DI 3 Final Flashcards
Which of the following (organ or structure outline) can be visualized in the normal AP supine abdomen radiograph?
Spleen
Liver
Kidney
Urinary bladder
Describe the location of gas and/or barium in the stomach in the recumbent versus upright positions.
Upright position will see fluid line bubble.
Barium settles to the bottom and gas rises to the top.
Describe the appearance of gaseous distention of the small versus large intestine.
- Gas normal in Lrg. intestines, Abnormal in S.intestines
- Small intestinal (obstruction likely if >3cm); “stacked coin” or “coiled spring” appearance of mucosal folds
- Jejunum=feathery pattern
- Ileum=clumped pattern (if gas/obstruction present)
- Bubbles outside GI=abscess, necrosis;
- bubbles inside GI=benign
What is a sentinel loop?
Loops of small bowel distention
- indication of inflammatory process + halting of peristalsis
- dt acute pancreatitis MC
Posterior displacement of the magenblase (gastric air bubble) is suggestive of enlargement of which organ?
Liver
What is the normal orientation and position of the kidneys?
- Retroperitoneal
- Inf. pole is more lateral; Sup. pole is more medial
- Left kidney=higher=T11-L2
- Right kidney=lower=T12-L3
Describe the four different types of abdominal calcification patterns and common examples of each.
Concretions:
“lumen of vessel or hollow organ” (pelvic veins, GB, urinary tract) Homogeneously dense, round or oval
- Phleboliths=pelvic veins
- Gallstones
- Staghorn calculi (kidney)
- Bladder calculi
- Liver & spleen granulomas
- Pancreatic concretions
- Prostatic concretions
Conduit wall:
- Walls of hollow tubes/arteries
- Parallel tracks of calcification
- MC: abdominal aorta, common & internal iliac , splenic, and renal arteries, vas deferent calcification
- Parallel lines do NOT indicate aneurysm; usually dt atherosclerotic plaguing
Solid-Mass calcification:
- Irregular border & complex architecture
- Mottled density with radiolucencies within
- MC: mesenteric lymph nodes calcification dt TB
- MC in female pelvis: Uterine leiomyoma (fibroid)
What is a phlebolith?
*Normal calcification of pelvic veins, seen at pelvic brim (lateral portion of pelvis)
If seen midline, abnormal=> likely 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)?
Ultrasound 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 the midline at the level of L1-2 (conforms to the shape of the PN)
- Seen on plain film
*Dt chronic pancreatitis from alcoholism
What is a dermoid cyst?
Cystic teratoma
*MC ovarian tumor
20-40 y.o. females
Seen on plain film: tooth, bone or fat seen in area of ovary
Describe the appearance and location of a calcified uterine fibroma.
MC uterine tumor
Solid-mass calcification (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
Sharply defined homogenous calcifications
Seen at pubic symphysis
What is an injection granuloma?
Scar tissue from injections given routinely in the gluts
Solid mass calcification (mixed appearance)
Describe the appearance of residual contrast material in diverticulum.
“Chocolate-chip sign”; dots across the whole pelvis
What is a staghorn calculus?
- Huge Renal Lithiasis (kidney stone)
- Triple phosphate; 80 % calcify
- Grows to fill entire lumen of renal pelvis & calyces
- Entire collecting system is affected by huge stone
What are some causes of pneumoperitoneum?
*MC: recent abd surgery
Also: trauma, perforated organ (gastric/duodenal ulcer), bowel perforation, communication thru female genital tract
*Dx: on upright chest film best
Subphrenic air: air/space btn diaphragm & liver
Gallbladder
What is the percentage of radiolucent vs. radiopaque gallstones?
- Radiolucent: 70 %, see on ultrasound
* Radio-opaque (calcified): 30 %, see on x-ray
What is a porcelain gallbladder and its significance?
- Calcification of GB wall
- Carcinoma develops 10-20% of cases
- Can visualize GB on plain film if it is porcelain
Gastrointestinal tract:
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 of lumen
- Ulcer: often appears thickened or projecting outside wall (often in stomach or duodenum), often seen just below diaphragm as single excess pouch
- Diverticulum: opaque outpouchings (usually in sigmoid colon), multiple usually seen
What is the apple core deformity?
- AKA string sign
- Carcinoma of colon, or Crohn’s
- Tumor has encircled the lumen, so it appears thinner than rest of colon
What is the lead pipe appearance?
- Ulcerative colitis
* Loss of haustra, colon appears uniform in size, like a pipe
What is the coiled spring appearance of the small bowel?
Gas in small bowel, likely dt obstruction
Urinary tract:
Describe the appearance of contrast within the collecting system of both kidneys during an IVP in a patient with obstruction from a kidney stone in one ureter.
- MC stone site is at ureter-bladder junction
- Obstructed side: delayed visualization, then the ureter will appear dilated, and the kidney will retain the contrast longer than the normal side.
What is the percentage of radiolucent vs. radiopaque kidney stones?
Opaque: 80% dt calcification (see on x-ray)
Lucent: 10-20 % (see on U/S)
What is hydronephrosis?
Distension of kidney (pelvis & calyces) dt obstruction down the tract
When would a retrograde pyelogram be performed
Any hx of renal failure or suspected renal dysfxn
