Gore RM, Ghahremani GG et al. Anomalies and - Department of ...

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Anomalies -and Anatomic
Variants of the Gallbladder
and Biliary Tract
Richard M. Gore, MD . Ann S. Fulcher, MD .
Andrew J. Taylor, MD · Gary G. Ghahremani, MD
EMBRYOLOGY
AGENESIS OFTHEGALLBLADDER
DUPLICATION OF THEGAllBLADDER
ANOMALIESOF GAllBLADDER SHAPE
Phrygian Cap
Multiseptate Gallbladder
Diverticula
ABNORMALITIES OF GALLBLADDER
POSITION
Wandering Gallbladder
.
11wlr ilrl' many congenital abnormalities of the gallbladder
~IIII bill' ducts (Fig. 78-1) which) excluding biliary atresia
1i1111 thokdochal cysts, are usually of no clinical or functional
UI ,llkilnce.1 These anomalies
q( ". rvnluilling biliary disease
are usually found in the course
in an adult patient and are of
h!l~'Qh\ primarily to the surgeon) who must deal with the
oU'lI!ol!1ilvariation during the- course of surgery.2,3
tMOIIYOLOGY
\V!J£l1Ithe human embryo is 2.S mm in size (Fig. 78-2A), a
141hJbuu forms along the anterior margin of the primitive
"'1~WUllllldproliferates laterally into the septum transversum.
Ilul 111(11\' cephalad of these two diverticula is responsible
/oil !lw formation of the liver and intrahepatic bile ducts,
h-!l!tI~Ihl' caudal diverticulum develops into the gallbladder
wi t'\ll"fd1L'patic biliary tree. At the S-mm stage of develop-
HI'II! (IIi)!. 7H-2B) the originally hollow primordium of the
! ~IIIIllIdd('! and common bile duct becomes occluded with
iI.I,"I",,".1I cells but is soon revacuolated. If recanalization
'I'. "'"plrll', a compartmentalized multiseptate gallbladder
...11'.. .\ ;",..1 "...'..a CllH Ar~ontOOrl coontl1tY'1 t"pc1l1tc in thp
Gallbladder Torsion
Ectopic Gallbladder
ABNORMALITIES IN GALLBLADDER SIZE
Cholecystomegaly
Microgallbladder
BILIARY TRACT ANOMALIES
Choledochal Cysts
Choledochoceles
Caroli's Disease
phrygian cap deformity) whereas longitudinal septa produce
a bifid or triple gallbladder. The lumen of the common bile
duct is reestablished at the 7.S-mm stage and the gallbladder
and duodenal lumen somewhat later. Bile is secreted by the
12th week.4.5
At the 10- to IS-mm stage (6-7 weeks), the gallbladder has
formed and is connected to the duodenum by a canalized
choledochocystic duct. This duct originates from the lateral
aspect of the primitive foregut and eventually terminates on
the medial or posteromedial aspect of the descending portion
of the duodenum after the foregut completes its 270-degree
rotation (Fig. 78-2C and D).4.6
The formation of the intrahepatic ducts is preceded by
the development of the portal and hepatic veins and the formation
of the hepatocytes and Kupffer cells. The intrahepatic
ducts by the 18-mm stage consist only of a blindly ending
solid core of cells that extends from the junction of the cystic
and common ducts toward the liver hilum. At the point of
contact between this blindly ending ductal anlage and the
hepatocytes, the intrahepatic ducts develop along the framework
of the previously formed portal vein branches similar
to vinps on rt trellis. Sil!:nificant variation in the configuration

