Abdominal imaging Flashcards
(87 cards)
1
Q
GU xray I
A
1s dx test. r/o preg.
2
Q
KUB I
A
kidney stone, free air, abn calcifications, renal agencies, ascites, bowel obstruction, foreign body, skeletal pathology
3
Q
ascites KUB
A
incr density in pelvic cavity. obliteration of peritoneal fat pads, upward displacement of bowel loops
4
Q
bowel obstruction KUB
A
air fluid lvls, dilated bowel loops, obvious pt of transition.
5
Q
abdomen US I
A
1st line for imaging kidney in acute renal failure bc no contrast or rad so safe in pt with deranged kidney function
6
Q
IV pyelogram (IVP)
A
KUB+contrast. aka excretory urogram. contrast column suggest obstruction
7
Q
renal US look for
A
1) kidney size- vary based on age from 10-14cm and breadth 3-5cm
2) location: retroperitoneal, paraspinal, behind liver on right and spleen on left. right kidney is lower
3) renal outline- smooth. irregular - masses or scars
4) corticomedullar differentiation- cortex- hypoechoic (dark) relative to medulla (hyper echoic)
8
Q
kidney US I
A
hydronephrosis, calculi, cyst, renal masses, to guid kidney biopsy, renal artery stenosis (1st line), size change in kidney
9
Q
hydronephrosis US
A
calyceal splitting, if distal obstruction, see proximal dilation of ureter
10
Q
calculi US
A
echogenic. distal acoustic shadowing
11
Q
cyst US
A
can dd cyst c solid lesion. 1st line. hypo echoic. polycystic kidney disease
12
Q
renal artery stenosis imaging
A
US combined with doppler is 1st line screening modality
13
Q
enlarged kidney
A
amyloidosis, multiple myeloma, DM
14
Q
Atrophic kidney
A
post obstructive or post infective. hatchmarks
15
Q
abdominal CT I
A
1) renal stone disease (painful hematuria)
2) renal/bladder mass (painless hematuria)
3) trauma
16
Q
renal stone CT
A
noncontrast CT = gold standard. look for proximal signs of obstruction.
17
Q
renal/bladder masses CT
A
can delineate extent, characteristic, vascular involvement, lN, calcification.
18
Q
trauma CT
A
for evaluating extent, staking, prognosis
19
Q
Abdominal MRI adv over CT
A
soft tissue detail, better for staging genitourinary malig, provide functional info
20
Q
furosemide challenge
A
mod of IVP to r/o pelviureteric junction (PUJ) obstruction
21
Q
DMSA
A
nun study used to localize renal tissue- ectopic kidney
22
Q
MAG3
A
obstructive uropathy, renovascular HT,N, renal transplant evaluation
23
Q
renal calculi
A
causes- metabolic, structural defects, recurrent infection
CT-nonconstast is test of choice but X-ray may still be initial study.
24
Q
renal calculi DD
A
other conditions of medullary calcification: renal tubular acidosis, HPTH, sarcoidosis, hyperoxaluria, hypercalciuria, infectious disease (TB,), malig (rare, film’s, neuroblastoma)
25
acute renal failure approach
clinical Hx!
1st line- US to r/o obstruction and reversible causes, vasculopathy- renal artery stenosis.
2nd- noncontrast CT-ureteric calculi, contrast allows functional assessment
3rd- nun study for post transplant
26
kidney infection imaging indications
not for simple UTI. for recurrent, complicated course, deranged kidney function, unresponsive to antimicrobial meds
27
acute pyelonephritis
US- globally hypoechoc in acute. r/o strutural defect, abscess
DMSA-periperal defects denote edema or scarring
CT- peripheral wedge shaped hypodense area (dd from infarcts)
28
perinephric cyst
complication of UTI. pyelonephrosis imply abscess formation within renal parenchyma. peripherally enhancing
29
TB renal
end result is destruction, lof, calcification of entire kidney. deformed renal outline, cavitation, stricture formation. US - good for detect calyces dilation and obstruction. CT- focal caliectasis, hydronephrosis, calficiations, cortical thinning, soft tissue masses.
in early disease, best is IVP bc can detect change sin single calyx
30
angiomyolipoma
most common benign renal mass.
xray- defect in renal contour, lucency bc of fat, some calcification
US- echogenic - some cavitation, calcification
CT- HU compatible iwith fat
31
onocytoma
60-70s. central scare composed of fibrous tissue. angiography show spoke wheel pattern.
32
renal cell carcinoma
most common renal malig. solid mass is presumed this unless proven otherwise. triad- pain, flank mass, hematuria.
33
RCC imaging
IVP- if mass small=normal, large mass- mass effect with calyces splaying hydronephrosis
US- dd cystic from solid lesion, miss small solid isoechoic lesion
CT- best for staging. feature vary sep on size and type. most heterodynes, heterogeneously enchancing internal masses. possible irreg renal contour, calcyceal splaying, stretching, distortion of internal architecture, obstruction, vascular invasion, LN and distant metastases
MRI- better than CT for staging adv disease. detect venous involvement
34
transitional cell carcinoma
anywhere in collecting system to urinary bladder.
arise from urothelial lining. often synchronous and metachronous. most common bladder cancer.
