DOI: 10.1148/rg.263055101
Review of the Abdominal Manifestations of Cystic Fibrosis in the Adult Patient1
Michael B. Robertson, MD,
Kyuran A. Choe, MD and
Patricia M. Joseph, MD
1 From the Departments of Radiology (M.B.R., K.A.C.) and Internal Medicine (P.M.J.), University of Cincinnati, 234 Goodman St, ML 0761, Cincinnati, OH 45267-0761. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received April 25, 2005; revision requested May 24 and received July 15; accepted July 20. All authors have no financial relationships to disclose.
View larger version (109K):
[in a new window]
|
Figure 1. Marked fatty infiltration of the liver in a 19-year-old woman with CF. Axial contrast-enhanced CT image shows diffuse low attenuation of the liver (arrow).
|
|
View larger version (132K):
[in a new window]
|
Figure 2. Cholelithiasis with gallbladder wall thickening in a 29-year-old man with CF. Oblique US image of the right upper quadrant shows multiple shadowing calculi (arrow) and mild diffuse thickening of the gallbladder wall (arrowhead).
|
|
View larger version (151K):
[in a new window]
|
Figure 3a. Bile duct abnormalities in a 20-year-old man with CF. (a) Endoscopic retrograde cholangiopancreatogram shows strictures (white arrowhead) and dilatation (black arrowhead) of the bile ducts. Multiple filling defects (arrows) are also noted. (b) Oblique US image of the right upper quadrant shows multiple shadowing calculi (arrows) in the intrahepatic bile ducts.
|
|
View larger version (171K):
[in a new window]
|
Figure 3b. Bile duct abnormalities in a 20-year-old man with CF. (a) Endoscopic retrograde cholangiopancreatogram shows strictures (white arrowhead) and dilatation (black arrowhead) of the bile ducts. Multiple filling defects (arrows) are also noted. (b) Oblique US image of the right upper quadrant shows multiple shadowing calculi (arrows) in the intrahepatic bile ducts.
|
|
View larger version (95K):
[in a new window]
|
Figure 4a. Hepatic abscess in a 20-year-old man with CF (same patient as in Fig 3). CT was performed at a later date for evaluation of right upper quadrant pain. (a) Axial contrast-enhanced CT image shows a focal, round, hypoattenuating lesion with an enhancing rim (arrow) in the anterior segment of the right hepatic lobe, an appearance consistent with an abscess. (b) CT image obtained more inferiorly shows dilatation of an intrahepatic bile duct (arrow) in the left lobe.
|
|
View larger version (124K):
[in a new window]
|
Figure 4b. Hepatic abscess in a 20-year-old man with CF (same patient as in Fig 3). CT was performed at a later date for evaluation of right upper quadrant pain. (a) Axial contrast-enhanced CT image shows a focal, round, hypoattenuating lesion with an enhancing rim (arrow) in the anterior segment of the right hepatic lobe, an appearance consistent with an abscess. (b) CT image obtained more inferiorly shows dilatation of an intrahepatic bile duct (arrow) in the left lobe.
|
|
View larger version (148K):
[in a new window]
|
Figure 5. Biliary fibrosis in a 20-year-old man with CF. Transverse US image of the right upper quadrant shows diffusely increased hepatic echogenicity with periportal increased echogenicity (arrows).
|
|
View larger version (130K):
[in a new window]
|
Figure 6a. Multinodular cirrhosis in a 21-year-old man with CF who had cirrhosis. The patient’s spleen was surgically removed due to complications of portal hypertension. (a, b) Axial T1-weighted spin-echo (a) and T2-weighted fat-suppressed fast spin-echo (b) MR images show a nodular liver (arrows). There is a small amount of perihepatic ascites on the T2-weighted image (arrowhead in b). (c) Axial contrast-enhanced CT image shows multiple small varices in the omentum (arrows) and surrounding the stomach (white arrowhead). Note the fatty replacement of the pancreas (black arrowhead).
