Abdominal Imaging 4th year
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Joshua Lauder
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40 Slides • 11 Questions
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Dr Joshua Lauder, Consultant Radiologist, ELHT
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Know the imaging modalities used in the abdomen
Ultrasound
Xray
CT
Recognize common pathology
Large bowel obstruction and cancer
Small bowel obstruction and mesenteric ischaemia
Biliary pathology
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Lecture/quiz on abdominal imaging
Bowel
Biliary
Post DICOM demonstration of CT
Several self-directed cases on Post DICOM
Go through the cases together
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Anatomical planes
Density (Hounsfield units)
Windowing
IV Contrast
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Multiple Choice
List the anatomical planes from left to right
Coronal - Axial - Sagittal
Sagittal - Coronal - Axial
Sagittal - Axial - Coronal
Sagittal - Axial - Coronal
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Multiple Choice
Hounsfield Units are a measure of:
Radiation
Contrast
Density
Anatomical planes
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Large bowel obstruction
Small bowel obstruction
Inflammatory bowel disease
Mesenteric ischaemia
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Multiple Select
Choose the most appropriate investigation for this 50 year old male with severe abdominal pain and not passing flatus
Xray
Ultrasound
CT
MRI
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Multiple Choice
What is the pathology?
Gallstones
Small bowel obstruction
Large bowel obstruction
Mesenteric ischaemia
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Shows gas filled structures well
Limited information about soft tissue or fluid filled structures
Large bowel obstruction
Peripherally located
Haustra do not cross entire width
May contain faeces
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Multiple Choice
What is the most common cause of large bowel obstruction
Cancer
Stricture (diverticular or ischaemic)
Volvulus
Intussusception
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Faecal blood test
Colonoscopy
CT Colon
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Multiple Choice
What is the cause of the large bowel obstruction here?
Cancer
Diverticular stricture
Ischemic stricture
Sigmoid volvulus
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Multiple Choice
This patient presents extremely unwell with diarrhoea, what does the xray show?
Mechanical large bowel obstruction
Volvulus
Diverticular disease
Toxic Megacolon
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Non obstructive dilation of the colon, secondary to severe colitis.
Ulcerative colitis
Crohns
Infection
Ischemia
Systemically unwell
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Ultrasound and MRI used to reduce radiation burden
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Barium enema - obsolete
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Multiple Choice
This 60 year old female presents with acute abdominal pain and vomiting. No previous surgery. What is the most likely cause for findings?
Adhesions
Hernia
Tumour
Inflammatory bowel disease
Intussusception
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Adhesions (prior surgery)
Hernia (may be palpable)
Inflammatory bowel disease (Crohn's)
Intussusception (Children)
On xray
Small bowel is centrally located
Valvulae conniventes cross the width
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Multiple Choice
Which artery supplies the small bowel?
Coeliac
Superior mesenteric
Inferior mesenteric
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Normal SMA
SMA thrombus
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Dead bowel
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Ischemic colitis
Always affects left colon
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Bowel going inside bowel
Most common in children
If occurs in adults, its secondary to a lesion
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Cholecystitis
Gallstones
Pancreatic cancer
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Multiple Choice
40 Year old female presents with RUQ pain and raised bilirubin, what is the most appropriate initial test?
Ultrasound
CT
MRCP
ERCP
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Excellent for fluid filled structures
Gallbladder
Biliary tree
Liver
Kidneys
Can also guide procedures
Ascitic drain
Gallbladder drain
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normal comparison
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normal comparison
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Ultrasound has limitations
Magnetic Resonance CholangioPancreatography
Shows fluid in exquisite detail
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ERCP
Invasive procedure to treat gallstones in the CBD
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Multiple Choice
50 Year old male presents with new onset jaundice with no abdominal pain, what is the most likely diagnosis?
Cholecystitis
Gallstone in the CBD
Pancreatic cancer
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CT is used to detect pancreatic cancer.
Often presents after causing duct obstruction
CBD
Pancreatic duct
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Modality | Notes |
|---|---|
AXR | Mainly for bowel obstruction Poor soft tissue resolution |
CT | Extensive use in acute abdomen Can diagnose most pathology Need to justify use because of high radiation |
Ultrasound | First line in biliary pathology Also good for liver, spleen, ascites First line in children with acute abdomen Can be used to diagnose and monitor inflammatory bowel disease |
MRCP | Used to look for gallstones in the CBD if ultrasound cannot find them |
ERCP | Invasive technique to remove gallstones in the CBD |
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| Notes |
|---|---|
Case 1 AXR and CT 70 year old female with abdominal pain and vomiting | Look at the AXR first Then check CT to find the cause Has any procedure been performed? |
Case 2 CT History of acute severe abdominal pain and lactate of 8 | Check the blood vessels There is an interesting incidental finding of the bowel in this case |
Case 3 CT 70 Year old male with painless jaundice | Look at the biliary tree Try to measure the calibre of the CBD |
Dr Joshua Lauder, Consultant Radiologist, ELHT
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