IVP-most sensitive in dx early lesion involving collecting system. when large mimic RCC. use CT to DD
Ct/MRI-staging, MRI better for estimating invasion, fat involvement, dd scar tissue in post op.
cystoscope- allow interventions for tx and tx
35
adrenal adenoma
homogenous, smooth round mass with low density~30HU on post contrast. not detected on US.
CT-first study
MRI- isotendse or hypodense to liver on T1/2. tumor enhance post gado.
36
benign prostatic hypertrophy
usually arise from central gland while prostate ca is from peripheral gland.
1st study- US. transrectal or transabdominal- can be used for bx.
37
BPH US
variable. single or multi nodules in transition zone surrounded by hypo echoic rim. no capsular disruption unlike prostate ca. also do kidney to r/o back pressure changes. CT/MRI limited use.
38
testicular torsion
twisting testis in scrotom cause venous obstruction and then arterial obstruction --> vascular compromise. most common in puberty.
1st line -US. swollen, hypo echoic testis with sympathetic hydrocele in early stage. over time, secondary hemorrhage may cause incr echogenicity. doppler US in cord show decr material signal. absent flow in testis suggests torsion.
39
renal artery stenosis
causes- atherosclerosis, fibromuscular dysplasia.
1st line- doppler US. incr renal: aortic velocity >3.5, peak renal v of >100cm/s, or slow rise tp peak
Tc-Mac3-+ ACEi to examine renal HTN. if pos ACEi scintigraphy exam indicate renalvascular HTN is present and implies existence of hemodynamically sig renal artery stenosis.
angiography-confirmation. dealyed nephrogram and stenosed set with poststenotic dilatation
CTA with MIP and MRA
40
plain abndominal film
preliminary test. I: bowel obstruction, perforamtion, foreign body ingestion. for screening
41
abdominal xray
1) id sides and inspect liver and spleen shadow.
2) bilateral renal outline - symmetric and smooth. righ is lower
3) bilateral, symmetric psoas shadows.
4) urinary bladder may be outlined depending on degree of distention
5) visualize bony structure for abn
6) ID bowel gas pattern
42
abdominal US I
1) gallbladder and hepatic pathology
2) delineation and differentiation of intra-abdominal cystic structure
3) trauma, FAST
4) guilding procedure
5) doppler for vascular
43
abdominal US drawbacks
air artifacts, no mucosal detail
44
abdominal CT I
1) acute abdomen to r/o appendicitis, acute pancreattits, SBO, colitis
2) trauma,
CTA for vascular leaks, aneurysm, bowel infarcts
3) CT nterography is being used for IBD (crown's), virtual CT colonoscopy
45
ERCP
endoscope into duodenum then cannnulation of biliary tree. done often with papillotomy = therapeutic intervention for biliary calculi and drainage procedures of obstructed bile ducts.
46
ERCP I
indicated in jaundice of unclear origin and suspected pancreatic disease like chronic pancreatitis and pseudocyst
drainage and stenteing of biliary obstruction. advantage is not puncturing liver.
MRCP used instead in pos op bc noninvasive.
47
ERCP complications
pancreatitis, duodenal perforation, duodenal hemorrhage, hepatic and splenic injury, infection, stent misplacement
48
zenker's diverticulum
most common esophageal diverticulum. caused by increased intraluminal pressure
location- outpouching of pharyngeal mucosa above the cricopharyngeus (upper esophageal sphincter)
imaging- dx with barium esophagogram or endoscopy.
49
SBO imaging
goal- dx and dd complete v incomplete. no bowel gas beyond lvl of obstruction is a complete obstruction.
xray is 1st imaging
CT- dd paralytic ileum from anatomic obstruction
50
colitis
CT- reveal colonic wall thickening= small bowel gass
51
ulcerative colitis
large bowel. rectal + continuous proximal.
xray- toxic megabolon= a complication
double-contrast barium enema- detect mucosal changes =thickening, irregularity, superficial ulceration
colonoscopy is contraindicated in acute but can be used for direct visualization and obtaining specimen for histopathologoic correlation
52
Crohn's
terminal ileum. but can affect any part of GI tract.
barium enema- small bowel follow-through, enteroclysis, CT enterography
see mucosal inflm with transmural penetration, ulceration, strictures, skip lesions, abscess formation.
53
ischemic colitis
xray- pneumatosis or bowel distention.
