Exam IV: Abdominal and Pelvic Imaging Flashcards

Question

Abdominal CT

Answer 1

Axial, cross-sectional imaging Images are viewed “looking from the feet up” GI tract lumen identified via oral contrast I.V. contrast provides tissue enhancement, and is excreted by the kidneys Abdominal CT scan is from dome of liver to perineum, with contiguous “slices” 0.5-1cm thick Shorter patient- get more info and smaller slices Taller patient: get less information because larger slices

Answer 2

No matter which imaging method is involved or what part of the body you are looking at, if the image is axial it should be displayed the same way: The patient’s right side to your left and vice–versa Anterior is up, posterior is down

Answer 3

Highest slice Patient’s right on your left and vice-versa Right hemidiaphragm and liver are most superior part of abdomen Aorta “lights up” - IV contrast has been given Small portion of lungs visible ``` Remember relative densities: Bone and metal are white Fat below skin is dark grey Muscle and organs are lighter gray (heart and liver) Air is black (lungs, esophagus) ```

Answer 4

Stomach and spleen are larger Large vein within liver is portal vein Still some lung tissue visible posteriorly Gallbladder is dark – no contrast going there Stomach has air and contrast material in lumen – air fluid level IVC is buried within liver Muscles are more prominent in lumbar region

Answer 5

The first time you see a branch of the aorta you know it is the celiac trunk Left kidney shows up first Second large branch of aorta is superior mesenteric artery coursing downward Large diameter vessel crossing over to vena cava is left renal vein Aorta splits into iliac arteries – What spinal level? (L4) umbilical cord level

Answer 6

Sheet of tissue with arteries, veins, nerves, lymphatics that covers the GI tract; support system leading to the GI tract and holds it in

Answer 7

Diverticulosis is a simple asymptomatic outpouching of the colon easily seen on barium enema Diverticulitis is “inflammation of” the diverticula Signs include: Multiple pockets of air indicating abscess formation Bowel wall thickening Inflammatory changes of diverticulitis are best seen on CT (test of choice)

Answer 8

Denser than normal bile Not solid stones Abnormal but may or may not be symptomatic

Answer 9

Greater than 3mm is abnormal Fluid around gallbladder and thickening of wall Both are signs of inflammation and probable cholecystitis

Answer 10

Dilation of intrahepatic ducts indicates distal obstruction but does not tell where If bile cannot be excreted patient becomes jaundiced, eventually leads to liver failure

Answer 11

Ultrasound can measure the diameter of the duct Greater than 10 mm indicates dilation Multiple possible causes: gallstone benign stricture malignancy

Answer 12

Hepatobiliary iminodiacetic acid (HIDA) scan HIDA with radioactive tracer is injected IV, excreted by liver into bile, enters the GB and flows into the bowel With cholecystitis, the cystic duct is blocked, and there is no visualization of the GB, even on delayed images

Answer 13

Endoscope down throat into 2nd portion of duodenum Dye injected into ampula of Vater Endoscope and put into bile duct and inject contrast Pumping the contrast backwards = retrograde ERCP gives more detail than US or HIDA scan

Answer 14

``` Post cholecystectomy Checks for stones in common bile duct Negative image Dye is injected through cystic duct Darker area is contrast material ``` Take cystic duct and pump in contrast= white spots in the dark bile duct = gallstones blocking it- can be fatal or cause liver failure so need to remove them

Answer 15

Must be able to pass a guide wire in order to place a stent | Arterial wall is outside stent but does not show on x-ray

Answer 16

Materials containing Iodine and given IV are mildly toxic to the kidneys In patient with healthy, normal kidneys – no problem With a patient with renal “insufficiency” – no IV contrast If the patient is in full blown renal failure – No problem, contrast is removed at next dialysis IV iodinated contrast material can cause allergic reactions Rare (0.22 to 0.04 percent of patients) NOT associated with shellfish allergy

Answer 17

Each image is a “KUB” First film is taken before contrast is given and then at 5, 10, and 15 minutes On the five minute film: Contrast is in the Kidney and collecting system Kidneys should be roughly equal in size Calyces should be sharp in outline and symmetrical with equal filling Ureters are just beginning to show

Answer 18

10 minutes: Ureters are completely filled Any calculi (stones) or strictures would be seen here 15 minutes: Bladder is filling giving a clear outline Any abnormalities in shape or filling voids within would be visible Throughout the procedure attention is paid to the rate of filling and any abnormalities would be noted in the report Post void film would show whether bladder is emptying properly

Answer 19

Performed during cystoscopy by the Urologist Patient is sedated Catheters are visible going into ureters and bladder is not filling Gives excellent detail of collecting system, clearly defines stones or obstruction Uses the same iodinated contrast as IVP but less toxicity since the kidney does not have filter the material out of the bloodstream Inject dye into ureters into kidneys (but not filtered by kidneys) No functional info, just structure of kidneys

Answer 20

``` Screening modality Non invasive structural assessment Can measure size of kidney and characterize renal masses Evaluate for obstruction Does not give fine detail US are test of choice for cysts ```

Answer 21

Caused by obstruction of urine flow Presents with severe pain but no change in urine output Is reversible if treated early Ultrasound is test of choice

Answer 22

Sagittal view Provides information about labeled structures but with limited detail Very dependent upon body habitus- thin patient get excellent images, but more adipose tissue the worse the images

Answer 23

Sagittal image (divides right from left) Transvaginal imaging places the ultrasound transducer closer to the uterus with less intervening tissue Provides excellent detail See endometrium Doesn’t matter how much adipose tissue aka less dependent upon body habitus

Answer 24

Inject saline into uterus past the cervix= equivalent of contrast If endometrial polyp – see this

Answer 25

Transvaginal ultrasound is test of choice Multiple types from benign functional cysts to cystic malignancies Any time the differential diagnosis includes cysts, anywhere in the body, you think ultrasound Cysts inside of the ovaries = normal once a month

Answer 26

``` X-ray contrast is injected into uterus and fallopian tubes through a catheter Done for infertility or multiple miscarriages Shows shape of endometrial cavity and checks patency of tubes Retropyleogram contrast (iodine) ```

Answer 27

Most common prenatal imaging study Can check development, determine gestational age, look for abnormalities Indications and findings too numerous to list here Transvaginal approach- see clearer imagine

Answer 28

Next step in evaluation of abnormalities found on digital rectal exam or elevated Prostate Specific Antigen (PSA) Helps to differentiate prostate cancer form benign hypertrophy Can be used to guide biopsies or placement of radioactive seeds