2/19/2012

GI HOTSEAT: SAENZ 1

Rocky Saenz, D.O.

GASTROINTESTINALCase 21

Bile leak on ERCP

• Note the contrast pooling in the GB fossa

• Also a PIG is in place– Radiology too the rescue, we were already

draining the Pt.

• All ducts were normal in size, note their size in comparison to the scope.

Case 22

NOTES SAMPLE

2/19/2012

GI HOTSEAT: SAENZ 2

Type I Choledochal Cyst

• DDx:– Exophytic hepatic cyst

– Pancreatic pseudocyst

– Gallbladder OR enteric duplication

• Todani

Case 23

Free barium

• Note that the barium out lines the stomach and the colon– Be suspicious of linear barium

• Ask for cross-sectional to confirm!– See next slide, same pt.

NOTES SAMPLE

2/19/2012

GI HOTSEAT: SAENZ 3

Case 24

Met on Dynamic MR

• Note hepatic capsular retraction– This always means a neoplastic lesion!!!

– Mets or CholangioCA• No ductal dilatation, cholangio is out

Case 25

Omental Infarct

• Key radiographic findings– Focal stranding around clump of fat

• DDx– Epiploic appendagitis

– Omental Infarct

– Pancreatitis

– Fibrosing Sclerosing Mesenteritis

• *90% on R side!

NOTES SAMPLE

2/19/2012

GI HOTSEAT: SAENZ 4

Case 26

Autosplenctomy

• Sickle cell

Case 27

NOTES SAMPLE

2/19/2012

GI HOTSEAT: SAENZ 5

FNH on Eovist (gadoxetate)

• Key radiographic findings– lesion ISO-INTENSE to liver on hepatocyte phase

(20min)• DDx

– FNH– Heptocellular Carcinoma – well differenciated

• Consider telling the examiner to check labs AFP– This avoids unneeded Biopsy

Case 28

AdenoCA Duodenum

• DDx is the same as Case #13– PUD

– Primary Duodenal Neoplasm• Adenocarcinoma

• Lymphoma

• GIST

– Inflammatory

END

NOTES SAMPLE