DI 3- Final Flashcards
AP supine abd xray: stomach, SI, colon, Spleen
Visualized?
Stomach: ? can see magenblase
Small intestines: if contrast present, or gas, which is abN
Colon: yes, hepato and splenic-flextures); no: ascending and descending are retroperitoneal
Spleen-yes (SM mb seen)
AP supine abd xray: liver, GB, KD, adrenals
Visualized?
Liver: yes, anterior to stomach
GB:if stones or porcelain GB, otherwise need contrast
KD: outlined by fat, retroperitoneal, left higher than right, need contrast??
Adrenals: if calcifications
AP supine abd xray: pancreas, psoas, ureter, UB, ovaries, uterus
Visualized?
Pancreas: only if calcifications, retroperitoneal except tail
Psoas muscle: if calcifications from TB (Pott’s Dz)
Ureter: only w contrast
urinary bladder: yes, outline, more if full of pee
ovaries: no
Uterus: only see leiomyoma, if present
Describe the location of gas and/or barium in the stomach in the recumbent versus upright positions (both AP)
- Upright: see fluid line bubble. Barium settles to bottom, gas rises top
- Recumbent: see through all at once!
Describe the appearance of gaseous distention of the small versus large intestine.
- Gas acts as contrast agent, to highlight lumen
- LI: gas is normal
- SI: gas is abn (mb obst if >3cm); “stacked coin” or “coiled spring” appearance of mucosal folds (more folds in SI) = obst
- Jejunum: feathery pattern (gas/obst)
- Ileum=: clumped pattern (gas/obst)
- Bubbles: Outside GI = abscess, necrosis; Inside GI = benign
- Gas IN bowel wall: bubbles = benign; streaks = sinister
What is a sentinel loop?
• Loops of small bowel distention= indicate inflam + halted peristalsis dt acute pancreatitis (MC, L upper), acute appendicitis (R lower), acute cholecystitis (R upper)
Posterior displacement of the magenblase (gastric air bubble) is suggestive of enlargement of which organ?
• Liver: anterior to stomach, pushes things back more if enlarged
What is the normal orientation and position of the kidneys?
- Retroperitoneal
- Visible dt perirenal fat layer surrounding kidneys
- Inferior pole more lateral; superior pole more medial
- Left: higher, T11-L2
- Right: lower, T12-L3
4 different types of abdominal calcification patterns:
concretions
conduit wall
cystic
solid mass
abd calcif: concretions
- form in lumen of a vessel or hollow viscus (pelvic veins, GB, urinary tract) usu dt obst, stasis, infx, debris
- aka stones, caliculi (-lith)
- usu rounded or oval, mb faceted
- mb homogeneously dense (urinary calculi), slight central lucency (phlebolith), or circumferential laminations
- MC: Phleboliths (pelvic veins), gallstones, staghorn calculi (kidney), bladder calculi, fecaliths, appendicolith
- “non-lith”: liver & spleen granulomas, pancreatic concretions , prostatic concretions
abd calcif: Conduit wall
- in walls of hollow tubes/arteries, in parallel tracks (but mb not continuous)
- MC: abdominal aorta, common & internal iliac, splenic, renal arteries
- parallel lines of normal spacing do NOT indicate aneurysm; usually dt atherosclerotic plaques (must ddx)
abd calcif: cystic
o in wall of abn fluid-filled mass (ie not normally present, or normally seen w x ray, GB, etc)
o smooth, curvilinear rim of opacity, but mb gap/incomplete
o abd aortic aneurysm (50-80%, usu scattered)
o porcelain GB
o splenic cyst (ddx splenic a aneurysm)
o other aneurysms (not all?)
o other mesenteric and omental cysts (mb congenital, trauma, inflam)
abd calcif: solid-mass
• irregular border & complex architecture (mottled density, radiolucencies inside, mb whorled pattern w incomplete bands and arcs)
• Ex: LNs, leiomyoma, malig, dermoid cyst, TB, chronic abscess, bowel adenoma, adrenal abN
o psammaomatous calcifi: cloud-like or sand-like appearance in cystadenocarcinoma of ovaries
• MC: mesenteric LNs, usu dt TB; mb infx, Mets
• MC in female pelvis: Uterine leiomyoma (fibroid)
• Dermoid cyst (teratoma, mc ovarian tumor): L: ovaries; R: cystic teratoma
• adrenal gland: close to lumbar spine, often BL. Often incidental finding, mb Addison’s dz, other adenoma
What is a phlebolith?
- “vein stone”
- Normal: calc pelvic veins, seen at pelvic brim (lateral)
- oval to round, well defined, mb more translucent center
- Midline: always abn, mb dt mass in pelvis displacing the veins
Is plain film the best modality for diagnosis of an abdominal aortic aneurysm? If not, what is/are the best choice(s)?
