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Learning Radiology > Ch.13 - Recognizing the Normal Abdomen: Conventional Radiographs > Flashcards

Ch.13 - Recognizing the Normal Abdomen: Conventional Radiographs Flashcards

1
Q

Air is normally present:

A
  1. Stomach.
  2. Colon - Especially rectosigmoid.
  3. A small amount of air (2-3 loops) may be seen in normal small bowel.
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2
Q

An air-fluid level level is found normally in:

A
  1. Stomach.
  2. 2-3 air-fluid levels may be seen in non dilated small bowel.
  3. Usually no fluid is visible in the colon.
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3
Q

An acute abdominal series usually consists of:

A
  1. Supine abdomen.
  2. Prone abdomen (or its substitute, a lateral rectum view).
  3. Upright abdomen (or its substitute, a left lateral decubitus view).
  4. Upright chest (or its substitute, a supine chest).
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4
Q

Supine view of the abdomen:

A
  1. The general scout view for the bowel gas pattern.

2. Useful for seeing calcification and detecting organomegaly or soft tissue masses.

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5
Q

The prone view:

A

Allows air, if present, to be seen in the rectosigmoid, which is important in the evaluation of mechanical obstruction of the bowel.

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6
Q

Upright abdomen may demostrate:

A

Air-fluid levels in the bowel or free intraperitoneal air.

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7
Q

The upright chest radiograph may demonstrate:

A
  1. Free air beneath the diaphragm.
  2. Pleural effusion (which may provide a clue as to the presence and the nature of intraabdominal pathology).
  3. Pneumonia - Which can mimic an acute abdomen.
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8
Q

Assessment of organomegaly/soft tissue masses:

A

CT/MRI/US have essentially replaced conventional radiography in the assessment of organomegaly or soft tissue masses.

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9
Q

Recognizing the normal abdomen - What to look for:

A
  1. Gas pattern.
  2. Extraluminal air.
  3. Calcifications.
  4. Soft tissue masses.
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10
Q

Normal distribution of gas and fluid in the abdomen:

A

Stomach –> Normally gas –> Normally air-fluid levels.
Small bowel –> Normally gas (2-3 loops) –> Normally air-fluid levels.
Large bowel –> Normally gas (esp. rectosigmoid) –> NO AIR-FLUID levels.

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11
Q

Acute abdominal series - Supine abdomen - Look for:

A
  1. Bowel gas pattern.
  2. Calcifications
  3. Masses.
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12
Q

Acute abdominal series - Prone abdomen - Look for:

A

Gas in the rectosigmoid.

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13
Q

Acute abdominal series - Upright abdomen - Look for:

A
  1. Free air.

2. Air-fluid levels in the bowel.

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14
Q

Acute abdominal series - Upright chest - Look for:

A
  1. Free air.
  2. Pneumonia.
  3. Pleural effusions.
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15
Q

To see an air-fluid on conventional radiographs, you must have:

A
  1. Air.
  2. Fluid.
  3. A horizontal x-ray beam (parallel to the plane of the floor).
  4. Air-fluid interfaces cannot be visualized on conventional radiographs taken with a vertical x-ray beam.
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16
Q

Abdomen - Conventional radiograph - What to look for?

A
  1. Overall gas pattern.
  2. Extraluminal air.
  3. Abnormal calcifications.
  4. Soft tissue masses.
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17
Q

Important point when looking a conventional radiograph of the abdomen?

A

You are looking for the overall pattern, so don’t spend too much time trying to identify every bubble of bowel gas you see.

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18
Q

Virtually, all gas in the bowel comes from …?

A

Shallowed air. Only a fraction comes from the bacterial fermentation of food.

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19
Q

There is almost always air in the stomach, UNLESS?

A
  1. The patient has recently vomited.

2. There is a nasogastric tube in the stomach and the tube is attached to suction.

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20
Q

The normal diameter of small bowel is less than?

A

2.5cm.

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21
Q

Large bowel - There is almost always air in the …?

A

Rectum + Sigmoid. Varying amounts in the remainder of the colon.

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22
Q

Stool is recognizable by …?

A

The multiple, small bubbles of gas present within a semisolid-appearing mass.

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23
Q

Aeophagia?

A

Individuals who shallow large quantities of air.

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24
Q

Aerophagia is characterized by?

A

Numerous polygonal-shaped, air-containing loops of bowel, none of which is dilated.

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25
Q

Stomach - Do we see fluid inside the stomach?

A

Yes - An air-fluid level is almost always demonstrated in the stomach.

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26
Q

How many air-fluid levels may be NORMALLY seen in small bowel?

A

2 or 3 air-fluid levels.

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27
Q

Air-fluid levels in colon?

A

NONE very few.

28
Q

Many air-fluid levels may be present in the colon, if the patient …?

A

Has had a recent enema or if the patient is taking medication with a strong anticholinergic, antiperistaltic effect.

29
Q

Depending on the amount of … around visceral organs, their outlines may be partially visible on conventional radiographs.

A

FAT –> Example is the psoas muscle which is surrounded by fat.

30
Q

Differentiating large bowel from small bowel - Recognizing large bowel?

A
  1. Peripherally placed.
  2. Haustral markings usually DO NOT extend completely across the large bowel from one wall to the other.
  3. If they do connect one wall with another, haustral markings are spaced more widely apart than the valvulae conniventes of the small bowel.
31
Q

Differentiating large from small bowel - Recognizing small bowel?

A
  1. Small bowel is centrally placed in the abdomen.
  2. Valvulae markings typically extend across the lumen of small bowel from one wall to the other.
  3. Valvulae are spaced much closer together than the haustra of the large bowel.
  4. Small bowel can achieve a max diameter, even when dilated, of about 5cm.
  5. Large bowel can dilate to many times that size.
32
Q

Normal PRONE abdomen?

