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Radiology > Abdominal imaging > Flashcards

Abdominal imaging Flashcards

1
Q

GU xray I

A

1s dx test. r/o preg.

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2
Q

KUB I

A

kidney stone, free air, abn calcifications, renal agencies, ascites, bowel obstruction, foreign body, skeletal pathology

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3
Q

ascites KUB

A

incr density in pelvic cavity. obliteration of peritoneal fat pads, upward displacement of bowel loops

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4
Q

bowel obstruction KUB

A

air fluid lvls, dilated bowel loops, obvious pt of transition.

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5
Q

abdomen US I

A

1st line for imaging kidney in acute renal failure bc no contrast or rad so safe in pt with deranged kidney function

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6
Q

IV pyelogram (IVP)

A

KUB+contrast. aka excretory urogram. contrast column suggest obstruction

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7
Q

renal US look for

A

1) kidney size- vary based on age from 10-14cm and breadth 3-5cm
2) location: retroperitoneal, paraspinal, behind liver on right and spleen on left. right kidney is lower
3) renal outline- smooth. irregular - masses or scars
4) corticomedullar differentiation- cortex- hypoechoic (dark) relative to medulla (hyper echoic)

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8
Q

kidney US I

A

hydronephrosis, calculi, cyst, renal masses, to guid kidney biopsy, renal artery stenosis (1st line), size change in kidney

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9
Q

hydronephrosis US

A

calyceal splitting, if distal obstruction, see proximal dilation of ureter

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10
Q

calculi US

A

echogenic. distal acoustic shadowing

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11
Q

cyst US

A

can dd cyst c solid lesion. 1st line. hypo echoic. polycystic kidney disease

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12
Q

renal artery stenosis imaging

A

US combined with doppler is 1st line screening modality

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13
Q

enlarged kidney

A

amyloidosis, multiple myeloma, DM

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14
Q

Atrophic kidney

A

post obstructive or post infective. hatchmarks

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15
Q

abdominal CT I

A

1) renal stone disease (painful hematuria)
2) renal/bladder mass (painless hematuria)
3) trauma

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16
Q

renal stone CT

A

noncontrast CT = gold standard. look for proximal signs of obstruction.

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17
Q

renal/bladder masses CT

A

can delineate extent, characteristic, vascular involvement, lN, calcification.

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18
Q

trauma CT

A

for evaluating extent, staking, prognosis

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19
Q

Abdominal MRI adv over CT

A

soft tissue detail, better for staging genitourinary malig, provide functional info

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20
Q

furosemide challenge

A

mod of IVP to r/o pelviureteric junction (PUJ) obstruction

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21
Q

DMSA

A

nun study used to localize renal tissue- ectopic kidney

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22
Q

MAG3

A

obstructive uropathy, renovascular HT,N, renal transplant evaluation

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23
Q

renal calculi

A

causes- metabolic, structural defects, recurrent infection

CT-nonconstast is test of choice but X-ray may still be initial study.

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24
Q

renal calculi DD

A

other conditions of medullary calcification: renal tubular acidosis, HPTH, sarcoidosis, hyperoxaluria, hypercalciuria, infectious disease (TB,), malig (rare, film’s, neuroblastoma)

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25
Q

acute renal failure approach

A

clinical Hx!
1st line- US to r/o obstruction and reversible causes, vasculopathy- renal artery stenosis.
2nd- noncontrast CT-ureteric calculi, contrast allows functional assessment
3rd- nun study for post transplant

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26
Q

kidney infection imaging indications

A

not for simple UTI. for recurrent, complicated course, deranged kidney function, unresponsive to antimicrobial meds

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27
Q

acute pyelonephritis

A

US- globally hypoechoc in acute. r/o strutural defect, abscess
DMSA-periperal defects denote edema or scarring
CT- peripheral wedge shaped hypodense area (dd from infarcts)

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28
Q

perinephric cyst

A

complication of UTI. pyelonephrosis imply abscess formation within renal parenchyma. peripherally enhancing

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29
Q

TB renal

A

end result is destruction, lof, calcification of entire kidney. deformed renal outline, cavitation, stricture formation. US - good for detect calyces dilation and obstruction. CT- focal caliectasis, hydronephrosis, calficiations, cortical thinning, soft tissue masses.
in early disease, best is IVP bc can detect change sin single calyx

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30
Q

angiomyolipoma

A

most common benign renal mass.
xray- defect in renal contour, lucency bc of fat, some calcification
US- echogenic - some cavitation, calcification
CT- HU compatible iwith fat

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31
Q

onocytoma

A

60-70s. central scare composed of fibrous tissue. angiography show spoke wheel pattern.

