Imaging of the Abdominal Viscera

Question 1

Abdominal radiography has a lower ———- and ———- than CT but still retains a useful role in diagnosis

Answer 1

Sensitivity and specificity

Question 2

Answer 2

Question 3

Abdominal radiography (AXR) features:

Answer 3

• patient supine
• exposure taken on expiration
• should include diaphragm, pubic symphysis, lateral flank lines
• sof tissue structures and bony detail should be well demonstrated
  0 no overlying artefacts eg clothing, zips

Question 4

Valid reasons for referral for abdominal radiography (AXR) (8):

Answer 4

• clinical suspicion of obstruction
• acute exacerbation of IBD
• palpable mass (specific circumstances)
• constipation (elderly)
• acute and chronic pancreatitis (specific circumstances)
• sharp/poisonous body eg battery
• blunt or stab injury

Question 5

For abdominal pain only what imaging mode is appropriate?

Answer 5

• AXR not usually indicated
• US, erect CXR, CT KUB, CT abdomen

Question 6

Inappropriate requests for abdominal radiography (AXR) (5):

Answer 6

• abdominal pain only
• Right or left iliac fossa pain
• Right upper quadrant pain
• Epigastric pain
• Altered bowel habits

Question 7

Normal appearances of abdominal radiography (AXR)?

Answer 7

Question 8

Answer 8

Question 9

Answer 9

Question 10

Answer 10

Question 11

Answer 11

Question 12

Answer 12

Question 13

Answer 13

Large bowel and rectum = normal
Contains faeces and air giving a mottled appearance

Question 14

Answer 14

Question 15

Why refer to abdominal CT (5)?

Answer 15

• to assess tumour staging
• to determine disease eg cirrhosis
• to determine site and causes of obstruction
• to identify perforation - free air
• trauma
• for biopsy or other interventional procedure

Question 16

What is shown?

Answer 16

• abdominal axial CT
• distended colon

Question 17

Axial CT abdomen

Answer 17

Question 18

Answer 18

Question 19

What modality?

Answer 19

CT colonoscopy

Question 20

CT colonoscopy (5):

Answer 20

• known as CTC or virtual colonoscopy
• can replace barium enemas for patients whom colonoscopy has failed
• assess for strictures/ Carcinoma of the colon
• minimally invasive low dose of radiations
• comparable accuracy to optical colonoscopy

Question 21

CT colonoscopy can be viewed as a virtual colonoscopy by

Answer 21

Images obtained in all planes can be reconstructed to 3D

Question 22

CT colonoscopy requirements:

Answer 22

• bowel must be empty; high dose laxative
• distended with gas via rectal tube
• IV contrast given to demonstrate tumours

Question 23

Answer 23

Question 24

Who can refer for MRI abdomen?

Answer 24

• not usually from primary care; outpatient/inpatient most common
• liver, gynaecological, prostate, MRI bowel most common
• patients must be able to lie still and be MRI safe

Question 25

MRI of the bowl: generally called?

Answer 25

MR Enterography

Question 26

MR enterography: - commonly used to - comparison to barium Studies - assess for (4)

Answer 26

- commonly used to evaluate the extent of Crohn’s disease - more sensitive and specific than barium studies - assess for thickening of bowel wall, fistulae, abscesses, inflammatory changes

Question 27

MR Enterography requires

Answer 27

- patients to starve for 4-6 hours - drink 1.5L contrast to distend the bowel to evaluate the bowel wall

Question 28

Which modality shown below?

Answer 28

Axial MRI abdomen MR Enterography

Question 29

Which modality shown below?

Answer 29

MR Enterography

Question 30

MRCP stands for

Answer 30

Magnetic resonance cholangiopancreatography

Question 31

MRCP (5):

Answer 31

- non invasive - to assess biliary tree, pancreatic ducts; stones, strictures tumours - replaces ERCP for some patients - data obtained and reformatted to create 3D images - breath hold technique used

Question 32

Which imaging modality shown below? What does the white arrows show?

Answer 32

MRCP

Question 33

Abdominal ultrasound

Answer 33

- good first line test for solid viscera - referral reasons should be specific and appropriate; jaundice, suspected gallbladder disease, mass - all abdominal organs scanned in both transverse and longitudinal planes

Question 34

Answer 34

Question 35

What pathology? AXR

Answer 35

Small bowel obstruction

Question 36

What pathology? AXR

Answer 36

Large bowel obstruction Distended over gem

Question 37

Perforation: what do the arrows show? What sign?

Answer 37

Question 38

If abdominal perforation, exr may be appropriate & is seen by

Answer 38

A thin crescent of air under right hemidliaphragm, which is a normal finding in post operative period

Question 39

What pathology shown below?

Answer 39

- Abdominal perforation

Question 40

What pathology shown below?

Answer 40

Yellow-raunde=kidneystones Red= larger = edge of liver over kidney = gallstones

Question 41

Abdominal aortic aneurysm

Answer 41

- more than 5 1/2cm - risk of rupture increases with size - result in massive haemorrhage - surgical repair - sometimes an incidental finding

Question 42

What imaging modality? What pathology?

Answer 42

Abdominal radiography (AXR) Abdominal aortic aneurysm

Question 43

What imaging modality? What pathology?

Answer 43

Abdominal axial CT Abdominal aortic aneurysm

Question 44

What imaging modality? What pathology?

Answer 44

Coronal volume CT with contrast Abdominal aortic aneurysm