). State E classication.
x(i) x(ii)
J. H. Bortz et al.
x(iii) x(iv)
y(i) y(ii) y(iii)
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Question 25
Describe the ECFs on Fig.28.1y(i–iii). State E classication.
Question 26
Describe the ECFs on Fig.28.1z(i–iii), and state E classication.
z(i) z(ii) z(iii)
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Question 27
Figure 28.1aA(i, ii) is of a patient who presented for a screening CTC.Describe the appearances of
the images. What would be the future management of the patient?
Aa(i) Aa(ii)
Question 28
Dene an anal papilla and state what causes it.
Question 29
Patient preparation is an essential step in a CTC study. What should be done if several patients present
with poor bowel preparation?
Question 30
Describe the features of a colon lipoma image.
28.3 Answers
Question 1
3D y-through (Fig.28.2a(i)) shows a polypoidal lesion on a haustral fold suspicious for a polyp
(black arrow). Figure (ii) is a translucent display (TD) showing the lesion is white indicating barium
on a fold and not a polyp (black arrow). 2D axial view (Fig.28.2a(iii)) shows barium attached to a fold
(red arrow) and no evidence of a polyp.
a(i)
Comment
a(ii)
Colour attenuation values of TD are discussed in 10.5in Chap. 10. Careful scrutiny of the 2D is
required for those sites that do not have TD.
a(iii)
b(i)
b(ii)
c(i)
c(ii)
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Question 2
Figure 28.2b(i) 3D view shows a non-polypoidal lesion (black circle) corresponding to the at lesion.
Figure28.2b(ii) 2D axial view of the R colon shows partial covering of a at lesion by barium (red
arrow). Note its position on the non- dependent portion of the bowel wall.
Comment
Tagging is important as 80% of at polyps have some form of covering aiding in their visualisation. Flat polyps are responsible for 30% of colorectal cancers particularly on the R side of the
colon. Important to take accurate measurements of polyps in terms of C classication as shown
in Table 14.1.
Question 3
Figure 28.2c(i) 3D view showing an artefact (open black arrows). Figure 28.2c(ii) 2D axial view
showing artefact (black arrows). It is a luminal artefact called the ‘dense water fall sign’ (DWS). It
occurs when opacied luminal uid ows from a higher to a lower level relative to the patient position
on the scanner table.
Comment
The DWS is discussed in 12.2.8.1in Chap. 12. It is a distinctive arciform artefact. It is not due
to patient breathing, patient movement, spasm, or beam hardening. It is best seen on 2D views
where the artefact is most prominent.
372
d(i)
d(ii)
e(i)
e(ii)
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Question 4
Figure 28.2d(i). 3D supine image showing a diverticulum (black circle). There is also a polypoidal
lesion simulating a polyp (black arrow). Figure28.2d(ii) 2D sagittal image shows diverticula (hexagon) and an impacted diverticulum (red arrow) which is the one shown in the black circle on the 3D.
Comment
Diverticular disease (DD) is the most common benign colonic abnormality in people over the
age of 50years. It is considered to be a normal nding as discussed in Chap. 16. However, if a
diverticulum becomes lled with thickened or congealed stool and/or barium it may then bulge
into the colonic lumen causing a polypoidal defect on 3D endoluminal views. DD does have
complications as discussed in 16.10in Chap. 16.
Question 5
Punctate calcication seen in the liver (red circle) in Fig.28.2e(i), and in the spleen (red circles) in
Fig.28.2e(ii). The latter is typical granuloma calcication. A history of an infection (e.g., TB) is a
cause of granuloma. It is an ECF of low clinical importance (E2).
Comment
See Table 18.1 for E classications. Granuloma is an E2 classication. Granulomas are usually
caused by an infection. Most common causes are: (i) tuberculosis, (ii) sarcoidosis, (iii) histoplasmosis, (iv) aspergillosis, and (v) Wegener’s granulomatosis.
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Question 6
Figure 28.2f(i) is a 2D axial supine image showing a 1cm calcied calculus in the neck of the gallbladder (red circle). Figure28.2f(ii) shows a dilated gallbladder and mild calcication (red arrow) of
part of the gallbladder wall. E2.
f(ii)
f(i)
Comment
Dilated gallbladder probably due to fasting. The small area of calcication may relate to a previous inammation.
Question 7
Figure 28.2g(i) shows polypoidal swelling (black arrows) around the rectal tube in keeping with large
haemorrhoids on the 3D supine view. Figure28.2g(ii) is a 2D supine axial view. Red arrow indicates
polypoidal swelling adjacent to the tube in keeping with haemorrhoids.
g(i)
g(ii)
Comment
Haemorrhoids are best visualised in the prone position with the balloon deated as shown in
Fig.28.2g(iii): numerous vessels are evident (black arrows) in keeping with haemorrhoids. As discussed in Chap. 13, it is important to deate the balloon in the prone position to best visualise
internal haemorrhoids. See 13.4.1 and 13.6in Chap. 13.
g(iii)
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