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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Introduction
Introduction
1 topic, 1 min. of video
Right Upper Quadrant Pain
Right Upper Quadrant Pain
20 topics, 55 min. of video
Normal Anatomy and Basic Ultrasounds: Abdomen and Pelvis
8 m.Cholelithiasis
2 m.Case: Acute Cholecystitis on Ultrasound
2 m.Acute Cholecystitis on Ultrasound
3 m.Case: Acute Cholecystitis on CT
2 m.Acute Cholecystitis on CT
1 m.Case: Cholecystitis With Calcified Stones
3 m.Gallstones on CT
2 m.Case: Tensile Gallbladder Fundus Sign
2 m.Tensile Gallbladder Fundus Sign
2 m.Case: Gangrenous Cholecystitis
2 m.Gangrenous Cholecystitis
2 m.Case: Emphysematous Cholecystitis With Portal Venous Gas Air
2 m.Emphysematous Cholecystitis With Portal Venous Gas Air
4 m.Case: Emphysematous Cholecystitis With Perforation
5 m.Emphysematous Cholecystitis Summary
3 m.Case: Mirizzi Syndrome With Dilated Intrahepatic Bile Ducts
4 m.Mirizzi Syndrome
6 m.Case: Choledocholithiasis
5 m.Choledocholithiasis
4 m.Midline Pain
Midline Pain
10 topics, 24 min. of video
Case: Acute Gallstone Pancreatitis
2 m.Causes of Pancreatitis
4 m.Cases: Pancreatitis Without/With Necrosis
3 m.Revised Atlanta Classification
6 m.Case: Pancreatitis With SMV and Splenic Vein Thrombosis
3 m.Pancreatitis Complication: SMV and Splenic Vein Thrombosis
3 m.Case: Pancreatitis With Pseudoaneurysm of Splenic Artery
2 m.Pancreatitis Complication: Splenic Artery Pseudoaneurysm
2 m.Case: Duodenal Ulcer With Perforation
2 m.Types of Perforated Ulcers
2 m.Lower Quadrant Pain
Lower Quadrant Pain
4 topics, 11 min. of video
Left Lower Quadrant Pain
Left Lower Quadrant Pain
11 topics, 16 min. of video
Case: Classic Diverticulitis
2 m.Diverticulitis
2 m.Case: Diverticulitis With Free Air
2 m.Case: Diverticulitis, Perforated with Abscess
2 m.Diverticulitis: Perforated With Abscess Post Drainage
2 m.Case: Diverticulitis With Colovesical Fistula
2 m.Diverticulitis With Colovesical Fistula
1 m.Case: Diverticulitis With IMV Thrombosis
2 m.Diverticulitis With IMV Thrombosis
2 m.Case: Epiploic Appendagitis
2 m.Epiploic Appendagitis and Omental Infarction
3 m.Bowel Obstruction
Bowel Obstruction
26 topics, 1 hr. of video
Case: Umbilical Hernia
3 m.Obstructing Umbilical Hernias
3 m.Groin Hernias: Introduction
3 m.Case: Indirect Inguinal Hernia
2 m.Inguinal Hernias
2 m.Case: Femoral Hernia
2 m.Case: Obturator Hernia
2 m.Groin Hernias: Summary
3 m.Case: Simple Bowel Obstruction
2 m.Case: High Grade Bowel Obstruction
2 m.Case: Gallstone Ileus
3 m.Gallstone Ileus and Cholecytocolic Fistula
3 m.Case: Closed Loop Small Bowel Obstruction
3 m.Closed Loop Small Bowel Obstruction
5 m.Case: Large Bowel Colonic Obstruction
2 m.Large Bowel Colonic Obstruction
2 m.Case: Perforated Colon From Colon Cancer
3 m.Perforated Colon
4 m.Case: SMA Embolism With Bowel Ischemia
3 m.SMA Embolism
4 m.Case: Mesenteric Vein Thrombosis
3 m.Mesenteric Vein Thrombosis
2 m.Case: Cecal Volvulus
2 m.Cecal Volvulus
4 m.Case: Sigmoid Volvulus
3 m.Sigmoid Volvulus
3 m.Retroperitoneum
Retroperitoneum
15 topics, 46 min. of video
Retroperitoneum
3 m.Case: Ruptured Abdominal Aortic Aneurysm
2 m.Abdominal Aortic Aneurysm Rupture
4 m.Case: Bleeding Angiomyolipoma
3 m.Angiomyolipoma
2 m.Case: Psoas Hematoma
3 m.Retroperitoneal Bleeding
2 m.Case: Renal Stones
3 m.Enhancement Patterns of Kidneys
7 m.Case: Forniceal Rupture
4 m.Forniceal Rupture
2 m.Case: Pyelonephritis
3 m.Pyelonephritis
3 m.Case: Renal Infarcts
3 m.Renal Infarcts
9 m.0:00
Okay, so this is diverticulitis
0:02
with IMV thrombophlebitis.
