Imaging Approach to Abdominal Manifestations of Systemic Conditions

Published on 09/08/2015 by admin

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Last modified 22/04/2025

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(Left) Coronal volume-rendered CTA shows the entire common hepatic artery

arising from the superior mesenteric artery. The left gastric artery also has a separate origin from the aorta, though difficult to perceive on this image. The “celiac trunk” in this patient consists only of the splenic artery. Congenital variations of vascular anatomy are very common.

(Right) Oblique view of CTA clearly shows the origin of the accessory right hepatic artery from the superior mesenteric artery.

(Right) Oblique view of CTA clearly shows the origin of the accessory right hepatic artery from the superior mesenteric artery.

Inferior phrenic veins
Inferior vena cava (IVC)
Renal veins
Right gonadal vein
Ascending lumbar vein
Middle sacral vein
Adrenal veins
Ascending lumbar vein
External iliac vein
Internal iliac (hypogastric) vein
(Top) The inferior vena cava (IVC) is formed by the confluence of the common iliac veins, which are formed by the confluence of the internal and external iliac veins. Note the ascending lumbar veins, which anastomose freely between the IVC and azygous, hemiazygos, and renal veins. These form a pathway for collateral flow in the event of IVC obstruction and play an important role in the systemic spread of pelvic tumors and infection.

Thoracic duct
Cisterna chyli
Lumbar trunks (of cisterna chyli)
Right lumbar (retrocaval) node
Aortocaval nodes
Celiac nodes
Superior mesenteric nodes
Intestinal trunk (of cisterna chyli)
Lumbar (paraaortic) nodes
Inferior mesenteric nodes
Common iliac nodes
External iliac node
Internal iliac (hypogastric) nodes
(Bottom) The major lymphatics and lymph nodes of the abdomen are located along, and share the same name as, the major blood vessels.

(Left) Axial CT in a 50-year-old woman with non-Hodgkin lymphoma (NHL) shows splenomegaly and marked enlargement of multiple upper abdominal and retrocrural lymph nodes.

(Left) Axial CT in a 50-year-old woman with non-Hodgkin lymphoma (NHL) shows splenomegaly and marked enlargement of multiple upper abdominal and retrocrural lymph nodes.

(Right) On this CT section in the same case, the duodenum is displaced by large retroperitoneal nodes; the mesenteric vessels are surrounded or “sandwiched” by mesenteric nodes . The lumbar nodes are often referred to as para- or retroaortic (or -caval) , indicating their position relative to the great vessels.

(Right) On this CT section in the same case, the duodenum is displaced by large retroperitoneal nodes; the mesenteric vessels are surrounded or “sandwiched” by mesenteric nodes . The lumbar nodes are often referred to as para- or retroaortic (or -caval) , indicating their position relative to the great vessels.

(Left) This 33-year-old African American woman presented with dyspnea and general weakness. CT shows bilateral hilar and subcarinal lymphadenopathy .

(Left) This 33-year-old African American woman presented with dyspnea and general weakness. CT shows bilateral hilar and subcarinal lymphadenopathy .

(Right) CT at lung windows in the same patient shows diffuse pulmonary nodules predominantly in a peribronchial distribution.

(Left) CT in the same patient shows massive splenomegaly with innumerable small, poorly defined, hypodense nodules. Similar lesions were present in the liver, better seen on narrow window-width images (not shown). There are innumerable focal hypodense nodules in both kidneys, as well as upper abdominal lymphadenopathy .

(Left) CT in the same patient shows massive splenomegaly with innumerable small, poorly defined, hypodense nodules. Similar lesions were present in the liver, better seen on narrow window-width images (not shown). There are innumerable focal hypodense nodules in both kidneys, as well as upper abdominal lymphadenopathy .

(Right) CT in the same patient shows more of the splenic , renal , and nodal disease. All lesions were found to represent sarcoidosis and responded to steroid medication.

(Right) CT in the same patient shows more of the splenic , renal , and nodal disease. All lesions were found to represent sarcoidosis and responded to steroid medication.

(Left) This woman had abdominal pain for several months following laparoscopic right nephrectomy. A digital radiograph shows a curvilinear radiopaque stripe within the right side of the abdomen .

(Left) This woman had abdominal pain for several months following laparoscopic right nephrectomy. A digital radiograph shows a curvilinear radiopaque stripe within the right side of the abdomen .

(Right) CT in the same patient shows an encapsulated collection of fluid and gas density with an adjacent thin, radiopaque structure that corresponds to the stripe seen on the radiograph. This is a classic gossypiboma, a retained surgical sponge that has resulted in a chronic abscess or foreign body reaction.

(Right) CT in the same patient shows an encapsulated collection of fluid and gas density with an adjacent thin, radiopaque structure that corresponds to the stripe seen on the radiograph. This is a classic gossypiboma, a retained surgical sponge that has resulted in a chronic abscess or foreign body reaction.

(Left) This young man was injured in a motor vehicle crash (MVC). CT shows a distended IVC and periportal edema , which might be mistaken for dilated bile ducts or hepatic injury.

