Week 8- Medical Imaging Abdomen

Question 1

Talk through the densities on Xray

Answer 1

• Foreign objects – intensely white
• Bone/calcification – white
• Soft tissue – grey

–Fat - darker grey ( absorbs less x-rays)

•Air – black

Question 2

How can you differentiate between the small & large bowel?

Answer 2

Small bowel: Central distribution & valvulae conniventes which go full width of bowel

Large bowel: Peripheral distribution & haustra crosses part of the bowel wall

Question 3

How to approach an abdominal X-ray

a) steps and what you are looking for

Answer 3

• Patient details, date and time of abdominal Radiograph
• Bowel Gas Pattern
  
  • Small bowel - less than 3cm
  • Large Bowel – less than 5cm
• Extra luminal gas
  
  • Under the diaphragm
  • Riglers sign
• Calcification
  
  • Pancreas
  • Gallstones
  • Renal Stones
• Bone and soft tissues
• Post surgical/interventional
  
  • Surgical clips
  • Stents - Bowel, EVAR etc
  • Drains
  • Vascular lines/Feeding tubes

Question 4

What is this showing? How do you know?

Answer 4

Small bowel obstruction

Markings (CV) across the whole width of boweland dilation >3cm. Also centrally placed

Question 5

What is this showing? And how do you know?

Answer 5

Small bowel obsturction

Centrally placed and dilated (>3cm). Valculae commientes hard to see. Distinct large bowel on patients left with haustra. Fluid level is visible (fluid secreted when bowel is sick)

Question 6

What is this showing? How do you know?

Answer 6

Large bowel obstruction

>5cm dilation. Markings not going across the whole way. Bowel peripherally located. . May be obstructing small bowel loops but unable to see due to large bowel

Question 7

What can cause large bowel obstruction?

Answer 7

• Malignancy
• Volvulus

Question 8

What can cause small bowel obstruction?

Answer 8

• Adhesions
• Hernia
• Foreign body

Question 9

What are the complications of bowel obstruction?

Answer 9

• Perforation
• Bowel necrosis/ ischemia

Question 10

What is this showing?

Answer 10

Sigmoid volvulus

Question 11

What are the signs of a pneumoperitoneum?

Answer 11

• Riglers sign (can see air on both sides of bowel)
• Free air under diaphragm

Question 12

What is this showing?

Answer 12

Nasojejunal tube

Question 13

What is an IVC filter? Where would you expect to see it?

Answer 13

An IVC filter may be used to reduce the risk of large pulmonary emboli

Question 14

What is this showing?

Answer 14

Aortic aneurysm

Question 15

What is this showing?

Answer 15

Cholecystectomy Clips

Question 16

What is this showing?

Answer 16

Phlebolith

Question 17

What sign could be used to differentiate a phelebolith from uteric calculi?

Answer 17

Comet tail sign

helpful to distinguish ureteric calculus from phlebolith- strongly favour phlebolith. Soft tissue extending from calcification representing collapsed/scarred/thrombosed parent vein.

Question 18

What is this showing?

Answer 18

Kidney ‘pig-tail’ stent

Question 19

Where do the ureters run in relation to key landmarks seen on an xray?

Answer 19

Follow urinary tract: under rib 12th –> down transverse processes VUJ @ ischial spine

Question 20

What is this showing?

Answer 20

Bladder stone

Question 21

What can you see on this X-ray?

Comment if anything can be done about them

Answer 21

Gall stones together in blue

Calcification of aorta (nothing can be done)

Calcifications along ribs in yellow (nothing can be done)

Purple- hip replacement

Question 22

What is this showing?

Answer 22

PD catheter

(starts in abdo and coils up in pelvis)

Question 23

What is this showing?

Answer 23

PEG

also median sternotomy clips