GASTROINTESTINAL RADIOLOGY DIFFERENTIAL DIAGNOSES

PROXIMAL ESOPHAGEAL DIVERTICULI

1.        Zenker's diverticulum
2.        Killian-Jameson diverticulum
3.        Lateral pharyngeal pouches

THICKENED ESOPHAGEAL FOLDS

1.        Reflux esophagitis
2.        Varices
3.        Varicoid esophageal carcinoma

SHORT ESOPHAGEAL STRICTURE

1.        Reflux esophagitis (include Barret’s stricture)
2.        Esophageal carcinoma
3.        Drug induced

LONG ESOPHAGEAL STRICTURE

1.        Caustic stricture
2.        Radiation stricture
3.        Prolonged NG intubation.

DILATED ESOPHAGUS

1.        Primary achalasia
2.        Secondary achalasia (from distal esophageal malignant or benign stricture)
3.        Scleroderma

ESOPHAGEAL PSEUDODIVERTICULI

1.        Reflux esophagitis
2.        Candidial esophagitis

SMALL ESOPHAGEAL ULCERS

1.         Viral (Herpes, CMV) esophagitis
2.         Reflux esophagitis
3.         Drug-induced esophagitis

LARGE ESOPHAGEAL ULCERS

1.        Esophageal carcinoma (Squamous or Adeno)
2.        Viral (HIV, CMV) esophagitis
3.        Caustic esophagitis

THICKENED GASTRIC FOLDS

1.        Gastritis  – erosive, hypertrophic,
2.        Gastric adenocarcinoma
3.        Gastric lymphoma
4.        Gastric metastases (BREAST, LUNG, MELANOMA)
5.        Menetrier’s  disease (fundal fold thickening)
6.        Crohn’s

GASTRIC ULCERS

1.        Peptic ulcer disease.
2.        Gastric carcinoma
3.        Gastric metastases
4.        Zollinger Ellison syndrome

LEATHER BOTTLE STOMACH/ LINITIS PLASTICA

1.        Gastric adenocarcinoma
2.        Metastases (breast, lung, melanoma)
3.        Lymphoma

HYPERDENSE LIVER

1.        Hemochromatosis
2.        Amiodarone therapy
3.        Glycogen storage disease

NODULAR LIVER CONTOUR

1.        Cirrhosis
2.        Treated metastatic disease
3.        Budd –Chiari syndrome

SOLITARY HYPODENSE HYPOVASCULAR LIVER MASS

1.        Cyst
2.        Metastasis
3.        Abscess
4.        Biliary cystadenoma
5.        Cholangiocarcinoma

MULTIPLE HYPODENSE/CYSTIC APPEARING HEPATIC LESIONS

1.        Cysts
2.        Metastases
3.        Abscesses

HEPATIC  HYPERVASCULAR MASS(ES) IN A CIRRHOTIC LIVER OR WITH KNOWN HCC RISK FACTORS

1.        HCC
2.        HCC
3.        HCC
4.        HEMANGIOMA
5.        FNH
6.        ADENOMA

HEPATIC HYPERVASCULAR MASS(ES) IN A NON CIRRHOTIC LIVER & WITH NO H/O HCC RISK FACTORS

1.        HEMANGIOMA
2.        METS
3.        FNH
4.        HCC
5.        ADENOMA


HYPERVASCULAR HEPATIC METASTASES

1.        Neuroendocrine tumors (Islet cell, pheochromocytomas, carcinoid)
2.        Melanoma
3.        Renal cell carcinoma
4.        Choriocarcinoma
5.        Thyroid
6.        Sarcoma

HYPOVASCULAR HEPATIC METASTASES

1.        Colon
2.        Lung
3.        Breast

Note: Most mets are hypovascular.

CALCIFIED HEPATIC METASTASES

1.        Mucinous colonic  adenocarcinoma
2.        Serous ovarian adenocarcinoma
3.        Neuroendocrine tumors

CYSTIC HEPATIC METASTASES

1.        Mucinous adenocarcinoma  colon
2.        Mucinous adenocarcinoma ovary – usually hepatic surface implants
3.        Neuroendocrine (usually as a secondary central cystic change due to necrosis)

INTRAHEPATIC BILIARY DUCTAL STRICTURES

1.        Primary sclerosing cholangitis
2.        Ascending cholangitis
3.        AIDS cholangiopathy

GALLBLADDER WALL THICKENING DIFFUSE AND SYMMETRIC

1.        Cholecystitis
2.        Congestive heart failure
3.        Cirrhosis
4.        Hepatitis
5.        Hypoproteinemia

GALLBLADDER WALL THICKENING FOCAL AND ASYMMETRIC

1.        Gall bladder adenocarcinoma
2.        Gallbladder metastases
3.        Adenomyomatosis


SOLID PANCREATIC MASS

1.        Adenocarcinoma
2.        Islet cell tumor
3.        Solid & papillary epithelial neoplasm
4.        Lymphoma
5.        Metastatic disease

CYSTIC  PANCREATIC MASS

1.        Pseudocyst
2.        Mucinous cystadenoma
3.        Serous cystadenoma
4.        IPMN
5.        SPEN
6.        Cystic islet cell tumors

SOLID SPLENIC MASS

1.        Hamartoma
2.        Hemangioma
3.        Hemangioendothelioma
4.        Lymphoma

MULTIPLE SPLENIC MASSES

1.        Metastatic disease
2.        Lymphoma/leukemia
3.        Microabscesses
4.        Granulomatous disease (TB, sarcoid)

SMALL BOWEL THIN REGULAR FOLDS

1.        Obstruction or Ileus
2.        Sprue  (look for reversal of fold pattern)
3.        Scleroderma (look for hidebound bowel i.e., increase in number of folds despite bowel loop dilatation & antimesenteric sacculations)

SMALL BOWEL THICK REGULAR FOLDS

1.        Edema
2.        Hemorrhage
3.        Ischemia

SMALL BOWEL THICK IRREGULAR FOLDS

1.        Crohn’s disease
2.        Lymphoma
3.        Metastases

ANEURYSMAL DILATATION OF SMALL BOWEL

1.        Lymphoma
2.        Metastases
3.        Adenocarcinoma
4.        GIST

TERMINAL ILEAL WALL THICKENING

1.        Crohn’s > Ulcerative colitis (backwash ileitis)
2.        Infections (Yersinia, campylobacter, CMV, tuberculosis)
3.        Lymphoma


CECAL MASS

1.        Appendicitis/appendiceal abscess
2.        Cecal/appendiceal carcinoma
3.        Appendiceal Mucocele.
4.        Lymphoma

COLONIC WALL THICKENING

1.        Infectious colitis
2.        Inflammatory bowel disease
3.        Ischemic colitis (water shed territories – splenic and sigmoid common)
4.        Cancer

MESENTERIC MASS WITH CALCIFICATIONS AND FIBROUS MESENTERIC RADIATIONS

1.        Carcinoid
2.        Retractile mesenteritis
3.        Metastases

NODULAR THICKENED OMENTUM +/- MESENTERY

1.        Peritoneal carcinomatosis.
2.        Tuberculous peritonitis.
3.        Peritoneal mesothelioma
4.        Peritoneal lymphomatosis.