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32
Q

renal cell carcinoma

A

most common renal malig. solid mass is presumed this unless proven otherwise. triad- pain, flank mass, hematuria.

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33
Q

RCC imaging

A

IVP- if mass small=normal, large mass- mass effect with calyces splaying hydronephrosis
US- dd cystic from solid lesion, miss small solid isoechoic lesion
CT- best for staging. feature vary sep on size and type. most heterodynes, heterogeneously enchancing internal masses. possible irreg renal contour, calcyceal splaying, stretching, distortion of internal architecture, obstruction, vascular invasion, LN and distant metastases
MRI- better than CT for staging adv disease. detect venous involvement

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34
Q

transitional cell carcinoma

A

anywhere in collecting system to urinary bladder.
arise from urothelial lining. often synchronous and metachronous. most common bladder cancer.
IVP-most sensitive in dx early lesion involving collecting system. when large mimic RCC. use CT to DD
Ct/MRI-staging, MRI better for estimating invasion, fat involvement, dd scar tissue in post op.
cystoscope- allow interventions for tx and tx

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35
Q

adrenal adenoma

A

homogenous, smooth round mass with low density~30HU on post contrast. not detected on US.
CT-first study
MRI- isotendse or hypodense to liver on T1/2. tumor enhance post gado.

36
Q

benign prostatic hypertrophy

A

usually arise from central gland while prostate ca is from peripheral gland.
1st study- US. transrectal or transabdominal- can be used for bx.

37
Q

BPH US

A

variable. single or multi nodules in transition zone surrounded by hypo echoic rim. no capsular disruption unlike prostate ca. also do kidney to r/o back pressure changes. CT/MRI limited use.

38
Q

testicular torsion

A

twisting testis in scrotom cause venous obstruction and then arterial obstruction –> vascular compromise. most common in puberty.
1st line -US. swollen, hypo echoic testis with sympathetic hydrocele in early stage. over time, secondary hemorrhage may cause incr echogenicity. doppler US in cord show decr material signal. absent flow in testis suggests torsion.

39
Q

renal artery stenosis

A

causes- atherosclerosis, fibromuscular dysplasia.
1st line- doppler US. incr renal: aortic velocity >3.5, peak renal v of >100cm/s, or slow rise tp peak
Tc-Mac3-+ ACEi to examine renal HTN. if pos ACEi scintigraphy exam indicate renalvascular HTN is present and implies existence of hemodynamically sig renal artery stenosis.
angiography-confirmation. dealyed nephrogram and stenosed set with poststenotic dilatation
CTA with MIP and MRA

40
Q

plain abndominal film

A

preliminary test. I: bowel obstruction, perforamtion, foreign body ingestion. for screening

41
Q

abdominal xray

A

1) id sides and inspect liver and spleen shadow.
2) bilateral renal outline - symmetric and smooth. righ is lower
3) bilateral, symmetric psoas shadows.
4) urinary bladder may be outlined depending on degree of distention
5) visualize bony structure for abn
6) ID bowel gas pattern

42
Q

abdominal US I

A

1) gallbladder and hepatic pathology
2) delineation and differentiation of intra-abdominal cystic structure
3) trauma, FAST
4) guilding procedure
5) doppler for vascular

43
Q

abdominal US drawbacks

A

air artifacts, no mucosal detail

44
Q

abdominal CT I

A

1) acute abdomen to r/o appendicitis, acute pancreattits, SBO, colitis
2) trauma,
CTA for vascular leaks, aneurysm, bowel infarcts
3) CT nterography is being used for IBD (crown’s), virtual CT colonoscopy

45
Q

ERCP

A

endoscope into duodenum then cannnulation of biliary tree. done often with papillotomy = therapeutic intervention for biliary calculi and drainage procedures of obstructed bile ducts.

