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ST Radiology > Exam 3 - Abdomen > Flashcards

Exam 3 - Abdomen Flashcards

0
Q

What kind of special imaging is MC used for the esophagus?

A

Barium Swallow

Esophogram for Morphology & Motility

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1
Q

Special imaging for Pharynx & Esophagus

A
  • Barium

- CT Scan

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2
Q

What special imaging is used for the Stomach & Duodenum?

A
  • Barium: upper GI series

- CT Scan: Neoplasia & extent of disease

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3
Q

Why is barium used as special imaging for stomach & duodenum?

A

For Upper GI Series

Esophagogastric junction to Ligamen of Treitz

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4
Q

What special imaging is used for the Gallbladder?

A

Oral Cholecystography **
Ultrasound
CT Scan
HIDA aka cholescintigraphy **

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5
Q

What are the contents of Oral Cholecystography for Gallbladder?

A
  • Telopaque (contrast agen) - good for filling defects

- Cholecystagogue (fatty drink) - good for function

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6
Q

What is used to tract the flow of bile

Dx: bile duct obstruction, bile leakage, cholecystitis, gallstones

A

HIDA (hepatobiliary iminodiaceic acid scan) aka

Cholescintigraphy

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7
Q

What special imaging is the Gold Standard for the Pancreas?

A

CT Scan

It’s done first when disease is suspected

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8
Q

What special imaging is used for the Genitourinary Tract?

A
  • IVP/IVU
  • Excretory
  • Ultrasound
  • CT Scan
  • Cystography
  • Nuclear scans, angiography, MRI
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9
Q

What is IVP/IVU for Genitourinary Tract?

A 
IVP = intravenous pyelography
IVU = intravenous urography
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10
Q

What is Excretory for Genitourinary tract?

A

Pyelography / Urography

Run cannula up urethra & dump contrast

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11
Q

What is the most basic radiographic study of the urinary tract?

A

Excretory (pyelography / urography)

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12
Q

Special imaging for Genitointestinal tract?

A
  • Barium: GI mucosa & lumen
  • Iodinated Contrast: used with CT & MRI to show vasculature, duct systems, suspected perforation of lumen, parenchyma of solid organs
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13
Q

Special imaging for Colon:

  • Plain film?
  • CT Scan?
  • Colonoscopy?
  • Barium Enema?
A
  • Plain Film: obstruction
  • CT Scan: extent of disease
  • Colonoscopy: lumen
  • Barium Enema: obstruction, diverticulitis, inflammatory bowel disease, primary neoplasm
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14
Q

Special imaging for Liver & Bile Ducts

A
  • MRI & CT: small mass lesions
  • Nuclear Scinitigraphy
  • Ultrasound: obstruction (not complete) or inflammatory disease of bile ducts (initial evaluation) > cholangiography or retrograde cholangiography
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15
Q

Special imaging for Ovaries & Uterus

A
  • Ultrasound: usually used as the initial study
  • CT scan
  • MRI
  • Hysterosalpingography
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16
Q

Special imaging for Prostate

A
  • Ultrasound

- Retrograde urethrogram: looking for narrowing of prostate

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17
Q

An acute impairment of renal function after exposure to a contrast medium

  • Rise in serum creatinine within 2-5 days of exposure & usually returns to normal in 7-12 days
  • 1 in 75,000 contrast administrations result in death (allergic rxn)
  • Greater risk with intravenous delivery
A

Contrast Nephropathy

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18
Q

What patients are at a greater risk for Contrast nephropathy?

A
  • Pre-existing renal insufficiency
  • Insulin dependent diabetic w/ secondary renal disease
  • Repeated administration of contrast over short time (w/in 72hr)
  • Transplant & renal dialysis pts
  • Total iodine dose > 100g w/in 24 hour period
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19
Q

Disease that causes fibrosis of the skin & internal organs due to use of gadolinium in pts with renal insufficiency

  • Gado is not safer than iodinated contrast
  • Nephrotoxic
  • Carries & FDA blackbox warning
  • Should only be used for areas approved by FDA
  • Certain types more toxic than others
  • Pt w/anaphylaxis to iodine have increased risk to anaphylaxis w/gado
A

Nephrogenic Systemic Fibrosis (Dermopathy)

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20
Q

What film of the abdomen is used to diagnose bowel obstructions, gallstones & kidney stones?

A

KUB

Kidney Ureters Bladder

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21
Q

What is a KUB?

A

Plain film - Supine
SCOUT film — for barium enemas, bowel gas patterns, soft tissue
Ca++ may be obscured by contrast
Oblique view may be warrented

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22
Q

Describe Normal Bowel Gas in Stomach, Small Bowel & Large Bowel.

