Y v

Abdomen Lymphoma Images Nodules

Fig. 9.66a The ultrasound cross-section shows the liver surrounded by ascites. There is a tumor at the underside of the diaphragm. It is a peritoneal metastasis of a pancreatic carcinoma. b The CT of another patient shows some tumor nodules in the omentum (arrows) ventral to the liver. c The extensive infiltration of the major omentum ("omental caking," arrows) is appreciated on this scan of another patient. d In the final stages of extensive peritoneal carcinomatosis a paralytic ileus may develop, which manifests itself in a dilatation of intestinal loops.

In case of ascites the cause must be found.

Teratoma

Teratoma: A teratoma is an infrequent incidental finding in the abdomen (Fig. 9.67). A fatty component and remnants of dental or osseous buds hint strongly at the diagnosis.

Retroperitoneal lymph node enlargement: This is most commonly associated with lymphoma. The nodular structure is typical and they can be discriminated from blood vessels by careful evaluation of successive images and also by contrast administration (Fig. 9.68). Some cancers such as testicular cancer can be associated with enlarged lymph nodes in the retroperitoneum next to the large vessels.

Fig. 9.67 The fat planes and the calcifications that probably correspond to dental remnants are well appreciated in this case.

I Retroperitoneal Lymphoma

9.11 Gregory's Test

Fig. 9.68 The whole abdomen of this patient is filled with enlarged lymph nodes; the mesenteric vessels are surrounded and displaced.

Retroperitoneal fibrosis: This entity is also called Ormond disease (Fig. 9.69). It can be induced by medication. Frequently, however, the cause remains obscure. Retroperito-neal metastatic disease may look similar; a core needle biopsy may therefore be necessary to verify the histology.

• Diagnosis: Joey has recognized the nodular character of the retroperitoneal mass at once. He considers this to be a lymphoma until proven otherwise. Joey calls up the ward and makes an appointment for a CT-guided biopsy. He hopes, of course, that Dr. Chaban will let him have a go at it. The oncologists are quite happy to get the diagnosis so rapidly and agree to the test.

Friday afternoon around 3 p.m., the onrush and excitement in the gastrointestinal clinic has died down. McDougal, the technician from Fluoroscopy, has obtained a few of the good old hotdogs from the food shack downstairs in the lobby. "Watch those breadcrumbs, lads. I don't want them to mess up the developer!" he tells our students, who are leaning against the x-ray developer unit chewing away quietly. Suddenly the peace is disturbed and backs are straightened. A fair shock of hair appears at the opposite end of the hallway. "It's Blondy the shark," groans Paul. "Quick! Hide the hotdogs!" Giufeng throws him a red-hot angry glance. Gregory strolls over to them and cheerfully hurls a load of x-ray folders on the table in front of the viewbox. "Hi, friends of the opera. Boy, does this smell good. You don't happen to have a spare sausage for this poor fella, have you?" "We're really sorry, Gregory, but there are none left," apologizes Paul with a cold smile. "You can have a bite of mine," Giufeng says into the intense silence. Paul turns pale and Hannah and Ajay fall into a big grin. Greg clears his throat and— very cautiously—bites off a little piece of Giufeng's sausage. "Well, ahem, thanks a lot, Giufeng. Where was I now? Oh yes, well, I have a few cases for you, to get you ready for the weekend as it were. Hey, Paul, how about starting with this one?" "Paul is indisposed," declares Hannah; she pushes Paul back into the second row and positions herself in front of the viewbox. "Show us the beef, Greg!" Go ahead and try on your own (Fig. 9.70)! The last case (Fig. 9.70n) is for true intellectuals. You'll find the solutions to the test cases on p. 342.

Every retroperitoneal tumor needs histological verification.

I Retroperitoneal Fibrosis

Fig. 9.69 The fibrotic tissue in the retroperitoneal space (arrows) surrounds the aorta, infiltrates the mesentery, and also involves the renal hilum.

Test Cases a This patient has swallowing problems.

a This patient has swallowing problems.

Fig. 9.70

Test Cases b Abdominal pain is the major symptom here.

c This patient had a routine check.

b Abdominal pain is the major symptom here.

d An incidental finding in an obese patient.

c This patient had a routine check.

f This neonate behaved abnormally.

e An incidental finding in another patient.

e An incidental finding in another patient.

g Loss of body weight was the symptom here.
Bodies Cirrhosis Patients

I Test Cases h This patient is well known. j Severe abdominal pains developed acutely in this case.

I Test Cases h This patient is well known. j Severe abdominal pains developed acutely in this case.

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