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CT COURSE > CT ABDOMEN > Flashcards

CT ABDOMEN Flashcards

1
Q

When are non- contrast studies used to visualise the abdomen (CT)?

A

When the patient:

  1. Has impaired renal function
  2. Has renal colic
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2
Q

When is the arterial phase helpful?

A

To visualise:

  1. Haemorrhage
  2. Aneurysms
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3
Q

How long does it take IV contrast to reach the portal veinous system (I.e. when can you image in the portal veinous phase)?

A

60 s

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4
Q

What is the main phase used to image the abdomen for an undifferentiated illness?

A

Portal- veinous phase

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5
Q

When can you image in the delayed phase?

A

6-10 minutes after admin of contrast

Collects in the renal calyces and pelvis

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6
Q

What is the delayed phase helpful for?

A

To image eg incidental liver lesions, urinary tract injuries

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7
Q

When is PO contrast used?

A

To image the bowel in case of post surgical leak or fistula

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8
Q

In which windows must you review the images?

A

Soft tissue
Bone
Lung - look for pneumoperitoneum

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9
Q

Name one systematic technique you may use not to miss anything when reviewing the abdominal CT.

A 
Solid organs 
Hollow viscera
Soft tissue 
Retroperitoneum 
Lymph nodes 
Bones
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10
Q

Discuss how the liver is separated into segments and by which veins.

A

By the portal veins transversely and the hepatic veins vertically

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11
Q 
In a clockwise direction
Which lobes can you see on the liver in a transverse view when: 
1. Separated by the hepatic veins
2. Portal veins 
3. Below portal veins
A
  1. 7,8,4a, 2
  2. 6/7, 5/8, 4a/b, 2/3
  3. 6,5, 4b, 3
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12
Q

What are the tributaries of the portal vein?

A

Superior mesenteric and portal veins

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13
Q

What does a hepatitic liver appear as on CT?

A

Normal
Diffuse/ patchy hypodensity
Hepatomegaly

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14
Q

What are the mimics of hepatitis?

A

Diffuse fatty infiltration

Hyperechoic fat on US

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15
Q

What do patients with hepatic abscesses normally present with?

A 
RUQ pain
Fever 
Rigours
Malaise 
Weight loss
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16
Q

Describe the appearance of a liver abscess on CT

A

Hypodense lesion with peripheral enhancement

May or may not have a fluid level

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17
Q

What are the common routes of infection in the liver?

A

Biliary tree
Portal vein
Spleen
Direct extension from bowel

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18
Q

What are the complications of a liver abscess?

A

Portal or hepatic vein thrombosis

19
Q

Describe the CT appearance of the following:

  1. Simple cysts
  2. Haemangioma, adenoma, HCC, FNH
  3. Cholagiocarcinoma
A
  1. No enhancement
  2. Arterial enhancement
  3. Delayed phase enhancement
20
Q

Describe the CT appearance of a perforated gall bladder

A

Irregular wall with loss of continuity

Collections forming next to gall bladder

21
Q

What is the first line investigation of acute cholecystitis?

A

Ultrasound

22
Q

What are the CT appearances of acute cholecystitis?

A 
Normal in early cases 
Distension
Fat stranding 
Subserosal halo 
Wall thickening >3 mm + enhancement 
Visible gallstones in 15% radio opaque
Mucosal sloughing
23
Q

What are the complications of acute cholecystitis?

A 
Abscess
Haemorrhage 
Gallstone ileus 
Perforation 
Emphysematous cholecystitis
24
Q

What is the CT sensitivity for cholelithiasis?

A

30% depending on calcium content

25
Q

Why is it not useful to image tha spleen in the arterial phase?

A

The spleen can appear markedly heterogenous
Can appear lacerated
Or lesions

26
Q

How does the spleen appear on the portal veinous phase?

A

Homogenous

27
Q

What are the anatomical divisions of the pancreas?

A

Head, neck, body, tail

Head body and tail often visible in the transverse view

28
Q

How does acute pancreatitis appear on CT?

A

Diffusely enlarged with peripheral enhancement and fat stranding

29
Q

Describe the appearance of the adrenal glands on CT in the transverse view.

A

Consists of a body, medial and lateral limbs,

Very tiny

30
Q

What does adrenal haemorrhage appear as, on CT?

A

Can be a massive heterogenous mass

Or 30-90 HU density around the adrenals, can be small

31
Q

What does at adrenal adenoma look like on CT?

A

Low density, containing fat, small lesion

32
Q

How do the kidneys appear on contrast- enhanced imaging?

A

The corticomedullary differentiation is quite clear, there are upper, mid and lower poles

33
Q

When is the rest of the urinary system best imaged?

A

6-10 minutes after contrast administration on the delayed phase, you can visualise the pelvis and the ureters more clearly. Use delayed phase imaging to further delineate the collecting system in trauma settings

34
Q

What are the kinds of renal trauma you can possibly get?

A

Range from haematoma -> laceration of the medulla -> larger including laceration of the pelvis, ureters -> vascular injury involving the renal pedicle.

35
Q

Laceration appearance of kidneys on CT

A

Linear hypotedense lesions

36
Q

What are the features of acute pyelonephritis on CT?

A
  • Normal
  • Swelling
  • Altered nephrogram
  • Loss of corticomedullary differentiation
  • Dilated renal pelvis and urter- +/- wall thickening
  • Perinephric stranding
37
Q

Describe the appearance of renal infarction on CT

A 
Sharp demarcation, 
Altered enhancement
Loss of corticomedullary differentiation
Cortical rim sign (subacute)
\+/- Subcapsular fluid collection
38
Q

What are the common sites of renal calculi

A

PUJ
Pelvic brim where it crosses the iliac vessels
VUJ

39
Q

What is the likelihood of a 4 mm stone passing?

A

80%

40
Q

What is the likelihood of 4-6 mm stones passing?

A

60%

41
Q

What is the likelihood of >8 mm stones passing?

A

20%

42
Q

How do cysts appear in the renal cortex?

A

Low density circumscribed lesions
0-10 HU
Pedunculated/ cortical/ parapelvic

43
Q

0-100 HU, heterogenous, circumscribed lesions with risk of haemorrhage with minor trauma
What is this lesion?

A

Angiomyolipoma

44
Q

Poorly defined lesion with soft tissue density
May have renal vein extension
Lymph node involvement

A

Renal cell carcinoma

CT COURSE (1 decks)

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