A

Stomach: almost always meganblasse
Small Bowel: 2-3 loops of nondistended bowel
Large Bowel: rectum & sigmoid (almost always

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23
Q

What is the normal diameter of the small bowel?

A

2.5 cm = 1 US quarter

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24
Q

What are the normal fluid levels in the stomach, small bowel, large bowel.

A

Stomach: almost always except supine
Small Bowel: 2-3 levels possible
Large Bowel: none normally

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25
Q

Supine abdomen view is looking for…

A

Bowel gas pattern, mass or calcification

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26
Q

Prone abdomen view is looking for…

A

Air in rectosigmoid

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27
Q

Upright abdomen is looking for..

A

Free air & air fluid levels in bowel

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28
Q

Upright PA Chest is looking for…

A

Free air, Pneumonia, Pleural effusion

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29
Q

May be difficult to see because they are ST structures surrounded by ST and fluid
Must be able to see an edge or notice displacement of surrounding structures

A

Organomegaly

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30
Q

How do you diagnose an enlarged liver? What is it called?

A

> 15 cm at midclavicular line 83%+

Hepatomegaly

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31
Q

How would you diagnose or recognize Hepatomegaly?

A
  • (>15cm) at midclavicular line 83%+
  • Inferior hepatic flexure
  • Transverse colon below right kidney
  • Liver shadow crosses right psoas margin
  • Elevated diaphragm
  • Riedel lobe
  • Liver should not be over right ilium
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32
Q

Anomalous lobe by inferior tongue of liver; not continuous with shape of liver

A

Riedel lobe

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33
Q

How would you diagnose Splenomegaly?

A
  • 12 cm longest axis
  • Not project below 12 post rib
  • Medial displacement of meganblasse
  • Inferior displacement of splenic flexure, left kidney inf & med
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34
Q

Describe an adult kidney

A
  • 10-14cm
  • No more than 1.5 cm difference from side to side
  • Right projects shorter than left (liver?)
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35
Q

Describe a child’s kidney

A
  • Measure fr: superior endplate of L1 thru inferior endplate of L4
  • Add 1cm to this measurement
  • This should be the length of the right kidney
  • Allow 1cm difference side to side
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36
Q

MC focal renal parenchymal lesions

  • Rare under 30 yoa
  • Found in 50% of adults over 50 yoa
  • Benign & contain serous fluid
  • May slowly increase or decrease in size over the years
  • Will be seen on plain film if there is calcification: peripheral rim
A

Simple Renal Cyst

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37
Q

May be seen on plain film when full of urine

  • Males: ______ on top
  • Female: _______ on top
A

Urinary Bladder
Males: Round on top
Females: Flat on top

38
Q
  • Superior or Inferior (MC 95%) poles are connected by functioning or nonfunctioning (fibrous) tissue
  • 1 in 400 births
  • MC renal fusion anomaly
  • MC in males
  • 1/3 have other anomalies (visceral or skeletal)
  • 1/3 asymptomatic
  • Midline mass on xray
  • More susceptible to trauma injury bc ureters pass over connecting tissue
  • Often have poor drainage = stasis or urine = infection & stones
A

Horseshoe Kidney ***

39
Q
  • Both superior & inferior poles are connected
  • Rare
  • Same possible complication as horseshoe
  • Midline soft tissue mass
A

Calxed (Caked) Kidney

40
Q

Kidney has bumps on the surface which are a residual from development

A

Fetal Lobulation

41
Q
  • Only left kidney

- Upper lateral aspect flat due to molding of the spleen

A

Dromedary Hump

42
Q

What kind of Obstruction:

  • Post surgical adhesions (MC 60%) weeks to year later
  • Neoplasms (20%)
  • Hernia (10%)
  • Inflammatory bowel disease (5%)
  • Volvulus (3%)
  • Ischemic strictures
  • Foreign bodies (over size of quarter)
  • Intussusceptions
  • Radiation ***
A

Mechanical Small Bowel Obstructions

43
Q

What type of obstruction:

  • Colon is dilated to the point of obstruction
  • Cecum is usually most dilated segment (12-15cm may rupture)
  • No or very few air fluid levels
A

Mechanical Large Bowel Obstruction

44
Q

What are the Plain film findings for bowel obstructions:

  • Upright?
  • Supine?
  • Air Fluid levels?
A

Upright = multiple air fluid levels >2.5cm inverted U dilated loops
Supine = dilated loops >3cm, step ladder, stack of coins
May not see air in large bowel

45
Q

Etiologies for Mechanical Large Bowel obstructions?

A
  • Colon CA (MC)
  • Diverticulitis (MC)
  • Hernia
  • Sigmoid or Cecal Volvulus
  • Fecal Impaction
46
Q

Etiologies for Small Bowel Obstruction?