"
Hepatic duct
Accessory ducts
Atresias
Common hepatic duct
Duplications
Atresias
Common bile duct
Duplications
Atresias
Cystic dilation
Figure 78-1. Sites of potential malformation of the gallbladder and
biliary tract. (From Gray SW, Skandalakis JR:Embryology for Surgeons.
Philadelphia, WB Saunders, 1972.)
/
of the intrahepatic ducts can be accounted for by the unpredictable
manner in which they wind around preexisting
portal veins.4-6
AGENESIS OF THE GALLBLADDER
Agenesis of the gallbladder is caused by failure of development
of the caudal division of the primitive hepatic diverticulum
or failure of vacuolization after the solid phase of
embryonic development. Atresia or hypoplasia of the gallbladder
also represents aborted development of the organ.7-"
Other congenital anomalies are present in two thirds of these
patients, including congenital heart lesions, polysplenia, imperforate
anus, absence of one or more bones, and rectovaginal
fistula.1O There appears to be a genetic input as well, because
several families with multiple individuals having agenesis
have been identified.1O This malformation is reported in
0.013% to 0.155% of autopsy series, but many of these cases
are in stillborn and young infants. The surgical incidence of
Figure 78-2. Drawings illustrate the normal embryologic development of the pancreas and biliary tract. The ventral pancreatic bud (arrow in A and
B) and biliary system arise from the hepatic diverticulum, and the dorsal pancreatic bud (arrowhead in A and B) arises from the dorsal mesogastrium.
C. After clockwise rotation of the ventral bud around the caudal part of the foregut, there is fusion of the dorsal pancreas (located anterior) and ventral
pancreas (located posterior). D. Finally, the ventral and dorsal pancreatic ducts fuse, and the pancreas is predominantly drained through the ventral
duct, which joins the common bile duct (CBD) at the level of the major papilla. The dorsal duct empties at the level of the minor papilla. (From Mortele
KR, Rochar TC, Streeter JL, et al: Multimodality imaging of pancreatic and biliary congenital anomalies. RadioGraphies 26:715-731, 2006.)

I,jllhludder agenesis is approximately 0.02%.10.11 Nearly two
Ihll d~ of adult patients with agenesis of the gallbladder have
bllllll'Y tract symptoms, and extrahepatic biliary
h'l'"rtl.'d in 25% to 50% of these patients. 12-14
calculi are
l'l'l.'operative diagnosis of gallbladder agenesis is difficult,
MildIhe absence of the gallbladder is often an intraoperative
nlldlng.i,8,14 Ultrasound or CT may suggest the diagnosis, but
1111.disorder is usually
bl"ddcr is not found
diagnosed at surgery when the gall-
15
at cholangiography. Intraoperative
\l1I1i1,ound may be helpful in establishing the diagnosis and
'.1
hiding a completely intrahepatic gallbladder.16 Agenesis of
'1111' ~lIlIbladder is a rare cause of false-positive. hepatobiliary
)CllIllscansY
J)UPLICATION OF THE GALLBLADDER
pi1llhladder duplicati,on o.ccurs in abo~t 1 in 400,0 people
4,H% of domestic ammals.18-2o This anomaly IS caused
~"d
\1Y Incomplete revacuolization of the primitive gallbladder,
fl. "II ing in a persistent longitudinal septum that divides the
pllhludder lengthwise. Another possible mechanism is the
~ll\llTl:nce of separate cystic buds. To establish the diagnosis,
\'W1t~eparate gallbladder cavities, each with its owq cystic
Utili, l11ustbe present. These duplicated cystic ducts may enter
Ow 10l11mOnduct separately or form a Y configuration before
'''1t11l1110n entrance.21
tvlosl reported cases of gallbladder duplication have a clinit~1
I'll-lure of cholecystitis with cholelithiasis in at least one
~,. IhI.' gallbladders. Sometimes one of the gallbladders ap-
~1~11I~ !lormal on oral cholecystography, while the second,
(II.I',ISI'd,nonvisualized, and unsuspected gallbladder produces
~YII11'1

a right upper quadrant mass. Gangrene develops in more than
50% of cases and is extremely common when the pain has
been present for more than 48 hours. On cross-sectional
imaging, the gallbladder is distended and may have an unusual
location and show mural thickening. The diagnosis is seldom
made preoperatively, however.40.41
Ectopic Gallbladder
The gallbladder can be located in a variety of anomalous positions
(Fig. 78-3). In patients with an intrahepatic gallbladder,
the gallbladder is completely surrounded by hepatic parenchyma.
The intrahepatic gallbladder usually presents little
difficulty in imaging, but it may complicate the clinical diagnosis
of acute cholecystitis because of a paucity of peritoneal
signs resulting from the long distance between the gallbladder
and peritoneum. This anomaly also makes cholecystectomy
more difficult. On sulfur colloid scans, the intrahepatic
gallbladder presents as a cold hepatic defect.
The gallbladder has also been reported in the following
positions: suprahepatic, retrohepatic (Fig. 78-4), supradiaphragmatic,
and retroperitoneal. In patients with cirrhosis,
small or absent right lobes, or chronic obstructive pulmonary
disease, the gallbladder together with the colon is often
interposed between the liver and the diaphragm.42 Left-sided
gallbladders may occur in situs inversus or as an isolated
finding. They can also lie in the falciform ligament, transverse
mesocolon, and anterior abdominal wall.
ABNORMALITIES IN GALLBLADDER SIZE
Cholecystomegaly
Enlargement of the gallbladder has been reported in a numhcl
of disorders including diabetes (because of an autonomic
neuropathy) and after truncal and selective vagotomy. The
gallbladder also becomes larger than normal during pregnancy,
in patients witb sickle hemoglobinopathy, and ill
extremely obese people.43-46
Microgallbladder
In patients with cystic fibrosis, the gallbladder is typically
small, trabeculated, contra

