B5-016 Abdominal Imaging Flashcards
if you can see lung bases in the view this typically indicates…
upright position
what are normal KUBs good for?
evaluating gas patterns
looking for free air
where would you expect to see gas on normal KUB?
stomach
most segments of colon
normal limits of bowel distension
small bowel: 3cm
colon: 6cm
cecum: 9cm
3-6-9 rule
what portion of the small bowel will be in the LUQ on normal KUB?
jejunum
what portion of the small bowel is in the RLQ on normal KUB?
ileum
where does the air collect in an upright view of pneumoperitoneum?
under the diaphragm
normal gas pattern
calcification in RUQ
gallstones
calcifications in renal silhouette
kidney stone
what imaging modality is better for evaluating solid viscera?
CT/ultrasound
would you use contrast in evaluating nephrolithiasis via CT?
no
actually makes the stones harder to see
identify liver, spleen, esophagus, stomach, IVC
identify lobes of liver, ligamentum venosum, ligamentum teres hepatis
3 structures of porta hepatis
portal vein, hepatic artery, common duct
common duct is hard to see in nondistended state
identify the structures of the porta hepatis
common duct cannot be visualized in nondistended state
dominant vessel to liver providing 80% of blood flow to hepatic parenchyma
portal vein
formed by confluence of splenic vein and superior mesenteric vein
portal vein
identify portal vein, splenic vein, SMV, SMA
how would the gallbladder look in a post prandial state?
contracted
hard to visualize
what is the arrow pointing to?
gallbladder
structures surrounding pancreas
4
- biliary tract
- duodenum
- aorta/IVC
- splenic vessels
what structure is the arrow pointing at?
cecum
what structure is the arrow pointing at?
transverse colon
what is the arrow pointing at?
descending colon
major branches of aorta
4
celiac axis
SMA
IMA
renal arteries
normal measurement of abdominal aorta
2 cm
the left renal vein is […] than the right renal vein
longer
what structure is outlined?
adrenal gland
what imaging modality would be preferred to exam solid organs in patients who cannot have IV contrast or need limited radiation?
ultrasound
what imaging modality is great for looking at vessels?
ultrasound
due to color Doppler imaging
what is the significance of this imaging?
round hypoechoic areas scattered throughout liver
malignant metastasis in liver
what is the significance of this image?
dilated renal pelvis
hydronephrosis
kidney stones -US
ACR Appropriateness Criteria for Jaundice- no known predisposing criteria
just list the green ones
US abdomen
CT abdomen with contrast
MRI abdomen without and with IV Contrast
how might you describe this US of liver?
nodular
heterogenous
cirrhosis
what does the image indicate?
in general
solid mass
color doppler shows vascular structure
if a mass demonstrates
- early hyperenhancement (hepatic arterial supply)
- rapid washout (tumor neovascularity/AV shunting)
- delayed rim enhancement (mass effect)
HCC
definitive test, no need for biopsy
- most common primary hepatic malignancy
- strongly linked to chronic liver disease
- third most common cancer death worldwide
HCC
leading cause of cirrhosis in US
viral hepatitis
followed by alcoholism
predicted to become leading cause of cirrhosis in the US in 10-15 years
NASH
currently third most common
what imaging modality is used for screening for HCC?
US
what imaging modality is used for diagnosis of HCC?
CT and/or MRI
biopsy not necessary for treatment
a target sign on US confirms
intussusception
treatment for intussusception
therapeutic air enema
how does intussusception occur?
the invagination of the intussuceptum into the intussusceptient in the telescope-like manner
most intussusception occur where?
ilieocolic
terminal ileum telescopes into cecum
why are intussuceptions more common in winter months?
thought to be associated with viral illnesses
- crampy abdominal pain
- blood, currant jelly stool
- palpable right sided abdominal mass
- child 3 months-1 year old
intussusception
contraindication of image guided reduction of intussusception
perforation
a majority of intussusception are
cause
idiopathic
what is the most likely type of intussusception?
ileo-colic
what age group are intussusceptions most common in
under 1
during winter months
describe the classic enhancement characteristics of HCC on CT/MRI
increased early enhancement and decreased delayed enhancement
leading causes of non alcoholic fatty liver disease
DM and obesity
expected to become the leading cause of cirrhosis in the US in 10-15 years
non alcoholic fatty liver disease
pneumoperitoneum is an absolute contraindication to performing
air enema reduction of intussusception
leading cause of cirrhosis currently
chronic hepatitis
normal limits for small bowel distension
3 cm
normal limits for colon distension
6 cm
normal limits for cecum distension
9 cm
in an upright radiograph, free intraperitoneal gas will be seen where?
under right hemidiaphragm
a KUB is best used to evaluate
gas patterns
gas seen within the colon on a KUB would most likely be seen where?
periphery of colon
gas seen within the jejunum on KUB would most likely be seen in which location?
upper left quadrant
gas seen within the ileum on KUB would most likely be seen in which location?
right lower quadrant
gas seen within the small bowel on KUB would most likely be seen in which location?
centrally located
why is US not typically used to evaluate bowel?
air in the bowel has high acoustic impedence and will cause a lot of shadowing