CT- with oral and IV contrast in early. nonspecific bowel wall thickening. sometimes see gas in mesenteric vein. heterogenous enhancement and loss of austral markings
54
appendicitis
right iliac fossa.
choice-abn CT- see inflamed appendix with streaking. US-appendix diameter>6mm, non compressibility, lack of peristalsis, periappendiceal fluid collection
55
midgut volvulus
whirlpool sign. bowel loops and superior mesenteric vein wrap around superior mesenteric artery
56
cecal volvulus
```
cecum normally in right iliac fossa but twisting can happen along vertical or transverse axis.
xray- 1s test and diagnostic. see displaced cecum, small and large bowel obstruction up to pt of torsion, paucity of gas in distal colon.
hypaque enema (single contrast) may confirm dx and lead to reduction or evolved cecum
CT-swirl sign with surrounding dilated bowel. more in adults
```
57
sigmoid volvulus
usually in left lower quadrant. twist around mesenteric axis. usually in elderly debilitated pt with chronic constipation
xray- 1st and diagnostic- see double loop obstruction with variable proximal SMO. coffee bean sign. single contrast barium enema can dx and tx
CT- delineate complications like vascular ischemia
58
pancreatitis xray
not necessary. but would see gases abdomen. sentinel loop sign= localized dilated small bowel. ileum of duodenal loop. colon cutoff sign. pancreatic calcifications in chronic cases
59
pancreatitis CT
bulky, swollen pancreas with surrounding edema. localized fluid collections, abscesses, pancreatic ductal dilation
60
esophageal cancer
SCC-upper esophagus. adenocarcinoma in lower.
early ca- dx on barium swallow done for eval of dysphagia
adv cancer-appear as mediastinal mass on X-ray and cause esophageal dilation with air fluid lvl, achalasia.
CT or endoscopic US for staging and tx.
PET- highest sensitivity
61
indication for modified barium swallow
mouth -hypopharynx.
I: swallowing motor problem/ suspected aspiration e.g. post stroke
perform by speech pathology in conjunction with radiologist,
62
I for esophagram
hypopharynx-GE junction / proximal stomach
| I: dysphagia
63
I for upper GI series
esophagus to ligament of trietz
| I: epigastric pain, recurrent vomitting, post-gastric surgery, suspected malrotation and volvulus, GI bleed
64
I for small bowel follow through and barium enema
duodenum -ileocecal valve
| I: abdominal pain, suspected groin's disease, suspected SBO, malabsorptive sx, GI bleed, suspected fistula
65
DD colonic wall thickening
thumbprinting is sign of bowel wall thickening
1) bowel wall edema from IBD,
2) toxic megacolon,
3) ischemia
4) infection (C dif
5) hemorrhage
66
supine radiograph
evaluated bowel distention, urinary that stone/stent, foreign body, tube placement
67
oral contrast abdomen CT
I: IBD, abscess, extravasation post surgery, fistula mapping
| allergies rare
68
rectal contrast CT
I: penetrating trauma to pelvis, distal colorectal abn like fistula, surgical anastomotic leak
69
IV contrast CT
opacify vasculature and visceral organ and urinary collecting system for detecting masses, abscesses, mesteric ischemia and aneurysms
70
arterial phase CT
35-40s. pulmonary embolism, vascular lesion in liver or pancreas, anatomy of arteries
71
portal venous phase CT
60-90s. solid abdominal viscera
72
delayed phase CT
5-15min. lesion of liver, biliary, adrenal, renal, pancreas. CT urogram
73
oral cotnrast MR
for enterography.
74
barium edema or lower GI study
rectum to cecum or terminal ileum.
75
double contrast BE
air insufflated to rectum along with barium
| I: polyps, cancer, heme pos stool, diarrhea
76
single contrast BE
barium or water contrast with no air
| I: suspected perforation, obstruction, volvulus, ogilvies
77
no GB reasons
non-distention due to inadequate fasting, surgically removed, congenitally absent, ectopic location, filled with stones
78
nuclear hepatobiliary scan can detect
discriminate acute (direct detection of cystic duct obstruction) v chronic (greater than 4 hr post injection see GB bc of scaring of cystic duct, can be sped up by morphine) cholecystitis
2) dx acalculus cholecystitis in pt undergoing prolonged fasting.
3) CBD obstruction- lack of visualization of duodenum
4) dx bile leaks
79
HIDA procedure
Tc-mebrofenein or DISIDA. = bile salt analog. 4 phases over 60min
1) uptake by hepatocyte
2) excretion into biliary tree
3) cocn in GB
4) passage into duodenum
80
CT appendicitis
appendices wall thickening and enhancement- diameter >6mm
pericolonic fat inflm changing
pericolonic fluid- free or located
free intraperitoneal gas if perforated
maybe appenicolith
use IV contrast and get and and pelvis bc of variable location. oral contrast if have time
81
ureterolithiasis
non-contrast CT abdomen/pelvis NCT- doesn't assess renal func or degree of obstruction. passage likely if
82
contrast induced nephropathy (CIN)
in 40% of pt with underlying renal failure.
prophylax with prednisolone and benadryl.
therapy- hydration with saline and or NaHCO3 and or N-acetylcysteine
prog- most recover normal renal function
83
renal vascular hypertension
first line is MRA or CTA
84
99mTc-MAG3 scintography
evaluate fun of kidneys tracked by gamma camera
85
hematuria
need workup if >3RBC/hpf. if painless use CT urography bc suspect genitourinary malignancy
86
kidney US
no doppler flow over lesion suggest cyst over solid mass
87
cyst characterization
anechoic, homogenous, thin well defined walls with posterior through transmission need no further workup after US. round of oval shape.
if complex, next workup with MR abdomen with gad or pre/post IV CT
