Test #3 Flashcards by Caleb Spreiter

What imaging agents are used primarily for the stomach & duodenum?

Barium (Upper GI series; esophagogastric junction to lig. of treitz)
CT scan: neoplasia & extent of ds

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What imaging agents are used primarily for the pharynx & esophagus?

Barium: for morphology & motility

CT scan: Extent of the ds

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What imaging agents are used primarily for the sm. intestine?

Plain film/CT scan: if obstruction is suspect
Barium: Intestinal ds
Enteroclysis
Retrograde Infusion

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What imaging agents are used primarily for the colon?

Plain film: obstruction
CT Scan: extent of ds
Colonscopy: Lumen
Barium Enema: obstruction, diverticulitis, inflammatory bowel ds, primary neoplasm

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What imaging agents are used primarily for liver & bile ducts?

MRI, Nuclear Scintigraphy, US, CT scan: mass lesion

US: obstruction or inflammatory ds of bile ducts

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What imaging agents are used primarily for gallbladder?

Oral cholecystography(telopaque)/cholecystagogue: Filling defects & function
US: Acute & chronic gallbladder ds
CT scan: Abscess or carcinoma
HIDA AKA Cholescintigraphy: Tracks flow of bile

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What does HIDA (hepatobiliary iminodiacetic acid scan) AKA cholescintigraphy test for?

Bile duct obstruction
Bile leakage
Cholecystitis
Gallstones
Congenital abnormalities of the bile ducts

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What imaging agents are used primarily for the pancreas?

Plain film: calcfication, masses
CT scan: Done 1st when ds is suspected
US
Endoscopic retrograde pancreatography
Angiography

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What are examples of special imaging used for the GU tract?

IVP/IVU (intravenous pyelography/urography)
Excretory pyelography/urography
Iodinated contrast films
Compression device over ureters

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What is US used to visualize in the GU tract?

Kidney size
Parenchymal mass cysts
Dilatation of collecting system
Bladder

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In the GU tract, doppler US is used to visualize what?

renal vasculature

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In the GU tract, CT scan is used to visualize what?

Subtle density difference
Renal vessels
Charac. masses

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In the GU tract, what is cystography used to visualize?

Traumatic rupture of bladder

Incontinence in female

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What is usually used as the initial study for the ovaries & uterus?

Ultrasound

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What is used to visualize the uterine tubes up to the ovaries?

Hysterosalpingography

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What is used to visualize the prostate?

Retrograde urethrogram

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What are risks assoc. w/ contrast nephropathy?

An acute impairment of renal function after exposure to a contrast medium
Rise in serum creatinine w/i 2-5 days of exposure
Rarely results in death

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What type of pts are at greater risk for side effects of contrast nephropathy?

Pre-existing renal insufficiency
Insulin dependent diabetic w/ secondary renal ds
Repeated admin. of contrast over a short period of time
Transplant & renal dialysis pts
Total iodine dose is >100g w/i a 24 hr period

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This is a ds that causes fibrosis of the skin & internal organs d/t the use of gadolinium in pts w/ renal insufficiency

Nephrogenic Systemic Fibrosis (Dermopathy)

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What, generally, is visualized on a K.U.B.?

Bones
Bowel gas patterns
Soft tissue

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What is the normal diameter of the small bowel?

2.5cm

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What part of the bowel are fluid levels not normally seen?

Large bowel

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What are you looking for on a supine abdominal view?

Bowel gas pattern
Mass
Calcification

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What are you looking for on a prone abdominal view?

Air in rectosigmoid colon

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What are you looking for on an upright abdominal view?

Free air | Air fluid levels in the bowel

What are you looking for on an upright PA chest in an acute abdominal series?

Free air Pneumonia Pleural effusion

What views are in an acute abdominal series?

Supine ab. Prone ab. Upright ab. Upright PA chest

What are features of hepatomegaly on film?

``` >15cm at midclavicular line (83%+) Inf. hepatic flexure Transverse colon below the R kidney Liver shadow crosses R psoas margin Elevated diaphragm Riedel lobe ```

What are features of splenomegaly seen on film?

12cm longest axis Should not project below 12 post. rib Med. displacement of meganblasse Inf. displacement of splenic flexure, L kidney inf. & med

What is the normal size of kidneys in an adult?

10-14cm No more than 1.5cm difference side to side R projects shorter than the L b/c the liver

What is the M/C renal parenchymal lesion & what age is effected most?

Simple Renal Cyst | Rare under 30yr old; found in 50% of adults over 50yr old

Can the urinary bladder be seen on film?

Yes, when full of urine Males: round on top Females: flat on top d/t uterus

What is it called when the sup. or inf.(M/C) poles of the kidney are connected by functioning or nonfunctioning (fibrous) tissue? M/C type of renal fusion anomaly

Horseshoe kidney

What are complications of horseshoe kidney?

1/3rd have anomalies 1/3rd are asymptomatic More susceptible to traumatic injury b/c the ureters pass over the connecting tissue Often have poor drainage, leads to infection & stones

What is it called when both the sup. & inf. poles of the kidney are connected?

Calxed (Caked) kidney

What is it called when the kidney has bumps on the surface which are a residual from development?

Fetal lobulation

Upper lat. aspect of L kidney is flattened d/t the spleen.

Dromedary hump

What is the M/C etiology of mechanical small bowel obstruction?

Post surgical adhesions

What are plain film findings assoc. w/ small bowel obstructions?

Upright - multiple air fluid levels >2.5cm inverted U dilated loops Supine - Dilated loops >3cm, step ladder, stack of coins

What is the most dilated segment w/ a mechanical large bowel obstruction?

Cecum (12-15cm may rupture)

What are the M/C etiologies of a large bowel obstruction?

Colon CA | Diverticulitis

What are the 4 common locations of extraluminal air in the abdomen?

Intraperitoneal (pneumoperitoneum) Retroperitineal air Air in the bowel wall (pneumatosis intestinalis) Air in the biliary system (pneumobilia)

What is the M/C etiology of extraluminal air in the abdomen?

Perforated gastric/duodenal ulcer

What are radiographic findings assoc. w/ extraluminal air in the abdomen?

Air beneath the diaphragm Visualization of both sides of the bowel wall (Rigler/double wall/gas relief sign) Visualization of the falciform lig.

Air in the biliary tree d/t a communication w/ the GI tract or skin is called what?

Pneumobilia

What are etiologies assoc. w/ Pneumobilia?