- US is best; 98% accurate
- CT also OK, esp if leak suspected
- X-ray shows 50-80% calcifications
Describe the appearance and location of pancreatic calcification. Give the most common cause.
- Numerous dense, discrete opacities that cross midline at level of L1-2 (conforms to shape of PN)
- Seen on plain film
- MC: dt chronic pancreatitis from alcoholism
What is a dermoid cyst?
- Cystic teratoma
- MC ovarian tumor
- F, peak 20-40
- Seen on plain film: tooth, bone or fat, mb rim of calcification seen in area of ovary
Describe the appearance and location of a calcified uterine fibroma.
- MC uterine tumor, 25% F > 35
- Solid-mass calcif (irregular border and complex inner architecture, scattered radiolucencies)
- Seen somewhat midline in pelvis
- When small may look like LN
Describe the appearance and usual location of prostate calculi.
- Concretion calcification
- Dt chronic prostatitis, usu M>40, mb dt TB
- Sharply defined homogenous calcifications
- Seen at pubic symphysis (R = oblique)
What is an injection granuloma?
- Scar tissue from injections (SubQ into fat, rather than IM), usu gluts
- Solid mass calcification (mixed appearance)
Describe the appearance of residual contrast material in diverticulum.
• “Chocolate-chip sign”; dots across entire pelvis
What is a staghorn calculus?
- lithiasis fills entire lumen of renal pelvis & calyces
- pelvis may enlarge, thus stone will ↑
- Triple phosphate; 80 % calcify
- Entire collecting system affected
- Homogenously dense & sharply outlined
- Pure uric acid stones are radiolucent
What are some causes of pneumoperitoneum?
- MC: recent abd surgery (st intentional laparoscopic surgery)
- Also: trauma, perf viscus/organ (gastric/duodenal ulcer), bowel perf, communication thru F genital tract (spontaneous, medical EMERGENCY)
- Dx: on upright chest film best (or CT)
- Subphrenic air: air/space bw diaphragm & liver
What is the percentage of radiolucent vs. radiopaque gallstones?
- Radiolucent: 70 %, cholesterol, US, xray w oral cholecystogram (ingest radiopaque dye makes background white, stones radiolucent, also shows fxn)
- Radio-opaque (calcified): 30 %, x-ray, Ca-bilirubin stones
- Mercedes Benz sign: stones might look like a star
What is a porcelain gallbladder and its significance?
- Calcification of GB wall
- 10-20% → CA
- Normally don’t see GB on xray, unless its porcelain
What is a hiatal hernia and how may it appear on plain films?
- Protrusion of stomach thru portion of diaphragm
* See meganblase/gas above diaphragm
What is the difference in appearance in a contrast (barium) study of polyp, ulcer and diverticulum?
- Polyp: opacity inside lumen (usu do colonoscopy though!). Fewer than diverticulosis, usu bigger
- Ulcer: thickened or projecting outside wall (often stomach or duodenum), often just below diaphragm as single excess pouch
- Diverticulum: opaque outpouchings (usu sigmoid colon), usu mult
What is the apple core deformity?
- aka string sign
- colon CA (→ stricture/stenosis), or Crohn’s
- Annular CAs of colon = tumor encircles, narrows lumen
- looks like apple core or napkin ring
- see w contrast
What is the lead pipe appearance?
- UC
* Loss of haustra, colon appears uniform in size, like a pipe
What is the coiled spring appearance (also mb stacked coin) of the small bowel?
- Gas in small bowel, likely dt obst (SBO)
* mb solitary loop of air-filled dilated SI in LUQ (jejunum)
Describe the appearance of contrast within the collecting system of both kidneys during an IVP (IV pyelogram) in a pt w obst from a kidney stone in one ureter.
- MC stone site: ureter-bladder junction
- Obstructed side: delayed visualization
- then ureter will appear dilated
- kidney will retain the contrast longer than normal side
What is the percentage of radiolucent vs. radiopaque kidney stones?
- Opaque: 80% dt calcification (x-ray, cal ox, cal phos)
* Lucent: 10-20 % (US, pure uric acid stones)
What is hydronephrosis?
• Distension of kidney (pelvis & calyces) dt obst down the tract → atrophy of kidney
When would a retrograde pyelogram (RP) be performed
- RP = inject contrast into ureter to visualize ureter and kidney. Flow of contrast (up from bladder to kidney) is opposite the usual flow of urine (retrograde)
- Any hx renal failure or suspected renal dysfxn (looking for stones, tumors). Usu when IV excretory study (IVP or contrast CT) can’t be done dt renal dz or allergy to contrast
- Retrograde vs IV: Retro: dye just in pelvis and calyces and can see catheters; IVP more spread thru kidneys, “renal blush”