A

AIR in the ascending and descending colon + rectosigmoid.

33
Q

There are 2 things to look for on an upright view of the abdomen?

A
  1. Air-fluid levels.

2. Free intraperitoneal air.

34
Q

Acute abdominal series - What it may contain?

A
  1. Supine view - Almost always.
  2. Prone or lateral rectum view.
  3. Upright or left-side down (left lateral) decubitus view - One or the other is almost always included.
  4. Chest - Upright or supine view.
35
Q

Acute abdominal series - Supine abdomen - Look for?

A
  1. Bowel gas pattern.
  2. Calcifications.
  3. Masses.
36
Q

Acute abdominal series - Prone abdomen - Look for?

A

Gas in the rectosigmoid.

37
Q

Acute abdominal series - Upright abdomen - Look for?

A
  1. Free air.

2. Air-fluid levels in the bowel.

38
Q

Acute abdominal series - Upright chest - Look for?

A
  1. Free air.
  2. Pneumonia.
  3. Pleural effusions.
39
Q

Acute abdominal series - Supine view (“Scout Film”) - How is it obtained?

A

Patient lies on his or her back on the x-ray table or stretcher and the x-ray beam is directed vertically downward.

40
Q

Acute abdominal series: Supine View (“Scout film”) - Substitute view?

A

There is really NO OTHER view that substitutes for a supine view of the abdomen.
Virtually all patients, regardless of their condition, can tolerate this part of the examination.

41
Q

During the course of a routine rectal examination …?

A

Almost NO AIR is introduced into the rectosigmoid during the course of a routine rectal exam.

42
Q

Acute abdominal series - Prone view - Substitute view?

A
  1. Frequently, patients are UNABLE TO LIE PRONE because of their physical condition (eg recent surgery, severe abdominal pain).
  2. These can turn on their LEFT SIDE and have a LATERAL VIEW OF THE RECTUM exposed with a VERTICAL BEAM to substitute for the prone radiograph.
43
Q

Pancreatitis may sometimes associated with?

A

A LEFT pleural effusion.

44
Q

Some ovarian tumors may be associated with?

A

Right-sided or bilateral pleural effusions.

45
Q

An abscess beneath the right hemidiaphragm …?

A

May be associated with a right pleural effusion.

46
Q

2 Abdominal calcifications that should NOT be confused with ABNORMAL calcifications?

A
  1. Phleboliths.

2. Calcification of the rib cartilages.

47
Q

Phleboliths - What are they?

A

Small, rounded calcifications that represent calcified venous thrombi that occur with increasing age.

48
Q

Phleboliths - Most often seen in?

A

The pelvic veins of women.

49
Q

Phleboliths classically have a …?

A

Lucent center.

50
Q

The lucent center of the phlebolith …?

A

Helps differentiate them from ureteral calculi with which phleboliths can be confused.

51
Q

Calcified cartilages tend to have what appearance?

A

An amorphous, speckled appearance.

52
Q

Conventional radiographic evaluation of soft tissue structures in the abdomen is …?

A

LIMITED - Because these structures are soft tissue densities + they are surrounded by other soft tissues of fluid of similar density.

53
Q

2 fundamental ways of recognizing the presence and estimating the size of soft tissue masses or organs on conventional radiographs of the abdomen:

A
  1. Direct visualization of the edges of the structure –> Can ONLY occur if it is surrounded by something of different density than soft tissue, like FAT or FREE AIR.
  2. INDIRECT evidence of the mass or enlarged visceral organ by recognizing pathologic displacement of air-filled loops of bowel.
54
Q

Normal liver in conventional radiograph:

A
  1. Normally displaces ALL bowel gas from RUQ.

2. Tongue-like projection of the right lobe –> RIEDEL.

55
Q

Enlarged liver in conventional radiographs:

A
  1. Might be suggested from conventional radiographs if there is displacement of all bowel from the right upper quadrant down to the iliac crest + across the midline.
  2. Notoriously POOR for estimating size of the liver.
56
Q

Enlarged spleen?

A

If the spleen projects well below the 12th posterior rib OR displaces the stomach BUBBLE toward or across the MIDLINE –> Spleen is probably enlarged.

57
Q

The portions of the kidney outlines may be visible on conventional radiographs if …?

A

There is an adequate amount of perirenal FAT present.

58
Q

The kidney length is approx. ?

A

The height of 4 lumbar vertebral bodies or about 10 to 14cm in size in an adult.

59
Q

The left kidney is roughly the same length as the …?

A

Spleen.

60
Q

The urinary bladder is about the size of a … when CONTRACTED.

A

LEMON

61
Q

Bladder enlargement is usually recognized by …?

A

Displacement of bowel out of the pelvis by a soft tissue mass.

62
Q

Normal uterus dimensions:

A

4x6x98.

63
Q

… is the best tool for evaluating the size of the uterus and ovaries.

A

US.

64
Q

The key to differentiating enlarged uterus from a distended bladder is …?

A

Identification of the LUCENCY between the bladder + the uterus –> When the uterus is enlarged, the FAT PLANE will be present.
When the bladder is dilated, the FAT PLANE will NOT be visible.

65
Q

Psoas muscle?

A

One or both of them may be visible if there is adequate EXTRAPERITONEAL FAT.

66
Q

Evaluation of the abdomen should focus on 4 main areas:

A
  1. Gas pattern.
  2. Free air.
  3. Soft tissue masses/Organomegaly.
  4. Abnormal calcifications.

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