C
l'
114111 I" 1
I"u" '"
.IInl.-,\ ','
1111' I,
Hijlln,1i
ldirmed with biliary scintigraphy,
h,1I cysts, choledochoceles, and Caroli's disease
, ;1 spectrum of biliary anomalies that produce
I he biliary tree. They are discussed individually
I ng section, and their relationship is illustrated
Figure 78-4. Gallbladder ectopia. A. Intrahepatic gallbladder
(GB) demonstrated on CT scan. B. Retrohepatic gallbladder
shown on an oral cholecystogram. C. Situs inversus with leftsided
gallbladder.
Choledochal Cysts
Choledochal cysts are congenital cystic dilatations of any
portion of the extrahepatic bile ducts, most commonly the
main portion of the common bile duct.49-55 It is postulated
that this condition begins with an anomalous junction of
the common bile duct and pancreatic duct proximal to the
duodenal papilla (Fig. 78-7). Higher pressure in the pancreatic
duct combined with an absent ductal sphincter allows free
reflux of enzymes into the biliary tree, weakening the wall of
the common bile duct. There is a 3: 1 female predominance,
and 60% of patients present before age 10, although choledochal
cysts can present from birth to old age. This anomaly
is associated with an increased incidence of gallbladder
anomalies, other biliary anomalies (e.g., biliary stenosis or
atresia), and congenital hepatic fibrosis. Complications of
choledochal cysts in adults include rupture with bile peritonitis,
secondary infection (cholangitis), biliary cirrhosis and
portal hypertension, calculus formation, portal vein thrombo-
sis, liver abscess, hemorrhage, and malignant transformation
:nt h 1 :~ __~._;._ _ t;~_c;,,7
----

a A
II
I
i!
il
.
!
.1
!
i!
II
II
if
. I
---
Figure 78-5. Anatomic variants in the cystic duct. Drawings illustrate
how the cystic duct may insert into the extrahepatic bile duct with a
shows right lateral insertion (A), anterior spiral insertion (B), posterior
spiral insertion (C), low later~1 insertion with a common sheath (D),
proximal insertion (E), or low medial insertion (F). (From Turner MA,
Fulcher AS: The cystic duct: Normal anatomy and disease processes.
RadioGraphies 21 :3-22, 2001.)
Newborns and infants present with obstructive jaundice.s4,55Older
children and adults may have the classic triad
of right upper quadrant pain, intermittent jaundice, and a
palpable right upper quadrant mass. In adult patients, a
choledochal cyst is often first diagnosed on cross-sectional
imaging. CT (Fig. 78-8) and ultrasound demonstrate a fluidfilled
structure beneath the porta hepatis separate from the
gallbladder that communicates with the hepatic ducts. An
abrupt change in the caliber of the ducts occurs at the site
of the cysts. Intrahepatic ductal dilatation may be present
as well.
Cholangiography is necessary to confirm the diagnosis.
It demonstrates a cystic structure 2 to IS cm in diameter that
communicates with the hepatic ducts. An abrupt change in
ductal caliber occurs at the site of the cyst. Mild intrahepatic
ductal dilatation, stones, or sludge may be present as well.
Cholangiography is useful for fully defining ductal anatomy.
Upper gastrointestinal series may show a soft tissue mass
in the right upper quadrant that causes anterior displacement
of the second portion of the duodenum and antrum or
inferior displacement of the duodenum or widening of the
duodenal sweep. 54-56
Ultrasound findings reflect the specific type of choledochal
cyst, although a cystic extrahepatic mass is typically
present. Often a portion of the proximal bile duct can be seen
extending into the choledochal cyst. Hepatobiliary scans show'
late filling and stasis of the isotope within the choledochal
cyst. 53 They are useful in excluding hepatic cyst, pancreatic
pseudocyst, and enteric duplication.
Direct coronal MR imaging demonstrates a dilated tubular
structure that follows the expected course of the common bile
duct. MR cholangiopancreatography (MRCP) can also demonstrate
these dilated biliary structures because the luminal
contents of the bile appear hyperdense in contrast to the portal
vein. MR cholangiopancreatography can also diagnose biliary
----------
Figure 78-6. Choledochal cysts. A. Type I choledochal cyst. B. Type II
choledochal cyst.
calculi and stricture formation that frequently complicate
cystic disease of the bile ducts. Two studies showed that MR
cholangiopancreatography offered equivalent information
to endoscopic retrograde cholangiopancreatography (ERCP),
without the potential complications inherent in the latter
procedure. In patients with choledochal cysts who are reluctant
to undergo surgical resection, periodic follow-up ultrasound
and MR cholangiopancreatography may help achieve
early detection of malignant change. 52 The management of
choledochal cysts is surgical, with excision of all cyst tissue