|
|
View larger version (134K):
[in a new window]
|
Figure 6b. Multinodular cirrhosis in a 21-year-old man with CF who had cirrhosis. The patient’s spleen was surgically removed due to complications of portal hypertension. (a, b) Axial T1-weighted spin-echo (a) and T2-weighted fat-suppressed fast spin-echo (b) MR images show a nodular liver (arrows). There is a small amount of perihepatic ascites on the T2-weighted image (arrowhead in b). (c) Axial contrast-enhanced CT image shows multiple small varices in the omentum (arrows) and surrounding the stomach (white arrowhead). Note the fatty replacement of the pancreas (black arrowhead).
|
|
View larger version (138K):
[in a new window]
|
Figure 6c. Multinodular cirrhosis in a 21-year-old man with CF who had cirrhosis. The patient’s spleen was surgically removed due to complications of portal hypertension. (a, b) Axial T1-weighted spin-echo (a) and T2-weighted fat-suppressed fast spin-echo (b) MR images show a nodular liver (arrows). There is a small amount of perihepatic ascites on the T2-weighted image (arrowhead in b). (c) Axial contrast-enhanced CT image shows multiple small varices in the omentum (arrows) and surrounding the stomach (white arrowhead). Note the fatty replacement of the pancreas (black arrowhead).
|
|
View larger version (124K):
[in a new window]
|
Figure 7. Pancreatitis in a pancreatic sufficient 19-year-old woman with CF. Axial contrast-enhanced CT image shows enlargement of the pancreas with peripancreatic inflammation (arrows). There is also fatty infiltration of the liver (arrowhead).
|
|
View larger version (122K):
[in a new window]
|
Figure 8a. Complete fatty replacement of the pancreas. (a, b) Axial contrast-enhanced CT images, obtained at the levels of the pancreatic tail (a) and pancreatic head (b) in a 32-year-old man with CF, show replacement of the pancreatic parenchyma by fat (arrows). Splenomegaly is also present. (c) Axial T1-weighted MR image obtained in a 21-year-old man with CF shows similar findings (arrows).
|
|
View larger version (127K):
[in a new window]
|
Figure 8b. Complete fatty replacement of the pancreas. (a, b) Axial contrast-enhanced CT images, obtained at the levels of the pancreatic tail (a) and pancreatic head (b) in a 32-year-old man with CF, show replacement of the pancreatic parenchyma by fat (arrows). Splenomegaly is also present. (c) Axial T1-weighted MR image obtained in a 21-year-old man with CF shows similar findings (arrows).
|
|
View larger version (140K):
[in a new window]
|
Figure 8c. Complete fatty replacement of the pancreas. (a, b) Axial contrast-enhanced CT images, obtained at the levels of the pancreatic tail (a) and pancreatic head (b) in a 32-year-old man with CF, show replacement of the pancreatic parenchyma by fat (arrows). Splenomegaly is also present. (c) Axial T1-weighted MR image obtained in a 21-year-old man with CF shows similar findings (arrows).
|
|
View larger version (142K):
[in a new window]
|
Figure 9a. Lipomatous pseudohypertrophy of the pancreas in a 49-year-old woman with CF. Axial contrast-enhanced CT images obtained at the levels of the pancreatic tail (a) and pancreatic head (b) show an enlarged pancreas with fatty replacement (arrows). The patient also has peritoneal carcinomatosis secondary to colon carcinoma. There is a serosal implant along the liver (black arrowhead) and omental infiltration (white arrowhead).
|
|
View larger version (143K):
[in a new window]
|
Figure 9b. Lipomatous pseudohypertrophy of the pancreas in a 49-year-old woman with CF. Axial contrast-enhanced CT images obtained at the levels of the pancreatic tail (a) and pancreatic head (b) show an enlarged pancreas with fatty replacement (arrows). The patient also has peritoneal carcinomatosis secondary to colon carcinoma. There is a serosal implant along the liver (black arrowhead) and omental infiltration (white arrowhead).
|
|
View larger version (112K):
[in a new window]
|
Figure 10. Pancreatic cystosis in a 16-year-old girl with CF. Axial T2-weighted single-shot fast spin-echo MR image shows complete replacement of the pancreatic parenchyma by innumerable cysts (arrows).