46
Q

ERCP I

A

indicated in jaundice of unclear origin and suspected pancreatic disease like chronic pancreatitis and pseudocyst
drainage and stenteing of biliary obstruction. advantage is not puncturing liver.
MRCP used instead in pos op bc noninvasive.

47
Q

ERCP complications

A

pancreatitis, duodenal perforation, duodenal hemorrhage, hepatic and splenic injury, infection, stent misplacement

48
Q

zenker’s diverticulum

A

most common esophageal diverticulum. caused by increased intraluminal pressure
location- outpouching of pharyngeal mucosa above the cricopharyngeus (upper esophageal sphincter)
imaging- dx with barium esophagogram or endoscopy.

49
Q

SBO imaging

A

goal- dx and dd complete v incomplete. no bowel gas beyond lvl of obstruction is a complete obstruction.
xray is 1st imaging
CT- dd paralytic ileum from anatomic obstruction

50
Q

colitis

A

CT- reveal colonic wall thickening= small bowel gass

51
Q

ulcerative colitis

A

large bowel. rectal + continuous proximal.
xray- toxic megabolon= a complication
double-contrast barium enema- detect mucosal changes =thickening, irregularity, superficial ulceration
colonoscopy is contraindicated in acute but can be used for direct visualization and obtaining specimen for histopathologoic correlation

52
Q

Crohn’s

A

terminal ileum. but can affect any part of GI tract.
barium enema- small bowel follow-through, enteroclysis, CT enterography
see mucosal inflm with transmural penetration, ulceration, strictures, skip lesions, abscess formation.

53
Q

ischemic colitis

A

xray- pneumatosis or bowel distention.
CT- with oral and IV contrast in early. nonspecific bowel wall thickening. sometimes see gas in mesenteric vein. heterogenous enhancement and loss of austral markings

54
Q

appendicitis

A

right iliac fossa.
choice-abn CT- see inflamed appendix with streaking. US-appendix diameter>6mm, non compressibility, lack of peristalsis, periappendiceal fluid collection

55
Q

midgut volvulus

A

whirlpool sign. bowel loops and superior mesenteric vein wrap around superior mesenteric artery

56
Q

cecal volvulus

A 
cecum normally in right iliac fossa but twisting can happen along vertical or transverse axis. 
xray- 1s test and diagnostic. see displaced cecum, small and large bowel obstruction up to pt of torsion, paucity of gas in distal colon. 
hypaque enema (single contrast) may confirm dx and lead to reduction or evolved cecum
CT-swirl sign with surrounding dilated bowel. more in adults
57
Q

sigmoid volvulus

A

usually in left lower quadrant. twist around mesenteric axis. usually in elderly debilitated pt with chronic constipation
xray- 1st and diagnostic- see double loop obstruction with variable proximal SMO. coffee bean sign. single contrast barium enema can dx and tx
CT- delineate complications like vascular ischemia

58
Q

pancreatitis xray

A

not necessary. but would see gases abdomen. sentinel loop sign= localized dilated small bowel. ileum of duodenal loop. colon cutoff sign. pancreatic calcifications in chronic cases

59
Q

pancreatitis CT

A

bulky, swollen pancreas with surrounding edema. localized fluid collections, abscesses, pancreatic ductal dilation

60
Q

esophageal cancer

A

SCC-upper esophagus. adenocarcinoma in lower.
early ca- dx on barium swallow done for eval of dysphagia
adv cancer-appear as mediastinal mass on X-ray and cause esophageal dilation with air fluid lvl, achalasia.
CT or endoscopic US for staging and tx.
PET- highest sensitivity

61
Q

indication for modified barium swallow

A

mouth -hypopharynx.
I: swallowing motor problem/ suspected aspiration e.g. post stroke
perform by speech pathology in conjunction with radiologist,