A
E
Figure 78-6, cont'd. C. Choledochocele or type III choledochal cyst.
D. Type IV choledochal cysts. E. Type V choledochal cyst (Caroli
disease). (From Mortell' KR, RocharTC, Streeter JL, et al: Multimodality
imaging of pancreatic and biliary congential anomalies. RadioGraphies
26:715-731, 2006.)
t "1,...'/1 Normal and anomalous pancreatic duct-common bile duct anatomy. A. Drawing illustrates the sphincter of Oddi complex (arrow)
,"' .." , Ig the distal CBD and pancreatic duct. B. Drawing illustrates a long common channel (> 15 mm). Note that the sphincter of Oddi does not
,.I. ,I.. 'I'
"lIlIence (arrow) of the ducts. (From Mortell' KR, RocharTC, Streeter JL, et al: Multimodality imaging of pancreatic and biliary congenital
B

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.,
,
:<
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I c
,
'(,II
~I
!
. .....
Figure 78-8. Type I choledochal cysts. A. Coronal oblique
multiplanar reformatted image shows fusiform dilatation of
the common bile duct (arrow). Note also the dilatation of
the intrahepatic biliary tract (arrowhead). B. Percutaneous
transhepatic cholangiogram shows a large choledochal cyst
(C) at the level of the extrahepatic bile duct. Note the
aberrant entry of the common bile duct at the side of the
pancreatic duct (arrowhead). C. Photograph shows an excised
type 1 choledochal cyst of the common bile duct
(arrow) in continuity with the cystic duct and the gallbladder
(arrowhead).Scale is in centimeters. D. MRCP dilated main
common bile duct (arrow). (C from Brancatelli G, Federle
Mp, Vilagrain V, et al: Fibropolycystic liver disease: CT and
MR imaging findings. RadioGraphies 25:659-670, 2005.
o from Mortele KR, Rochar TC, Stretter JL, et al: Multimodality
imaging of pancreatic and biliary congenital
anomalies. RadioGraphies 26:715-731,2006.)

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ii
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i~
hepatic ducts, stones, strictures, and communicating hepatic
abscesses. CT can also demonstrate tiny dots with strong
contrast enhancement within dilated intrahepatic bile ducts
(the "central dot" sign). These intraluminal dots correspond
to intraluminal portal veins.64.68 CT and ultrasound demonstrate
multiple cystic areas within the liver69-71(Fig. 78-11).
Technetium Tc 99m sulfur colloid scans show multiple cold
defects, and hepatobiliary scans show an unusual pattern of
retained activity throughout the liver.54,55
MRCP with three-dimensional display is an accurate
method for demonstrating Caroli's disease because the luminal
contents of the bile ducts appear hyperintense in contrast to
the portal vein, which usually appears as signal void. Cystic
expansions of the intrahepatic biliary tract are depicted as
oval-shaped structures in continuity with the biliary tract
(Fig. 78-12). They are nearly signal void on black bile techniques
and have a high signal intensity on bright bile or MR
cholangiopancreatography sequences.72
Treatment depends on the clinical features and location of
the biliary abnormality. When the disease is localized to one
hepatic lobe, hepatectomy relieves symptoms and appears to
remove the risk of malignancy. In diffuse Caroli's disease,
treatment options include conservative or endoscopic therapy,
internal biliary bypass procedures, and liver transplantation
in carefully selected cases.
Figure 78-11. Caroli's disease: CT findings. The dilated segments of the
intrahepatic biliary tract may be visualized as "cysts" (straight arrows),
which are occasionally attached to more proximal ectatic segments of
the biliary radicles (curved arrow). The defining CT feature of Caroli's
disease is the central dot sign (open arrow). There is ectasia of the distal
nephrons in the kidneys. (From Taylor AJ, Bohorfoush AG: Interpretation
of ERCP with Associated Digital Imaging. Philadelphia, Lippincott-
Raven, 1997, p 52, with permission.)
Figure 78-12. Caroli's disease: MR findings. A. Coronal oblique MR cholangiopancreatography demonstrates multiple segmental saccular dilatations
of the intrahepatic bile ducts (arrows). Curved arrow, common bile duct. B. Coronal half-Fourier rapid acquisition with relaxation enhancement
(RARE) image of the kidneys shows multiple fluid-containing foci (arrows) in the papillae indicating renal tubular ectasia (medullary sponge kidney).
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'.

