Chapter 10 Radiology Tools for Abdominal Diagnosis
Evaluate your own performance utilizing scientific data. Consult a radiologist when unclear about the “best test” for your patient in order to maximize your learning experience while optimizing patient care.
Communicating the results of the study/procedure to your patient and appropriate team members in a timely manner demonstrates compassion, honesty, and empathy to your patient and professional regard for your colleagues.
The obstruction series is usually the first radiographic investigation utilized in the evaluation of patients presenting with abdominal pain, distention, or bowel obstruction suspected by history and physical examination. It is useful as a follow-up study in patients with known bowel obstruction, and can be helpful in differentiating ileus versus obstruction in patients who have undergone abdominal surgery.
The following mnemonic may be helpful to remind you of what to look for on a chest radiograph:
When viewing abdominal radiographs, it is important to evaluate for:
The erect abdominal radiograph is utilized to detect air-fluid levels in the GI tract, and “free” (extraluminal) intra-abdominal air. It is normal to have an air-fluid level present in the stomach on an erect film. Normally, minimal small bowel air is present and the small intestine should measure no more than 2.5 to 3.0 cm in diameter, with centrally located loops. The large bowel is located more toward the periphery of an abdominal radiograph, as the right colon, hepatic flexure, splenic flexure, and left colon generally have a fixed position. If a patient is too ill for an erect radiograph, a left lateral decubitus radiograph may be obtained.
|Gallstones||10% of gallstones are radiopaque. May be incidental finding.|
|Appendicolith||Its presence is associated with appendicitis.|
|Chronic pancreatitis||Multiple calcifications in pancreas.|
|Abdominal aortic aneurysm||Look for calcium in aortic wall.|
|Nephrolithiasis/ureterolithiasis||Stones may be apparent overlying kidney shadow. Ureteral stones may appear anywhere along course of ureter.|
|Gallstone “ileus”||A gallstone large enough to block the ileocecal valve enters the bowel via a biliary enteric fistula from the gallbladder to the duodenum; usually the result of untreated chronic cholecystitis.|
|Uterine fibroids||Calcified fibroids may appear in pelvis.|
|Dermoid cysts||A dermoid is a mature teratoma that may manifest as a calcified “tooth” in pelvis.|