62
Q

I for esophagram

A

hypopharynx-GE junction / proximal stomach

I: dysphagia

63
Q

I for upper GI series

A

esophagus to ligament of trietz

I: epigastric pain, recurrent vomitting, post-gastric surgery, suspected malrotation and volvulus, GI bleed

64
Q

I for small bowel follow through and barium enema

A

duodenum -ileocecal valve

I: abdominal pain, suspected groin’s disease, suspected SBO, malabsorptive sx, GI bleed, suspected fistula

65
Q

DD colonic wall thickening

A

thumbprinting is sign of bowel wall thickening

1) bowel wall edema from IBD,
2) toxic megacolon,
3) ischemia
4) infection (C dif
5) hemorrhage

66
Q

supine radiograph

A

evaluated bowel distention, urinary that stone/stent, foreign body, tube placement

67
Q

oral contrast abdomen CT

A

I: IBD, abscess, extravasation post surgery, fistula mapping

allergies rare

68
Q

rectal contrast CT

A

I: penetrating trauma to pelvis, distal colorectal abn like fistula, surgical anastomotic leak

69
Q

IV contrast CT

A

opacify vasculature and visceral organ and urinary collecting system for detecting masses, abscesses, mesteric ischemia and aneurysms

70
Q

arterial phase CT

A

35-40s. pulmonary embolism, vascular lesion in liver or pancreas, anatomy of arteries

71
Q

portal venous phase CT

A

60-90s. solid abdominal viscera

72
Q

delayed phase CT

A

5-15min. lesion of liver, biliary, adrenal, renal, pancreas. CT urogram

73
Q

oral cotnrast MR

A

for enterography.

74
Q

barium edema or lower GI study

A

rectum to cecum or terminal ileum.

75
Q

double contrast BE

A

air insufflated to rectum along with barium

I: polyps, cancer, heme pos stool, diarrhea

76
Q

single contrast BE

A

barium or water contrast with no air

I: suspected perforation, obstruction, volvulus, ogilvies

77
Q

no GB reasons

A

non-distention due to inadequate fasting, surgically removed, congenitally absent, ectopic location, filled with stones

78
Q

nuclear hepatobiliary scan can detect

A

discriminate acute (direct detection of cystic duct obstruction) v chronic (greater than 4 hr post injection see GB bc of scaring of cystic duct, can be sped up by morphine) cholecystitis

2) dx acalculus cholecystitis in pt undergoing prolonged fasting.
3) CBD obstruction- lack of visualization of duodenum
4) dx bile leaks

79
Q

HIDA procedure

A

Tc-mebrofenein or DISIDA. = bile salt analog. 4 phases over 60min

1) uptake by hepatocyte
2) excretion into biliary tree
3) cocn in GB
4) passage into duodenum

80
Q

CT appendicitis

A

appendices wall thickening and enhancement- diameter >6mm
pericolonic fat inflm changing
pericolonic fluid- free or located
free intraperitoneal gas if perforated
maybe appenicolith
use IV contrast and get and and pelvis bc of variable location. oral contrast if have time

81
Q

ureterolithiasis

A

non-contrast CT abdomen/pelvis NCT- doesn’t assess renal func or degree of obstruction. passage likely if

82
Q

contrast induced nephropathy (CIN)

A

in 40% of pt with underlying renal failure.
prophylax with prednisolone and benadryl.
therapy- hydration with saline and or NaHCO3 and or N-acetylcysteine
prog- most recover normal renal function

83
Q

renal vascular hypertension

A

first line is MRA or CTA

84
Q

99mTc-MAG3 scintography

A

evaluate fun of kidneys tracked by gamma camera

85
Q

hematuria

A

need workup if >3RBC/hpf. if painless use CT urography bc suspect genitourinary malignancy

86
Q

kidney US

A

no doppler flow over lesion suggest cyst over solid mass

87
Q

cyst characterization

A

anechoic, homogenous, thin well defined walls with posterior through transmission need no further workup after US. round of oval shape.
if complex, next workup with MR abdomen with gad or pre/post IV CT

Radiology (3 decks)

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