Fl'711'I. Type IIICholedochocysts: choledochocele. A,.ERCP shows saccular dilatation of the distal common bile duct (C) and choledocholiathias
'II I II. I "ronal MRCP image demonstrates bulbous dilatation of the intramural segment of the distal common bile duct (arrows), which protrudes
II) III

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Other Implanted Devices
Chronic ambulatory peritoneal dialysis is pcrl", IIII'd
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the pentoneal cavity and removmg It to allow 11"11r
" ""
toxins and regulation of electrolytes. This techniqll' 1"'lliltit"
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nal wall. Leaks, hernias, or fluid collections at tl" 'oIliI\1ttt':
entry site are optimally demonstrated by CT (Fig. II I ",). IItl:
beneficial to infuse dialysate mixed with iodinall'd ,tllIll'dJ-r
to enhance visualization of the configuration of thl' I" Iltlll\~1
lining at the catheter site.ll5 Other devices, such .1'. ,"lu_llfiL
ports, chemotherapy reservoirs, and cardiac pacl'lIl.d"'I~, IIr.!'
commonly s,een with cross-sectional imaging. Unb, II II" I"vll'¥
was placed recently, the presence of gas or fluid ;1I'IIIIHltlrf
implant should raise suspicion of infection. '
Figure 114-30. Trocar deformity. A. Acute changes at the post-trocar insertion site (arrows) are present in the anterior abdominal wall. 8.
II" "," 1'"1\
sites may serve as a chronic source of ventral herniation (arrows).
1
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CHAPTER 114 Hernias and Abdominal Wall Pathology
2175
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I:,
il
I
1

-----------------
TEXTBOOK OF
Gastrointestinal
Radiology
Richard M. Gore, MD
Professor of Radiology
Northwestern University Feinberg School of Medicine
Chief, Gastrointestinal Radiology Section
Evanston Northwestern Healthcare
Evanston, Illinois
Marc S. Levine, MD
Professor of Radiology
Advisory Dean
University of Pennsylvania School of Medicine
Chief, Gastrointestinal Radiology Section
University of Pennsylvania Medical Center
Philadelphia, Pennsylvania
VOLUME 2
---

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ELSEVIER
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TEXTBOOK OF GASTROINTESTINAL RADIOLOGY
Copyright @ 2008, 2000, 1994 by Saunders, an imprint of Elsevier Inc.
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Volume I Part No. 9996008037
Volume 2 Part No. 9996007553
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Library of Congress Cataloging-in-Publication Data
Textbook of gastrointestinal radiology/[edited by] Richard M. Gore,
Marc S. Levine.-3rd ed.
p.;cm.
Includes bibliographical references and index.
ISBN 1-4160-2332-1
1. Gastrointestinal system-Radiography. 1. Gore, Richard M.
n. Levine, Marc S.
[DNLM: 1. Gastrointestinal Diseases-diagnosis. 2. Diagnostic
Imaging-methods. 3. Digestive System-pathology. WI 141 T355 2008J
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- --
...
,I
.1

VOLUME 1
Imaging Contrast Agents 3
lovilas Skucas, MD
2 I'harmacoradiology '19
1\ }vitas Skucas, MD
J Barium Studies: Single Contrast 27.
I)"vid j. Ott, MD
" Barium Studies: Principles of Double
Contrast Diagnosis 37
Igor Laufer, MD . Marc S. Levine, MD
5 Pictorial Glossary of Double-Contrast
Radiology 49
Stephen E. Rubesin, MD
6 Ultrasound of the Hollow Viscera 71
Slephanie R. Wilson, MD
7 Multidetector-Row Computed Tomography
of the Gastrointestinal Tract: Principles of
Interpretation 81
I~ichard M. Gore, MD
, Abdomen: Normal Anatomy and
Examination Techniques 189
William Moreau Thompson, MD
() Gas and Soft Tissue Abnormalities 205
James M. Messmer, MD, MEd
Contents
8 Magnetic Resonance Imaging of the Hollow
Viscera 91
Russell N. Low, MD
9 Positron Emission Tomography/Computed
Tomography of the Hollow Viscera 107
Karen A. Mourtzikos, MD
10 Angiography and Interventional Radiology
of the Hollow Viscera 117
Stanley Taeson Kim, MD · Albert A. Nemcek, Jr., MD .
Robert L.Vogelzang, MD
11 Abdominal Computed Tomographic
Angiography 141
Vahid Yaghmai, MD
12 Magnetic Resonance Angiography of the
Mesenteric Vasculature 153
Ranista Tongdee, MD . Vamsi R. Narra, MD, FRCR
13 Endoscopic Ultrasound 167
Richard M. Gore, MD
14 Gastrointestinal Scintigraphy 173
Alan H. Maurer, MD
17 Abdominal Calcifications 225
Stephen R. Baker, MD
xiii