|
|
View larger version (72K):
[in a new window]
|
Figure 11. Distal esophageal adenocarcinoma in a 26-year-old man with CF and a history of chronic esophageal reflux and Barrett esophagus. Barium esophagogram shows a distal malignant stricture (arrowhead).
|
|
View larger version (148K):
[in a new window]
|
Figure 12a. Distal intestinal obstruction syndrome in a 37-year-old man with CF. (a) Scout radiograph for abdominal CT shows a nearly gasless abdomen. Bronchiectasis is present at the lung bases. (b, c) Axial contrast-enhanced CT images show dilated proximal small bowel loops (arrows in b) leading to a mid–small bowel loop with bubbly intraluminal contents (arrowhead in c). A small amount of ascites and mild edema of the small bowel mesentery are present. This case is located somewhat more proximally than is usually seen. The patient was treated with conservative medical management with resolution of the symptoms and radiologic findings.
|
|
View larger version (125K):
[in a new window]
|
Figure 12b. Distal intestinal obstruction syndrome in a 37-year-old man with CF. (a) Scout radiograph for abdominal CT shows a nearly gasless abdomen. Bronchiectasis is present at the lung bases. (b, c) Axial contrast-enhanced CT images show dilated proximal small bowel loops (arrows in b) leading to a mid–small bowel loop with bubbly intraluminal contents (arrowhead in c). A small amount of ascites and mild edema of the small bowel mesentery are present. This case is located somewhat more proximally than is usually seen. The patient was treated with conservative medical management with resolution of the symptoms and radiologic findings.
|
|
View larger version (124K):
[in a new window]
|
Figure 12c. Distal intestinal obstruction syndrome in a 37-year-old man with CF. (a) Scout radiograph for abdominal CT shows a nearly gasless abdomen. Bronchiectasis is present at the lung bases. (b, c) Axial contrast-enhanced CT images show dilated proximal small bowel loops (arrows in b) leading to a mid–small bowel loop with bubbly intraluminal contents (arrowhead in c). A small amount of ascites and mild edema of the small bowel mesentery are present. This case is located somewhat more proximally than is usually seen. The patient was treated with conservative medical management with resolution of the symptoms and radiologic findings.
|
|
View larger version (119K):
[in a new window]
|
Figure 13. Ileo-ileal intussusception in a 29-year-old man with CF. Axial contrast-enhanced CT image shows the intussusceptum (arrow) outlined by oral contrast material within the intussuscipiens (arrowhead).
|
|
View larger version (114K):
[in a new window]
|
Figure 14. Appendicitis in a 25-year-old man with CF. Axial contrast-enhanced CT image shows an enlarged, enhancing tubular structure (arrow) in the right lower quadrant.
|
|
View larger version (111K):
[in a new window]
|
Figure 15. Adenocarcinoma of the right colon in a 42-year-old man with CF. Axial nonenhanced CT image, obtained after administration of oral contrast material only, shows an annular mass (arrowhead) in the ascending colon.
|
|
View larger version (154K):
[in a new window]
|
Figure 16a. Pseudomembranous colitis in a 24-year-old woman with CF. Scout radiograph (a) and axial contrast-enhanced CT image (b) show diffuse mural thickening of the colon (arrows). Bronchiectasis is also present at the lung bases on the scout radiograph.
|
|
View larger version (133K):
[in a new window]
|
Figure 16b. Pseudomembranous colitis in a 24-year-old woman with CF. Scout radiograph (a) and axial contrast-enhanced CT image (b) show diffuse mural thickening of the colon (arrows). Bronchiectasis is also present at the lung bases on the scout radiograph.
|
|
View larger version (145K):
[in a new window]
|
Figure 17. Nephrolithiasis in a 23-year-old woman with CF. Axial contrast-enhanced CT image shows a calcification (arrow) in the right renal collecting system.
|
|
Copyright © 2006 by the Radiological Society of North America.