A
  • Post Surgical adhesions (MC 60%)
  • Neoplasms (20%)
  • Hernia (10%)
  • Inflammatory bowel disease (5%)
  • Volvulus (3%)
  • Ischemic strictures
  • Foreign bodies (over size of quarter
  • Intussusceptions
  • Radiation ***
47
Q

List 4 common locations for Extraluminal Air

A
  1. Intraperitoneal (pneumoperitoneum)
  2. Retroperitoneal
  3. Air in bowel wall (pneumatosis intestinalis)
  4. Air in biliary system (pneumobility)
48
Q

Etiologies:

  • Perforated gastric/duodenal ulcer (MC) ***
  • Perforation from carcinoma, appendicitis or diverticula
  • Trauma
  • Recent laparoscopy (resolves 3-10 days)
  • Ostomy bags / Colostomy bags
  • Peritoneal infection (gas forming organism)
  • Recent surgery
A

Pneumoperitoneum / Intraperitoneal

49
Q

Radiographic findings of Pneumoperitoneum/Intraperitoneal

A
  • Air beneath diaphragm
  • Visualization of BOTH SIDES of bowel wall (Rigler/double wall/gas relief sign) ***
  • Visualization of falciform ligament (a lot of air and supine)
50
Q

Air in the biliary tree due to a communication w/GI tract or skin
Etiologies:
- Surgery, Trauma, Biliary-enteric fistulas, infections, anomalous development of duct

A

Pneumobilia (air in bowel wall)

51
Q

MC non-surgical cause of Pneumobilia

A

Biliary-enteric fistulas

52
Q

Radiographic findings of Pneumobilia

A
  • Tubular branching lucencies over the liver shadow

- Air in lumen of gallbladder

53
Q

Obstruction of the intestine by an ectopic gallstone
- Mechanism:
Inflam > Adhesion > Duodenum > Gallstones erode thru
- MC females (7-8x)

A

Gallstone Ileus

54
Q
  • 70% of Small Bowel Obstructions (SBO) > 70yoa

- 70% obstruct ileocecal valve if > 3cm

A

Gallstone Ileus

55
Q

All of part of the stomach herniates thru the diaphragm

A

Hiatal Hernia

56
Q

MC type of Hiatal hernia & includes the fundus & cardia

A

Sliding (axial)

57
Q

2nd MC type of hiatal hernia & includes the fundus

A

Paraesophageal

58
Q

Type of hiatal hernia that includes entire stomach except pyloris

A

Intrathoracic

59
Q

Type of hiatal hernia that includes gastroeophageal junction

A

Short Esophagus

60
Q

Radiographic characteristics of Hiatal Hernia

frontal view & lateral view

A

May be fluid filled, air filled or air-fluid filled
Frontal: medial base of left lung over left side of heart
Lateral: posterior mediastinum (if larger) may cover spine

61
Q

What are some DDx of Hiatal Hernia?

A 
Pulmonary Cyst (normally not the case)
Lung Abscess (pt will be sick, fever, ill)
Diaphragm Tumor (no air density)
62
Q

What is the diagnostic for hiatal hernias?

A

Barium swallow

63
Q

What location aids in diagnosing & recognizing abnormal calcifications

A

Midline & L3/4 disc is horizontal line divider

64
Q

Intraperitoneal (anterior) structures:

A
  • Liver
  • Gallbladder
  • Spleen
  • Stomach
  • Omentum
  • Bladder (portion of)
  • Prostate (portion of)
  • Large & small bowel (portion of)
65
Q

Retroperitoneal (posterior) structures:

A
  • Kidneys & Ureters
  • Pancreas
  • Ovaries & Uterus
  • Rectum
  • Bladder (portion)
  • Prostate (portion)
  • Large & small bowel (portion)
66
Q

What structures lie in both Intraperitoneal (ant) & Retroperitoneal (post)?

A
  • Bladder
  • Prostate
  • Large & small bowel
67
Q

What are the following Patterns of Calcification:

  • Rim-like?
  • Linear or Track-like?
  • Lamellar or Laminar?
  • Cloud-like, Amorphous, Popcorn
A
  • Cyst
  • Conduit
  • Concretion
  • Mass
68
Q

List the 5 Cyst wall (rim-like) calcifications:

A
  1. Aneurysms
  2. Porcelain gallbladder
  3. Cysts w/in kidneys, adrenals, liver, ovary, mesentery
  4. Some uterine fibroids
  5. Bladder wall (rare)
69
Q

Type of calcification found in wall of a fluid filled cyst or hollow organ.