0:04
Because of the inflammatory state of patients
0:06
with diverticulitis, there is a opportunity for
0:10
thrombosis of portal venous drainage patterns.
0:13
So in the case of sigmoid colon, that would be
0:15
from the inferior mesenteric vein, which comes up
0:18
along here and then joins, usually with a splenic
0:20
or at the confluence with the portal vein and SMV.
0:23
It's very variable how it drains.
0:25
It will be found, you know, smack dab right
0:28
running down in front of that renal vein.
0:30
So it's one of those veins you want to look
0:31
at for, uh, thrombosis and diverticulitis.
0:34
It's also a vein that can be a landmark in some
0:36
of our weird internal hernias, so don't forget the
0:39
IMV, just because it's small and it doesn't get
0:41
as much love, it does deserve your interrogation.
0:45
The mortality rate for this is pretty high.
0:47
It's estimated 11% to 25%.
0:48
Not that I'm sure anyone has
0:50
a huge case series of them.
0:51
Their blood cultures are oftentimes positive.
0:53
They may be floridly septic, they need
0:55
antibiotics, and anticoagulation is
0:58
usually done for three to six months.
1:00
You know, you also wanna look for any other
1:02
SMV thrombosis, portal vein thrombosis,
1:04
all of those can occur in the setting
1:05
of diverticulitis or even appendicitis.
1:08
These patients can also have liver abscesses when
1:10
the infection spreads through the portal venous
1:13
system to the liver.
1:15
So there are complications of diverticulitis
1:18
that can be quite severe, and this is one of them.
1:20
So don't forget to look at the IMV.
1:23
Be the hero when you can, make the diagnosis
1:25
of thrombophlebitis, and you will give
1:28
this patient a better chance at survival.
Diverticulitis With IMV Thrombosis
HIDEInteractive Transcript
0:00
Okay, so this is diverticulitis
0:02
with IMV thrombophlebitis.
0:04
Because of the inflammatory state of patients
0:06
with diverticulitis, there is a opportunity for
0:10
thrombosis of portal venous drainage patterns.
0:13
So in the case of sigmoid colon, that would be
0:15
from the inferior mesenteric vein, which comes up
0:18
along here and then joins, usually with a splenic
0:20
or at the confluence with the portal vein and SMV.
0:23
It's very variable how it drains.
0:25
It will be found, you know, smack dab right
0:28
running down in front of that renal vein.
0:30
So it's one of those veins you want to look
0:31
at for, uh, thrombosis and diverticulitis.
0:34
It's also a vein that can be a landmark in some
0:36
of our weird internal hernias, so don't forget the
0:39
IMV, just because it's small and it doesn't get
0:41
as much love, it does deserve your interrogation.
0:45
The mortality rate for this is pretty high.
0:47
It's estimated 11% to 25%.
0:48
Not that I'm sure anyone has
0:50
a huge case series of them.
0:51
Their blood cultures are oftentimes positive.
0:53
They may be floridly septic, they need
0:55
antibiotics, and anticoagulation is
0:58
usually done for three to six months.
1:00
You know, you also wanna look for any other
1:02
SMV thrombosis, portal vein thrombosis,
1:04
all of those can occur in the setting
1:05
of diverticulitis or even appendicitis.
1:08
These patients can also have liver abscesses when
1:10
the infection spreads through the portal venous
1:13
system to the liver.
1:15
So there are complications of diverticulitis
1:18
that can be quite severe, and this is one of them.
1:20
So don't forget to look at the IMV.
1:23
Be the hero when you can, make the diagnosis
1:25
of thrombophlebitis, and you will give
1:28
this patient a better chance at survival.
Report
Faculty
Laura L Avery, MD
Assistant Professor of Emergency Radiology Harvard Medical School
Massachusetts General Hosptial
Tags
Large Bowel-Colon
Infectious
Gastrointestinal (GI)
Emergency
CT
Body
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