Final Flashcards
Which organs or structures can be visualized in the normal AP supine abdomen?
stomach, colon, spleen, liver, kidney, psoas m., urinary bladder
Can you visualize the GB on a normal AP supine xray?
No
exception: 30% of calcium stones show up; cholesterol stones do not appear
Can you visualize the pancreas on a normal AP supine xray?
No
exception: calcifications that are seen with chronic pancreatitis and alcoholism
Can you visualize the uterus on a normal AP supine xray?
No
exception: calcified leiomyomas
Describe the location of gas and/or barium in the stomach in the recumbent vs. upright positions
In both positions gas rises to the top and the barium settles in the bottom
recumbent: the barium looks sloshy & hazy
upright: the barium has a flat fluid line at the top of the stomach or bowel
Describe the appearance of gaseous distention of the small vs. large intestine
The small bowel is fine, feathery mucosal folds; many folds, looks like stacked coil or striations
The large intestine has farther apart haustra, it’s larger in diameter, and doesn’t loop as much
A sign seen on a xray that indicates localized ileus from nearby inflammation; a dilation of a segment of the large or small intestines, where the enlargement is > 3 cm
sentinel loop
What is the significance of a sentinel loop on an xray?
It may aid in localizing the source of inflammation
e.g. a loop in the upper abdomen, it may indicate pancreatitis & a loop in the RLQ may indicate appendicitis
Posterior displacement of the magenblase is suggestive of enlargement in which organ?
Liver
What is the magenblase?
air bubble in the fundus of the stomach
Are the kidneys normally visible on an AP supine abdomen?
Yes, due to perirenal fat
What is the normal orientation and position of the kidneys?
located in the retroperitoneal space
the inferior pole is more lateral than the superior; i.e. the angle outwards, laterally
right kidney is at T12-L3 and left kidney is at T11-L2
What does it mean if the inferior pole of the kidneys are angling medially, towards the spinal column?
it’s probably a horseshoe kidney
What are the four different types of abdominal calcification patterns?
1) Concretions
2) Conduit wall
3) Cystic
4) Solid mass
Kidney stones & phleboliths are examples of __________ type of abdominal calcification
concretions
vas deferens calcifications & aortic calcification are examples of __________ type of abdominal calcification
conduit wall
aortic aneurism and berry aneurism are examples of __________ type of abdominal calcification
cystic
calcified lymph node & uterine leiomyoma are examples of __________ type of abdominal calcification
solid mass
A venous calcification in a pelvic vein, typically dense, oval, well-definied
phlebolith
Where are phleboliths typically found?
arranged around the lateral edge of the bladder
What is does it mean if a phlebolith appears in the midline?
there is a chance that a mass (tumor) is pushing it outward
*a phlebolith in the midline is always regarded as abnormal
oval opacity in the pelvic area with a tiny core of lucency
phlebolith
What is the best method for detecting an abdominal aortic aneurysm?
ultrasound is more sensitive to xray; if detected on u/s, the surgeon will do a CT scan to get a better look
*only 50-80% of aaa will have calcifications (which makes the show up on xray)
numerou dense, discrete opacities that are across the midline at L1-2
pancreatic calcification
What is the MC cause of pancreatic calcification?
chronic pancreatitis d/t alcoholism
cystic teratoma that contains diverse developmentally mature soft tissue
dermoid cyst
What type of cyst can contain skin, hair, sweat glands, blood, bone, nails, eyes, teeth, etc.
dermoid
Where is a dermoid cyst found?
uterus
masses that have lucencies within them and might be whirled in appearance, located in the uterus
calcified uterine fibroma
sharply defined homogenous calcifications located above or in the pubic symphysis
prostate calculi
What is an injection granuloma?
an iatrogenic finding, granulation tissue at the site of an injection
a little, softly -opaque circle in the gluteal region
injection granuloma
What does residual contrast material in the diverticulum look like?
“chocolate chip” sign
small pockets of residual material within the diverticulum
a struvite (triple phosphate stone) that fills the medullary portion of the kidney…may become so large as to fill the renal pelvis and calyces
staghorn calculi
What is pneumoperitoneum?
presence of air or gas in the abdominal cavity
What are some causes of pneumoperitoneum?
bowel perforation, peptic ulcer, abdominal surgery, peritonitis, infection, trauma, air entering via the female genital tract
What is the percentage of radiolucent vs. radiopaque gallstones?
30% are radiopaque d/t calcium content
70% are radiolucent
What is the best imaging to look for gallstones?
ultrasound (xray isn’t as good b/c only 30% are radiopaque)
What is a porcelain gallbladder?
calcification of the gallbladder
What is the significance of porcelain gallbladder?
pt. with this sign have 10-20% chance of developing carcinoma of GB
How does hiatal hernia appear on plain films?
a magenblase (air bubble) can be seen above the diaphragm
What is appearance of (a) ulcer, (b) polyp, (c) diverticuli, on a contrast (barium) study?
(a) volcano (a pocket of barium fills ulcer crater); most visible if it occurs in the curvature of stomach but xray isn’t a great modality to visualize
(b) usu. single, circular thing that goes inward twd the lumen of the organ; i.e. intrinsic mass
(c) bunch of pouches going outward twd the abdominal cavity; i.e. extrinsic mass
constriction of the large bowel showing up on barium study
apple core deformity
(when a mass is filling part of the lumen of a hollow organ it makes the lumen smaller…check a minute later to make sure it’s still there and wasn’t just a snapshot of peristalsis)
What usu. causes an apple core deformity?
colorectal cancer in the ascending or descending colon
When do we see lead pipe colon?
ulcerative colitis
What is lead pipe colon?
distention of the bowel that is so extreme that you can no longer see the mucosal folding
What is the coiled spring appearance in small bowel?
gaseous distention on the mucosal contour in the SI causing thin mucosal folds; appears on xray as a coiled spring or stacked coins
What causes coiled spring appearance?
small bowel obstruction
What is intravenous pyelogram (IVP)?
Contrast material injected into a vein in the pt. arm and travels through blood stream to collect in kidneys & urinary tract, turning those areas bright white on xray
Allows radiologist to view and assess anatomy & fn of kidneys, ureters, and bladder
IVP of normally functioning kidneys
kidneys will first show signs of dye (bright white), then the ureters, and finally the bladder
IVP when there is obstruction from a kidney stone
stones will become stuck at jns (e.g. where kidneys drain into ureter, where ureter crosses pelvic bone, ureter-bladder junction), so contrast will only go to point of block and stop & you will see back pressure with dilation of upstream structures
What is the percentage of radiolucent vs. radiopaque kidney stone?
opaque is much more common (80-90%)
Distention of the pelvis and calyces d/t some obstruction
hydronephrosis
kidney swells d/t back-up of urine
What should you perform a retrograde pyelogram?
when the pt. has kidney damage and can’t take the dye through IV
when you need to visualize the GU system, but do not want to stress kidneys by injecting a chemical into circulation