xiv Contents
m Pharynx
STEPHEN E. RUBESIN, SECTION EDITOR
18 Pharynx: Normal Anatomy and Examination
Techniques 235
Stephen E. Rubesin, MD
19 Abnormalities of Pharyngeal Function 253
Bronwyn jones, MD
21 Barium Studies of the Upper
Gastrointestinal Tract 311
Igor Laufer, MD . Marc S. L~vine, MD
22 Motility Disorders of the Esophagus 323
David j. Ou, MD
23 Gastroesophageal Reflux Disease 337
Marc S. Levine, MD
24 Infectious Esophagitis 359
Marc S. Levine, MD
25 Other Esophagitides 375
Marc S. Levine, MD
26 Benign Tumors of the Esophagus 401
Marc S. Levine, MD
27 Carcinoma of the Esophagus 417
Marc S. Levine, MD . Robert A. Halvorsen, MD
33 Peptic Ulcers 529
Marc S. Levine, MD
34 Inflammatory Conditions of the Stomach
and Duodenum 563
Marc S. Levine, MD
35 Benign Tumors of the Stomach and
Duodenum 593
Marc S. Levine, MD
36 Carcinoma of the Stomach and
Duodenum 619
Marc S. Levine, MD . Alec j. Megibow, MD .
Michael L. Kochman, MD
20 Structural Abnormalities of the
Pharynx 271
Stephen E. Rubesin, MD
28 Other Malignant Tumors of the
Esophagus 447
Marc S. Levine, MD
29 Miscellaneous Abnormalities of the
Esophagus 465
Marc S. Levine, MD
30 Abnormalities of the Gastroesophageal
Junction 495
Marc S. Levine, MD
31 Postoperative Esophagus 507
Stephen E. Rubesin, MD . Noel N. Williams, MD
32 Esophagus: Differential Diagnosis 523
Marc S. Levine, MD
37 Other Malignant Tumors of the Stomach
and Duodenum 645
Marc S. Levine, MD · Alec j. Megibow, MD
38 Mi.scellaneous Abnormalities of the
Stomach and Duodenum 679
Ronald L. Eisenberg, MD . Marc S. Levine, MD
39 Postoperative Stomach and
Duodenum 707
Richard M. Gore, MD . Claire H. Smith, MD
40 Stomach and Duodenum: Differential
Diagnosis 727
Marc S. Levine, MD
f

