Introduction to Abdominal Radiology

Arranged By Djoko Untung T

Normal KUB ( "Flat Plate of the abdomen)

Abdominal plain film is often the starting point for the work up of abdominal problems The first thing to look for on the film is the bowel-gas pattern. Gas normally provides contrast in the bowel which can help determine the location of bowel loops, and any dilation of these loops which suggests abnormalities . There are two bowel structures to observe:

the small intestine which is central and the colon which is around the outside. The colon usually contains a moderate amount of gas. The small intestine is fixed by mesentery across the pancreatic bed. The small intestine has constant peristalsis and as a result when gas builds up it is moved quickly. Normally, there should be very little gas in the small bowel. A small amount of gas may exist in the stomach.

Bowel gas pattern

Gas is usually present in stomach. The small bowel may be partially filled with gas. Gas may also be seen throughout the entire colon

Soft tissue/visceral outlines

The outlines of soft tissue is made possible by radiolucent fat which surrounds intra-abdominal organs.
This allows for visualization of the following:

Liver -

posterior margin visible where outlined by retroperitoneal fat.

Spleen - often visible Kidneys - outlines may not be seen in entirety because of
overlying gas and stool

Psoas muscles seen in entirety

margins usually visible but may not be

A number of indications for requesting abdominal films:

Bowel obstruction - abnormal gas pattern Free air - abnormal gas pattern Abscess - abnormal gas pattern Calculi or other abnormal intra-abdominal calcifications Radiopaque foreign bodies

Pneumop

vesicolit

absc

Abnormal bowel gas patterns Too much gas

1. Adynamic ileus - leads to increased gas throughout the Gl tract, multiple air-fluid levels, and gas in the rectum. 2. Mechanical small bowel obstruction - leads to a ladder-like arrangement of dilated small bowel loops, also termed a "stacked coin" appearance. There is very little or absent gas in the colon. 3. Mechanical large bowel obstruction - leads to a distended colon but absence of gas in rectum and/or distal colon, +/small bowel distension

Dynamic:Small Kolon Adynamic

Gas in the wrong location Free intraperitoneal air (pneumoperitoneum) - MUST have either an upright or left lateral decubitus view, will see a crescent of air under the diaphragm or outlining the liver. Abscess - gas does not conform to a bowel loop in appearance or location, is persistent over time and with change of position. Ascites - small bowel loops are displaced to the center of the abdomen, "ground glass" appearance to abdominal contents. Other - emphysematous pyelonephritis, portal vein gas, gas in the biliary system.
Absence of gas

Fluid filled loops of bowel Abnormal mass

Abnormal soft tissues

Abnormal size or contour of organs Absence of expected soft tissue structure

Retro hemat renal art oclus

"Normal" calcifications Bones are the only normal calcified structures. Many other calcifications will be seen that have no clinical
significance

Vascular-veins of the pelvis (phleboliths) Costal cartilage Lymph nodes Granulomas Injection sites

Abnormal calcifications "Stones" - renal calculi, cholelithiasis, bladder calculi, appendicolith Vascular-calcifications, aneurysm

Athlerosclerosis Aortic Aneurism

Pancreatic chronic pancreatitis Leiomyoma

Uterine fibroid
dermoid cyst

Tumor calcification

Other / Fetoes

Ureterolit

apendicolit

uterinefibroid

Foreign bodies
Abnormalities of bone

Metabolic disease Arthritis Trauma-fractures Remember that a fractured bone may also have related soft tissue injuries:

A fracture of the left lower ribs may damage the spleen. A fracture of the transverse process of a lumbar vertebra may damage the ureter. A fracture of the pelvis may tear the urethra and/or rupture the bladder. Pelvic Fracture