A

Cyst Wall (rim-like) calcification

70
Q

Identify based on this description:

  • A thin shell of calcification is characteristic
  • Without calcification, a soft tissue mass may be seen
  • Lateral Lumbar view: measurement >3.8cm requires special imaging
  • AP view: usually projects to the left of the midline
  • Oppenheimer Erosions (5%)
  • Ultrasound is special imaging of choice
A

Abdominal Aortic Aneurysm

71
Q

Erosions made by an aneurysm at vertebral bodies

A

Oppenheimer Erosions

72
Q

Identify based on this description:

  • Up to 10% pts > 60 yoa
  • Etiologies: atherosclerosis, trauma, infection
  • Looks similar to cyst
A

Splenic Artery Aneurysm

73
Q

Identify based on this description:

  • Larvae from the tape worm
  • MC in Liver
  • Sheep, caribou –> Dog –> Us
A

Hydatid / Echinococcal Cysts

echinococcus granulosis

74
Q

Calcification within a channel that conveys fluid

May show flecks of calcification along the route of a vessel, parallel tracts, branching tracks or ring like opacities.

A

Conduit (linear or track-like) Calcification

75
Q

What are the 3 MC types of Conduits

A
  • Urinary Tract
  • Vas Deferens
  • Blood Vessels
76
Q

Tortuous blood vessel in LUQ

A

Splenic Artery Calcification

77
Q

Calcification in the Gallbladder wall

  • chronically inflamed & thickened wall
  • MC females (5:1)
  • asso w/ stones, obstructed cystic duct, carcinoma (10-20%)
  • ovoid or pear shaped
  • refer if pt has had past gallbladder issues (first differential)
  • refer if you see a cyst (2nd differential)
A

Porcelain Gallbladder

78
Q

Calcifications that form within a duct, conduit or hollow organ
Typically formed by precipitation of calcium salts which form layers over time (pearl in oyster)

A

Concretion (lamellar, laminar) Calcification

79
Q

What are some types of Concretion (lamellar, laminar) Calcification?

A
  • Gallbladder (gallstones)
  • Urinary tract (renal, ureteral, bladder stones)
  • Kidney stones
  • Staghorn Caliculi
80
Q

Concretion Calcifications that are calcium carbonate, show up on plain films (10-15%), “Mercedes Benz” sign or “Crow Foot” fissures that have fluid within them.

A

Positive Gallstones

81
Q

Concretion Calcification that are made of cholesterol, don’t show up on plain films (85-90%), Telopaque

A

Negative Gallstones

82
Q

Concretion calcifications in old men with urinary stasis or secondary to urinary stasis — higher incidence of bladder cancer

A

Urinary Tract

Renal, Ureteral, Bladder Stones

83
Q

Concretion Calcification that MC show up over the ilium, sometimes over the sacrum

A

Diverticulum/Appendix

Appendicolith, Fecalith or hard poop

84
Q

Concretion Calcification of pelvic veins

A

Phlebolith

85
Q

Concretion Calcification of the prostate would be most likely noticed where in an xray?

A

Tiny & right at pubic symphysis

86
Q

What % of kidney stones can be seen on plain film? What are the 3 common places they can be found?

A

90% seen on plain film

  1. Trigone/Pelvis of kidney
  2. Where ureter crosses iliac artery
  3. In trigone of bladder
87
Q

Concretion calcification in females with chronic kidney infections.

  • Resembles deer horn
  • Not a tumor
A

Staghorn Caliculi

88
Q

What is the most common cause of pancreatic calcification (concretion calcification)?

A

Alcoholics

Diabetics could also be because of this

89
Q

MC benign calcification in the abdomen

  • seen on film
  • concretion calcification
A

Mesenteric Lymph Node Calcification

90
Q

What type of calcification is this:

  • Wide range of radiographic patterns
  • Typically dense center w/irregular margins
  • May be amorphous (irregular shaped), curvilinear, flocculent
  • Calcified mesenteric lymph nodes
  • Some uterine fibroids
  • Liver & Kidney malignancies
  • Many benign tumors
A

Mass (cloud-like, amorphous, popcorn) Calcification

91
Q

10% of all ovarian tumors are …

A

Dermoid Cysts

92
Q

Mature teratomas / Cystic teratomas

  • contain tissue from all 3 germ layers (meso, endo, ecto)
  • arise during active reproduction years
  • radiographic characteristics:
    • may contain teeth (30%, bones & other tissue
    • 10% have marginal calcification
    • 35% contain fat (solid mass) & may be only radiographic finding
A

Ovarian Dermoid Cysts

93
Q

Calcification:
Popcorn or cauliflower like
Mottled or speckled
Coarse marginal rim
Cyst-like rim
- You cannot determine size or number of lesions based on calcification
- If area of calcification is noted to expand on films taken weeks to months apart = suggests malignant degeneration

A

Leiomyoma, Uterine Fibroid, Uterine Fibroma

ST Radiology (3 decks)

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