\
I
m,!i,'
' :'-
,.
. ..
.
Small Bowel
...- -- .u- ..
STEPHEN E. RUBESIN, SECTION EDITOR
--
'II Barium Examinations of the Small
Intestine 735
Slephen E. Rubesin, MD
,12 Computed Tomographic Enteroclysis 755
Dean D. T. Maglinte, MD . John C. Lappas, MD ·
Kumaresan Sandrasegaran, MD
-u Magnetic Resonance Enteroclysis of the
Small Bowel 765
Nicholas C. Gourtsoyiannis, MD ·
Nickolas Papanikolaou, PhD
'14 Video Capsule Endoscopy
Frans-Thomas Fork, MD, PhD .
Samuel Nathan Adler, MD
775
.1'> Crohn's Disease of the Small Bowel 78)
I~ichard M. Gore, MD . Gabriele Masselli, MD ·
Dina F. Caroline, MD, PhD
16 Inflammatory Disorders of the Small Bowel
Other than Crohn's Disease 807
Stephen E. Rubesin, MD
17 Malabsorption 825
Stephen E. Rubesin, MD
fit
.
,.,
'
'
.
- - -- ~ - -
Colon
-- ---
.)~, Barium Studies of the Colon 957
Igor '-,JUfer, MD . Marc S. Levine, MD
"Ii! Dynamic Evaluation of the Anorectum 969
'>.Ii Somers, MBChB . Clive I. Bartram, MD .
11I1i.1R. Fielding, MD . Kang Hoon Lee, MD ·
t~l(hard M. Gore, MD
./ Computed Tomographic
Colonography .989
lvIich,lel Macari, MD
.H Magnetic Resonance Colonography 1009
Ni, holas C. Gourtsoyiannis, MD . Thomas C.
I .lll!'l1slcin, MD . Nickolas Papanikolaou, PhD
.1) I )iv('rlicular Disease of the Colon 1019
1~1f1I.lId M. Gore, MD . Vahid Yaghmai, MD .
Iliid I. I!;dthazar, MD
.(1 I Ijs('ascs of the Appendix 1039
Idll . 1.lI'obs, MD . Emil J. Balthazar, MD
-- -- - ----
Contents xv
48 Benign Tumors of the Small Bowel 845
John C. Lappas, MD . Dean D. T. Maglinte, MD .
Kumaresan Sandrasegaran, MD
49 Malignant Tumors of the Small Bowel 853
Dean D.T. Maglinte, MD .John C. Lappas, MD .
Kumaresan Sandrasegaran, MD
50 Small Bowel Obstruction 871
Stephen E. Rubesin, MD . Richard M. Gore, MD
51 Vascular Disorders of the Small
Intestine 901
Karen M. Horton, MD . Elliot K. Fishman, MD
52 Postoperative Small Bowel 919
John C. Lappas, MD . Kumaresan Sandrasegaran, MD ·
Dean D. T. Mag/inte, MD
53 Miscellaneous Abnormalities of the Small
Bowel 933
Stephen E. Rubesin, MD
54 Small Intestine: Differential Diagnosis 945
Stephen E. Rubesin, MD
61 Ulcerative and Granulomatous Colitis:
Idiopathic Inflammatory Bowel
Disease 1071
Richard M. Gore, MD . Igor Laufer, MD .. Jonathan W.
Berlin, MD
62 Other Inflammatory Conditions of the
Colon 1109
Seth N. Glick, MD . Richard M. Gore, MD
63 Polyps and Colon Cancer 1121
Ruedi F. Thoeni, MD . Igor Laufer, MD
64 Other Tumors of the Colon 1167
Stephen E. Rubesin, MD . Emma E. Furth, MD
65 Polyposis Syndromes 1189
Carina L. Butler, MD . James L. Buck, MD
- -- - -- - -- - - - -

II
xvi Contents
66 Miscellaneous Abnormalities of the
Colon 1203
Richard M. Gore, MD . Richard A. Szucs, MD .
Ellen L. Wolf, MD · Francis J. Scholz, MD . Ronald L.
Eisenberg, MD . Stephen E. Rubesin, MD
VOLUME 2
_~ ~'::~
67 Postoperative Colon 1235
Francis J. Scholz, MD · Christopher D. Scheirey, MD
68 Colon: Differential Diagnosis 1245
Richard M. Gore, MD
~~iologic Principlesfor Imagingand Intervention of the SolidViscera
69 Computed Tomography of the Solid
AbdominalOrgans 1257
Frederick L. Hoff, MD
70 Ultrasound Examination of the Solid
AbdominalOrgans 1271
Stuart A. Barnard, MB, BS . Patrick M. Vos, MD .
Peter L. Cooperberg, MDCM
71 Magnetic Resonance of the Solid
Parenchymal Organs 1285
F. Scott Pereles, MD
II.
_- r
Gallbladder and Biliary Tract
-- - ----
75 Gallbladder and Biliary Tract: Normal
Anatomy and Examination
Techniques 1333
Mary Ann Turner, MD . Ann S. Fulcher, MD
76 Endoscopic Retrograde
Cholangiopancreatography 1357
Andrew J. Taylor, MD
77 Magnetic Resonance
Cholangiopancreatography 1383
Ann S. Fulcher, MD . Mary Ann Turner, MD
78 Anomalies and Anatomic Variants of the
Gallbladder and Biliary Tract 1399
Richard M. Gore, MD . Ann S. Fulcher, MD .
Andrew J. Taylor, MD . Gary G. Ghahremani, MD
79 Cholelithiasis, Cholecystitis,
Choledocholithiasis, and Hyperplastic
Cholecystoses 1411
Genevieve L. Bennett, MD
72 Positron Emission Tomography/Computed
Tomography of the Solid Parenchymal
Organs 1295
Karen A. Mourtzikos, MD
73 Techniques of Percutaneous Tissue
Acquisition 1301
Susan Delaney, MD . Erik K. Paulson, MD .
Rendon C. Nelson, MD
"
74 Abdominal Abscess 1315
Richard I. Chen, MD . KentT. Sato, MD .
Howard B. Chrisman, MD
80 Interventional Radiology of the Gallbladder
: and Biliary Tract 1457
David Hahn, MD
81 Neoplasms of the Gallbladder and Biliary
Tract 1467
Byung Ihn Choi, MD . Jeong Min Lee, MD
82 Inflammatory Disorders of the Biliary
Tract 1489
Vikram Rao, MD . Uday K. Mehta, MD .
Robert L. MacCarty, MD
83 Postsurgical and Traumatic Lesions of the
Biliary Tract 1505
Gabriela Gayer, MD . Daphna Weinstein, MD .
Marjorie Hertz, MD . Rivka Zissin, MD
84 Gallbladder and Biliary Tract: Differential
Diagnosis 1517
Richard M. Gore, MD
- --