``` Surgery Trauma Biliary-enteric fistulas (M/C nonsurgical cause) Infection Anomalous development of duct ```

What are radiographic findings assoc. Pneumobilia?

Tubular branching lucencies over the liver shadow | Air in the lumen of the gallbladder

Obstruction of the intestine by an ectopic gallstone is called what?

Gallstone Ileus

What gender is M/C'ly affected by a gallstone ileus?

Females7-8x

A gallstone ileus larger than >3cm typically obstructs what?

ileocecal valve

70% of small bowel obstructions in people over 70 yr old are caused by what?

Gallstone Ileus

This is when all or part of the stomach herniates through the diaphragm

Hiatal hernia

What are the different types of hiatal hernia?

Sliding (M/C): fundus & cardia Paraesophageal (2nd M/C): fundus Intrathoracic: entire stomach, not pylorus Short esophagus: gastroesophageal junction

What is the ddx assoc. w/ a hiatal hernia?

Pulmonary cyst Lung abscess Diaphragm tumor

What test is diagnostic for a hiatal hernia?

Barium swallow

What are the 4 main types of calcification?

Cyst Conduit Concretion Mass

Cyst-type calcification is assoc. w/ what?

``` Aneurysms Porcelain gallbladder w/i kidneys, adrenals, liver, ovary, mesentery Some uterine fibroids Bladder wall (rare) ```

These are erosions on the vert. body assoc. w/ an abdominal aortic aneurysm (AAA)

Oppenheimer Erosions

What is the imaging of choice for an AAA?

Ultrasound

What are the charac. of a splenic artery aneurysm?

up to 10% of pt >60yr old Etiologies: atherosclerosis, trauma, infection Looks like a cyst

These are caused by the larvae from the tape worm. M/C'ly found in the liver

Hydatid/Echinococcal Cysts

Type of calcification w/i a channel that conveys fluid. May show as flecks of calcification along the route of a vessel, parallel tracts, branching tracks, or ring-like opacities

Conduit (linear or track-like) calcification

Where are conduit calcifications typically seen?

``` Urinary tract Pancreatic ducts Vas deferens Fallopian tubes Biliary ducts Blood vessels Porcelain gallbladder ```

What is porcelain gallbladder?

Calcification in the gallbladder wall, caused by chronically inflamed & thickened wall. M/C in females Assoc. w/ stones, obstructed cystic duct, carcinoma Ovoid or pear shaped

Type of calcifications that form w/i a duct, conduit or hollow organ.

Concretion (lamellar, laminar) calcification

How are concretion calcifications formed?

Typically formed by precipitation of calcium salts which form layers over time (pearl in oyster)

Where are concretion calcifications seen?

Gallbladder: gallstones Urinary tract: renal, ureteral bladder stones Diverticulum/appendix: appendicolith, fecalith Pelvic veins: phlebolith Prostate

Which type of gallstones occur most often in people?

Negative gallstones

This is a type of kidney stone that is seen in females w/ recurrent UTI's. Forms in the collecting system.

Staghorn caliculi

Who is typically affected by bladder stones?

Older men

Where is prostate calcification usually seen on plain film?

Around the pubic symphysis

Where are appendoliths seen on plain film?

Over the R ilium

What ddx is assoc. w/ appendoliths?

Bone islands | Gallstones

These are caused by scar tissue from multiple injections in the butt. Look like phleboliths

Injection granulomas

Type of calcification w/ a wide range of radiographic patterns. Typically a dense center w/ irregular margins

Mass (cloud-like, amorphous, popcorn) calcifications

What typically forms mass calcifications?

``` Calcified mesenteric lymph nodes (M/C) Some uterine fibroids Pancreatic lithiases Adrenal calcification Liver & kidney malignancies Many benign tumors ```

What is the M/C cause of pancreatic calcification?

Alcoholism (pancreatitis)

These compose 10% of all ovarian tumors. Arise during active reproductive years

Ovarian dermoid cysts (mature teratomas/cystic teratomas)

What are the radiographic charac. of ovarian dermoid cysts?

May contain teeth, bones, & other tissue 10% have marginal calcification 35% contain fat (as a solid mass, may be only x-ray finding)

What type of calcifications are assoc. w/ leiomyoma, uterine fibroid, & uterine fibromas?

Popcorn/cauliflower like Mottled or speckled Coarse marginal rim Cyst-like rim

Adrenal calcification in a normal sized gland is M/C'ly secondary to what?

Neonatal hemorrhage

What pathologies is adrenal calcification assoc. w/?

Addison's Hemangioma Pheochromocytoma Cortical carcinoma

Test #3 Flashcards

(82 cards)