B5-016 Abdominal Imaging

Question 1

if you can see lung bases in the view this typically indicates…

Answer 1

upright position

Question 2

what are normal KUBs good for?

Answer 2

evaluating gas patterns
looking for free air

Question 3

where would you expect to see gas on normal KUB?

Answer 3

stomach
most segments of colon

Question 4

normal limits of bowel distension

Answer 4

small bowel: 3cm
colon: 6cm
cecum: 9cm

3-6-9 rule

Question 5

what portion of the small bowel will be in the LUQ on normal KUB?

Answer 5

jejunum

Question 6

what portion of the small bowel is in the RLQ on normal KUB?

Answer 6

ileum

Question 7

where does the air collect in an upright view of pneumoperitoneum?

Answer 7

under the diaphragm

Question 8

Answer 8

normal gas pattern

Question 9

calcification in RUQ

Answer 9

gallstones

Question 10

calcifications in renal silhouette

Answer 10

kidney stone

Question 10

what imaging modality is better for evaluating solid viscera?

Answer 10

CT/ultrasound

Question 11

would you use contrast in evaluating nephrolithiasis via CT?

Answer 11

no

actually makes the stones harder to see

Question 12

identify liver, spleen, esophagus, stomach, IVC

Answer 12

Question 13

identify lobes of liver, ligamentum venosum, ligamentum teres hepatis

Answer 13

Question 14

3 structures of porta hepatis

Answer 14

portal vein, hepatic artery, common duct

common duct is hard to see in nondistended state

Question 15

identify the structures of the porta hepatis

Answer 15

common duct cannot be visualized in nondistended state

Question 16

dominant vessel to liver providing 80% of blood flow to hepatic parenchyma

Answer 16

portal vein

Question 17

formed by confluence of splenic vein and superior mesenteric vein

Answer 17

portal vein

Question 18

identify portal vein, splenic vein, SMV, SMA

Answer 18

Question 19

how would the gallbladder look in a post prandial state?

Answer 19

contracted
hard to visualize

Question 20

what is the arrow pointing to?

Answer 20

gallbladder

Question 21

structures surrounding pancreas

4

Answer 21

• biliary tract
• duodenum
• aorta/IVC
• splenic vessels

Question 22

what structure is the arrow pointing at?

Answer 22

cecum

Question 23

what structure is the arrow pointing at?

Answer 23

transverse colon

Question 24

what is the arrow pointing at?

Answer 24

descending colon

Question 25

major branches of aorta | 4

Answer 25

celiac axis SMA IMA renal arteries

Question 26

normal measurement of abdominal aorta

Answer 26

2 cm

Question 27

the left renal vein is [...] than the right renal vein

Answer 27

longer

Question 28

what structure is outlined?

Answer 28

adrenal gland

Question 29

what imaging modality would be preferred to exam solid organs in patients who cannot have IV contrast or need limited radiation?

Answer 29

ultrasound

Question 30

what imaging modality is great for looking at vessels?

Answer 30

ultrasound | due to color Doppler imaging

Question 31

what is the significance of this imaging?

Answer 31

round hypoechoic areas scattered throughout liver | malignant metastasis in liver

Question 32

what is the significance of this image?

Answer 32

dilated renal pelvis | hydronephrosis

Question 33

Answer 33

kidney stones -US

Question 34

ACR Appropriateness Criteria for Jaundice- no known predisposing criteria | just list the green ones

Answer 34

US abdomen CT abdomen with contrast MRI abdomen without and with IV Contrast

Question 35

how might you describe this US of liver?

Answer 35

nodular heterogenous | cirrhosis

Question 36

what does the image indicate? | in general

Answer 36

solid mass | color doppler shows vascular structure

Question 37

# if a mass demonstrates * early hyperenhancement (hepatic arterial supply) * rapid washout (tumor neovascularity/AV shunting) * delayed rim enhancement (mass effect)

Answer 37

HCC | definitive test, **no need for biopsy**

Question 38

* most common primary hepatic malignancy * strongly linked to chronic liver disease * third most common cancer death worldwide

Answer 38

HCC

Question 39

leading cause of cirrhosis in US

Answer 39

viral hepatitis | followed by alcoholism

Question 40

predicted to become leading cause of cirrhosis in the US in 10-15 years

Answer 40

NASH | currently third most common

Question 41

what imaging modality is used for **screening** for HCC?

Answer 41

US

Question 42

what imaging modality is used for **diagnosis** of HCC?

Answer 42

CT and/or MRI | **biopsy not necessary** for treatment

Question 43

a target sign on US confirms

Answer 43

intussusception

Question 44

treatment for intussusception

Answer 44

therapeutic air enema

Question 45

how does intussusception occur?

Answer 45

the invagination of the intussuceptum into the intussusceptient in the telescope-like manner

Question 46

most intussusception occur where?

Answer 46

ilieocolic | terminal ileum telescopes into cecum

Question 47

why are intussuceptions more common in winter months?

Answer 47

thought to be associated with viral illnesses

Question 48

* crampy abdominal pain * blood, currant jelly stool * palpable right sided abdominal mass * child 3 months-1 year old

Answer 48

intussusception

Question 49

contraindication of image guided reduction of intussusception

Answer 49

perforation

Question 50

a majority of intussusception are | cause

Answer 50

idiopathic

Question 51

what is the most likely type of intussusception?

Answer 51

ileo-colic

Question 52

what age group are intussusceptions most common in

Answer 52

under 1 during winter months

Question 53

describe the classic enhancement characteristics of HCC on CT/MRI

Answer 53

increased early enhancement and decreased delayed enhancement

Question 54

leading causes of non alcoholic fatty liver disease

Answer 54

DM and obesity

Question 55

expected to become the leading cause of cirrhosis in the US in 10-15 years

Answer 55

non alcoholic fatty liver disease

Question 56

pneumoperitoneum is an absolute contraindication to performing

Answer 56

air enema reduction of intussusception

Question 57

leading cause of cirrhosis currently

Answer 57

chronic hepatitis

Question 58

normal limits for small bowel distension

Answer 58

3 cm

Question 59

normal limits for colon distension

Answer 59

6 cm

Question 60

normal limits for cecum distension

Answer 60

9 cm

Question 61

in an upright radiograph, free intraperitoneal gas will be seen where?

Answer 61

under right hemidiaphragm

Question 62

a KUB is best used to evaluate

Answer 62

gas patterns

Question 63

gas seen within the colon on a KUB would most likely be seen where?

Answer 63

periphery of colon

Question 64

gas seen within the jejunum on KUB would most likely be seen in which location?

Answer 64

upper left quadrant

Question 65

gas seen within the ileum on KUB would most likely be seen in which location?

Answer 65

right lower quadrant

Question 66

gas seen within the small bowel on KUB would most likely be seen in which location?

Answer 66

centrally located

Question 67

why is US not typically used to evaluate bowel?

Answer 67

air in the bowel has high acoustic impedence and will cause a lot of shadowing