Abdominal Imaging

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Abdominal Imaging
2013-01-19 20:08:08
Abdominal Imaging

Abdominal Imaging differential diagnosis
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  1. Gastric Dilatation with Volvulus
    Large radiolucent gas distended stomach which is an abnormal location/shape. The stomach may have some digesta in it.

    Compartmentalisation (banding) of the stomach most visible on the right lateral view

    Functional ileus of the oesophagus and small intestine => flaccid and gas distension of the oesophagus and small intestine. Intestines may show some gravelling.

    Spleen is displaced under the stomach
  2. Food Bloat
    Grossly overdistended stomach full of ingesta (speckled radio-opacity and radiolucency)

    NO compartmentalisation

    Stomach has expanded past the rib cage caudally.
  3. Pneumoperitoneum with free abdominal fluid- peritonitis.
    Can see the thin line of the diaphragm (diaphragmatic stripe) as the diaphragm has air on both sides. This is most easily seen dorsally.

    DV view often useful- air rises under cupula so shows up clearly.

    Where there is air on both sides of the bowel, the bowel wall will be clearly defined.

    Where there is fluid surrounding the bowel, there is a loss of serosal detail within the abdomen.

    Abdomen is often distended with radio-opaque fluid apparent in dependent parts of the abdomen.
  4. Acute intestinal obstructive pattern
    • Complete obstruction;
    • 2 populations of bowel
    • Gravelling in dilated bowel
    • Gas trapping within distended intestine
    • Abrupt lines- abrupt air and soft tissue demarcation in dilated bowel means foreign body¬†(obstructive pattern).

    The amount of bowel that is distended depends on the location of the obstruction;

    If the obstruction is proximal- only a small amount of the intestine is dilated but the stomach is dilated

    If the obstruction is distal, a large amount of the intestine is dilated but the stomach is not usually fluid distended.

    Acute obstructions tend to have little to no gravelling and less severely distended bowel.
  5. Chronic partial intestinal obstruction
    Tend to have a lot of gravelling upstream from the obstruction

    Tends to have one severely dilated intestinal segment (the rest of the intestines are ~ normal)

    Bowel gets further distended (wider than the vertebral body) with time
  6. Hepatomegaly
    enlarged liver causes the gastric axis to be more horizontal than normal (stomach = cranial most gas bubble)

    the caudoventral part of the liver protrudes beyond rib 13.

    If the hepatomegaly is diffuse than the caudal edges of the liver are rounded.
  7. Pyometra
    Enlarged uterine body lifting the colon off the bladder

    Caudoventral 'sausage' summating with the bladder

    VD view- tubular structures/elliptical eggs out laterally (in the lateral recesses of the abdomen)- intestines dont go out this lateral
  8. Mid-abdominal mass
    large, solidly radio-opaque area in the mid-abdomen causing displacement of the organs around it (mass effect)

    If the intestines are displaced caudally and the stomach is displaced cranially it is a pancreatic/splenic mass

    If the stomach is displaced caudally it is a hepatic mass.
  9. Free abdominal fluid
    loss of serosal detail in the andomen

     Increased opacity in the ventral abdomen (can only see the parts of the GIT that contain gas).

    Abdomen may be distended.
  10. Renal mass
    Large solidly opaque structure dorsally in the retroperitoneal area of the abdomen

    The renal mass has a mass effect- pushes the colon and intestines ventrally.

    There is also loss of serosal detail in the area of the mass.
  11. Intestinal mass
    Soft tissue opacity mass with gas filled bowel.

    Mass effect on other parts of the intestine.

    Loss of serosal detail ventrally.
  12. Diaphragmatic hernia
    Loss of diaphragmatic continuity so that some of the abdominal organs are now present in the thoracic cavity

    Cupula is pulled back flat. Cant see the diaphragm

    Abdominal organs are in abnormal locations
  13. Abdominal wall hernia
    An incongruity of the abdominal wall that allows abdominal organs/parts of the organs to be outside of the abdominal cavity.

    If the blood supply is compromised to these herniated organs or if their lumen is disrupted- get focal gas and/or fluid distension.
  14. Sublumbar lymphadenopathy
    Oval shaped soft tisue mass in the caudal retroperitoneal space. Displaces the distal descending colon ventrally.

    These sublumbar lymph nodes are not visible when normal.

    Should be able to identify/outline both kidneys => identify that the masses are not kidneys but are sublumbar lymph nodes.