(Left) This young man was injured in a motor vehicle crash (MVC). CT shows a distended IVC and periportal edema , which might be mistaken for dilated bile ducts or hepatic injury.

(Right) CT in the same patient shows water density ascites in the Morison pouch. There was no hemoperitoneum nor visceral injury. The findings were due to aggressive IV hydration of the patient and resolved by the following morning.

(Right) CT in the same patient shows water density ascites in the Morison pouch. There was no hemoperitoneum nor visceral injury. The findings were due to aggressive IV hydration of the patient and resolved by the following morning.

(Left) This young man was injured in an MVC. CT shows diffuse infiltration of the peripancreatic and mesenteric fat planes. The IVC and renal veins appear flattened .

(Left) This young man was injured in an MVC. CT shows diffuse infiltration of the peripancreatic and mesenteric fat planes. The IVC and renal veins appear flattened .

(Right) CT in the same patient shows the classic “shock bowel” appearance of intense mucosal enhancement and submucosal edema. All of these findings are explainable by severe hypotension alone. There was no abdominal visceral or bowel injury, and a repeat CT scan the next morning was completely normal.

NECT shows bilateral hilar lymphadenopathy in the thorax including some calcification.

NECT shows bilateral hilar lymphadenopathy in the thorax including some calcification.

CT at lung windows in the same case shows micronodularity along the bronchial tree , characteristic of pulmonary sarcoid.

CT at lung windows in the same case shows micronodularity along the bronchial tree , characteristic of pulmonary sarcoid.

CT in the same case shows a liver that is nodular with widened fissures that might be mistaken for cirrhosis. The presence of innumerable small hypodense nodules within the liver and spleen is a clue to the presence of sarcoid in these organs.

CT in the same case shows a liver that is nodular with widened fissures that might be mistaken for cirrhosis. The presence of innumerable small hypodense nodules within the liver and spleen is a clue to the presence of sarcoid in these organs.

CT in the same case shows abdominal lymphadenopathy , as another manifestation of sarcoidosis.

CT in the same case shows abdominal lymphadenopathy , as another manifestation of sarcoidosis.

CT shows nodes that are massively enlarged and of unusually low attenuation, all due to NHL.

CT shows nodes that are massively enlarged and of unusually low attenuation, all due to NHL.

CT in the same case shows massive pelvic lymphadenopathy. The major lymphatic channels and nodes follow the major blood vessels and have similar names, such as these external iliac nodes.

CT in the same case shows massive pelvic lymphadenopathy. The major lymphatic channels and nodes follow the major blood vessels and have similar names, such as these external iliac nodes.

Coronal T2WI MR in the same patient shows a pheochromocytoma .

Coronal T2WI MR in the same patient shows a pheochromocytoma .

Axial T2WI MR shows a large left adrenal mass that is heterogeneously hyperintense. This pheochromocytoma was not symptomatic but was detected in screening this patient with a medullary thyroid cancer, who was felt to be at risk for multiple endocrine neoplasia (MEN) syndrome.

Axial T2WI MR shows a large left adrenal mass that is heterogeneously hyperintense. This pheochromocytoma was not symptomatic but was detected in screening this patient with a medullary thyroid cancer, who was felt to be at risk for multiple endocrine neoplasia (MEN) syndrome.

Axial CECT in the same patient shows additional renal cysts and a solid, enhancing mass consistent with a renal cell carcinoma. Patients with von Hippel-Lindau are at risk for multiple and recurrent tumors of the kidneys and CNS. Imaging is critical to detect these at a potentially curable stage.

Axial CECT in the same patient shows additional renal cysts and a solid, enhancing mass consistent with a renal cell carcinoma. Patients with von Hippel-Lindau are at risk for multiple and recurrent tumors of the kidneys and CNS. Imaging is critical to detect these at a potentially curable stage.

Axial CECT in a patient with von Hippel-Lindau syndrome shows multiple cystic lesions in the pancreas and 1 of many cysts in the kidneys.

Axial CECT in a patient with von Hippel-Lindau syndrome shows multiple cystic lesions in the pancreas and 1 of many cysts in the kidneys.

Abdominal CECT in the same patient with tuberous sclerosis shows massive distortion of both kidneys by innumerable cysts and fat-density angiomyolipomas. The imaging findings are diagnostic of tuberous sclerosis, even if the patient has no family history of this disorder.

Axial NECT shows several of the calcified subependymal cortical tubers that are characteristic of tuberous sclerosis complex.

Axial NECT shows several of the calcified subependymal cortical tubers that are characteristic of tuberous sclerosis complex.

Axial CECT in the same patient shows multiple, bilateral retroperitoneal masses that are typical of plexiform neurofibromas of the lumbosacral plexus.

Axial CECT in the same patient shows multiple, bilateral retroperitoneal masses that are typical of plexiform neurofibromas of the lumbosacral plexus.

Axial CECT in a young patient with NF1 shows a right adrenal mass that proved to be a ganglioneuroma.

Axial CECT in a young patient with NF1 shows a right adrenal mass that proved to be a ganglioneuroma.

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