Abdominal Imaging
4th Year Lecture Series
What Radiology has to Offer
Plain Films Screening Ultrasound CT MRI Nuclear Medicine
Abdominal Films
Screening / Barium
Ultrasound
Ultrasound - Fatty Liver
CT
MD-CT (3D Capabilities)
MRI
Nuclear Medicine
What You can do for Us
Know your patient! Know why you are requesting the study Know what you will do with the result (+/-) Blood results - esp creatinine and LFTs Request Form
LEGIBLE, concise but informative PAGER NUMBER and Clear Name
Remember….
The Radiologist will be able to advise on the most appropriate imaging modality for clinical problems However, the referring medical or surgical team should know the best imaging strategy for common clinical probems…
Approach to AXR
Bones Stones Mass Gas
Kids Obstruction
A A I I M M
Suggested Imaging Strategies
Abdominal Pain due to possible bowel obstruction or perforated bowel: - AXR (erect, supine, decubitis) - CT Abdominal Pain due to possible cholecystitis/ pancreatitis/ appendicitis: - US - CT - MRI
Case One
44 yr old female previously well Colicky RUQ pain one week Tender RUQ Afebrile, Normal WCC What investigations?
Ultrasound
Cholecystitis
Case Two -Epigastric Pain
45 yr old male, 2 days of constant pain Central epigastrium, worsening Afebrile Normal white count Other Bloods? Investigations
Ultrasound - Biliary
CT Pancreas
Biliary MRI
Suggested Imaging Strategies
Pulsatile Abdominal Mass: - US - CT Probable Renal Colic: - AXR - IVU - CTU
Case Three - Belly Ache
59 yr old, hypertension Acute left flank pain Blood on dipstick ??pulsatile mass Investigations?
FAST Scan in ED
CT Aorta
Case Four
37 yr old male, Left flank pain Blood on dipstick Similar pain 8 yrs ago Investigations Consider 62 yr old male or 22 yr old female
CT - Renal
Suggested Imaging Strategies
Bowel Symtoms (change of bowel habit, rectal bleeding etc): - Fluoroscopy - CT Scrotal Pain or Mass: - US
Case Five
65 yr old female LIF pain 2 days Afebrile Tender LIF, no mass palpable WCC 11.8 with neutrophilia Investigations?
DC Barium Enema
CT Oral Contrast
Case 6 - Painful Scrotum
17 yr old, painful right testis 24 hrs Sexually active Swollen R hemiscrotum Very tender upper pole right testis Investigations?
Scrotal US
Suggested Imaging Strategies
Incidental Abdominal Mass or Derranged Liver Function Tests - US - CT - MR - Scinitgraphy
Case 6 - Incidental Liver Mass
27 yr old female Pelvis ultrasound for menorrhagia Incidental liver mass noted Normal liver function tests
FNH - MRI Features
FNH - Pathology
FNH - Scintigraphy
Case 7 - Liver Mass
42 yr old female Mildly deranged LFTs
MR Imaging
Case 8 - Liver Mass
66 yr old male Progressively deranged LFTs Weight loss Mass on US
I-CAC MR Imaging
Conclusions
There are multiple imaging modalities available It is important to gain some idea of the pros and cons for each modality Need to understand the appropriate imaging pathway for common problems