Introduction To Abdominal Urinary Imaging

Question 1

What do radiographs require/contain in order to work?

Answer 1

X-ray generators that generates X radiation from a torch-like machine and they can go on to spread/fan out
- Detector which is now usually electronic rather than film

Question 2

What are the 2 directions radiographs are commonly taken in?

Answer 2

1. Anterior-posterior (AP) - front of patient facing X-ray source
2. Posterior-anterior (PA) - back of patient facing X-ray source

Question 3

What are the 5 densities shown by X-ray?

Answer 3

1. Black: gas
2. Dark grey: fat
3. Grey: fluid/soft tissue
4. White: calcified structures e.g. bone
5. Bright white: metallic objects

Question 4

What are the 7 steps to reading a abdominal image systemically?

Answer 4

1. Check demographics e.g. patient ID, DOB & name
2. Modality (X-ray/CT/MRI/US?) & view (AP/PA)/orientation (use spinal processes)
3. Rotation (use spinal processes), inspiration (breath in) & penetration (exposure)
4. Bowel loops and gas - small & large
5. Extra-intestinal gas (abnormal)
6. Areas of calcification (bones e.g. ribs, fractures, cancers that decalcify bone)
7. Skeletal abnormalities
8. Other soft tissue outline e.g. kidneys, liver, spleen

Question 5

What can be given for e.g. when viewing the kidneys in imaging to aid viewing?

Answer 5

A contrast medium (be careful if patient has renal problems though)

Question 6

What will be shown in imaging if there is reflex of urine back up ureters?

Answer 6

The ureters will be dilated along with the kidneys at T12 (12th rib)-L3 and calyx’s will not be seen as clearly due to damage as a result of backflow/pressure

Question 7

If the kidney was not visible at the normal vertebral level, where would you check next and why?

Answer 7

You would check/track downwards because in embryology the kidneys originate from the pelvic cavity and ascend up so kidneys may not have descended properly

Question 8

If the vertebra of the spinal cord look like frogs heads and there is gaps in the bones, who is this image of?

Answer 8

A child because the gaps in bones are growth plates

Question 9

If the liver was shown to extend down to the right iliac fossa on imaging, would this be problematic?

Answer 9

This is a normal variant of the liver; it can drop down to pelvic cavity and obstruct view of kidneys

Question 10

What vertebral level does the duodenum sit between?

Answer 10

L1 (transpyloric region) is where transpylorus leads in 1st part of duodenum -> L3 classically

Question 11

What does the jejunum typically look like on imaging with contrast?

Answer 11

It is not a solid white pipe but a fluffy mucosa thrown into folds is shown

Question 12

If you can see all of the gut tube structures very clearly on imaging, what does this mean?

Answer 12

That the gut tube is filled with gas which is abnormal

Question 13

What is an artefact on imaging?

Answer 13

A zip, buttons if a patient is clothed, the coil, sterilisation clips etc. (sometimes can help identify gender in the latter 2 cases) - can be confusing

Question 14

Is the positions/sizes of organs the same in a child in comparison to an adult?

Answer 14

No

Question 15

What would a pneumothorax look like in imaging?

Answer 15

Pocket of air will be shown in the peritoneal cavity above the liver and under the diaphragm in a crescent moon shape - the patient must be stood up to allow the gas to rise - this can be due to perforation of bowel as gas can escape for e.g.

Question 16

What is Rigler’s sign?

Answer 16

Also called the double wall sign where there is gas inside AND outside the intestines (abnormal) - tubes of SI and LI can be seen very clearly

Question 17

What is a calcification in a vein in the pelvis called and what will it be seen as?

Answer 17

Phlebolith - small white stone in pelvic cavity

Question 18

What are faecoliths and what would they look like?

Answer 18

Stones made up of faecal matter; can arise in right iliac fossa where the caecum and appendix normally sit - shown as runs of little white circles in a line

Question 19

What is a caecal volvulus and what would it look like?

Answer 19

Caecum has twisted on itself and blocked intestine causing a build up of gas there and in proximal gut tube so you would see gas in the SI & caecum, but not in the LI due to obstruction

Question 20

What is a sigmoid colon volvulus and what would it look like?

Answer 20

Sigmoid has twisted back on itself and caused a blockage so you will see a large white line running along S-shape of sigmoid colon as it has dilated massively (coffee bean sign)

Question 21

Give an example of where and why gas could be seen in imaging that wasn’t coming from the GI tract/peritoneal cavity.

Answer 21

The kidneys will look enlarged and black due to gas in kidney infections which produce gas. The gas will be in the fascial layers covering the kidney so will communicate to both sides across retroperitoneal route making it harder to identify them and their internal structures.

Question 22

What is the characteristic appearance of a bladder stone?

Answer 22

Big white circle that has layers like an onion

Question 23

What is a Computed Tomography (CT) scan and what does it do?

Answer 23

• Uses X-rays and detects them electronically i.e. a fancy X-ray
• Machine spirals around patient gathering volumetric information
• Coordinate pixels in 3D space so can chop up data in whatever way you wish e.g. axial, longitudinal

Question 24

What is the standard view of a CT image?

Answer 24

Patient is lying on back and you are standing at the foot of the bed looking up their body