.~~v~ _
M~ liver: Normal Anatomy and Examination
IpC'hniques 1527
"i1I,'V,lnlln Namasivayam, MD, DNB, DHA .
M,IIIIH.dcep K. Kalra, MD . William C. Small, MD,
"III) . Sanjay Saini, MD, MBA
""
"1
Inturventional Radiology in the Cirrhotic
Ilv(~r 1553
1

t .~
XVIII Contents
106 Anomalies and Anatomic Variants of the
Spleen 1993
Abraham H. Dachman, MD
107 Benign and Malignant lesions of the
Spleen 2005
Patrick M. Vos, MD . Stuart A. Barnard, MB, BS . Peter
L. Cooperberg, MDCM
.Peritoneal Cav~t~
110 Anatomy and Imaging of the Peritoneum
and Retroperitoneum 2071
Dennis M. Balfe, MD . Christine M. Peterson, MD
111 Pathways of Abdominal and Pelvic Disease
Spread 2099
Richard M. Gore, MD . Morton A. Meyers, MD
112 Ascites and Peritoneal Fluid
Collections 2119
Richard M. Gore, MD . Geraldine Mogavero Newmark,
MD .Margaret D. Gore, MD
III
Pediatric Disease
-----
115 Applied Embryology of the Gastrointestinal
Tract 2179
Bruce R. Javors, MD . Joseph Patrick Mazzie, DO
116 Pediatric Gastrointestinal Radiology: An
Approach to the Child 2195
Sandra K. Fernbach, MD
117 Neonatal Gastrointestinal Radiology 2203
Sandra K. Fernbach, MD
118 Diseases of the Pediatric Esophagus 2235
Sandra K. Fernbach, MD
119 Diseases of the Pediatric Stomach and
Duodenum 2251
Richard M. Gore, MD
120 Pediatric Small Bowel Pathology 2271
Sandra K. Fernbach, MD
121 Radiology of the Pediatric Colon 2277
Sandra K. Fernbach, MD
- -- - -
108 Splenic Trauma and Surgery 2051
Vahid Yaghmai, MD
109 Spleen: Differential Diagnosis 2065
Richard M. Gore; MD
113 Mesenteric and Omental lesions 2135
Aparna Balachandran, MD . Paul M. Silverman, MD
114 Hernias and Abdominal Wall
Pathology 2149
Richard M. Gore, MD . Gary G. Ghahremani, MD .
Charles S. Marn, MD
122 Diseases Involving Multiple Areas of the
Gastrointestinal Tract in Children 2293
Sandra K. Fernbach, MD
123 Diseases of the Pediatric Gallbladder and
Biliary Tract 2305
Caroline W. T. Carrico, MD . George S. Bissett III, MD
124 Diseases of the Pediatric Liver 2325
Caroline L. Hollingsworth, MD . George S. Bissett III,
MD
125 Diseases of the Pediatric Pancreas 2341
Ana Maria Gaca, MD . George S. Bissett III, MD
126 Diseases of the Pediatric Spleen 2355
Caroline W. T. Carrico, MD . George S. Bissett III, MD
127 Diseases of the Pediatric Abdominal Wall,'
Peritoneum, and Mesentery 2371
Ana Maria Gaca, MD . George S. Bissett III, MD
- - - --

128 The Acute Abdomen 2385
Richard M.Gore,MD . Vahid Yaghmai, MD .
Uday K. Mehta, MD . Vikram Rao, MD . Geraldine
Mogavero Newmark, MD · Jonathan W. Berlin, MD
129 Gastrointestinal Hemorrhage 2403
Richard M. Gore,MD . Geraldine Mogavero Newmark,
MD . UdnyK. Mehta, MD . Jonathan w. Berlin, MD
Index
130 Abdominal Trauma 2417
Robert A. Halvorsen, MD .
Marc A. Camacho, MD
Contents xix