Radiology Tools for Abdominal Diagnosis

Chapter 10 Radiology Tools for Abdominal Diagnosis



Anton Mahne, MD, Andrew J. Curtin, MD, Harry G. Zegel, MD




Radiology and the Competencies





Patient Care


Provide safe and efficient patient care by appropriately utilizing diagnostic and/or interventional radiology techniques.



Medical Knowledge


Engage in continuous learning, using current evidence to select appropriate diagnostic and/or therapeutic radiology techniques for optimal patient care.



Practice-Based Learning and Improvement


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.



Interpersonal and Communication Skills


Explain to your patient the nature of any radiological study ordered, and obtain informed consent, if required.



Professionalism


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.



System-Based Practice


Learn how your in-patient and out-patient system functions. Utilize imaging resources in a cost-effective manner, while maintaining a high standard of patient care. Spend your health-care dollar wisely.



The Obstruction Series


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 obstruction series consists of three radiographs:


1) Chest radiograph (erect)

2) Supine abdominal radiograph

3) Erect abdominal radiograph or left lateral decubitus (if the patient is too ill to stand erect)


1. Chest Radiograph (PA)



image

Figure 10-1 Normal chest x-ray.


The following mnemonic may be helpful to remind you of what to look for on a chest radiograph:


Airway: trachea, bronchi, lung fields

Bones: clavicles, ribs, scapulae, spine

Cardiac: heart, mediastinum, pulmonary vasculature

Diaphragm: costophrenic and costocardiac angles, free air

Everything else: endotracheal, nasogastric and chest tubes; central lines, upper abdomen

Specific abnormal findings to look for on the chest x-ray:


image Free air under the diaphragm

image Pneumonic infiltrates

image Pneumothorax

image Pleural effusions

image Calcifications

image Pulmonary nodules

image Presence and position of tubes/catheters (e.g., central venous catheters, endotracheal tubes, chest tubes, and pacemakers)


2. Supine Abdominal Radiograph—Normal Anatomy (AP)



image

Figure 10-2 Note that specific organs can often be delineated on the supine abdominal radiograph.


When viewing abdominal radiographs, it is important to evaluate for:


1. Gas pattern

2. Air-fluid levels

3. Extraluminal air

4. Calcifications

5. Masses

6. Lines and tubes


3. Erect Abdominal Film (AP)


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.


Table 10-1 Calcifications Seen on Abdominal X-rays






























Entity Notes
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.

image

Figure 10-3 Note the numerous air-fluid levels, which will be seen only on the upright view. The patient proved to have a small bowel obstruction due to adhesions.

Related posts:

  1. Pigmented Skin Lesion in a 58-Year-Old Female (Case 12)
  2. Professor’s Pearls: Pediatric Surgery
  3. Whipple Procedure (Pancreaticoduodenectomy)
  4. Nutrition Support in the ICU

Stay updated, free articles. Join our Telegram channel
Tags:
Mar 20, 2017 | Posted by in GENERAL SURGERY | Comments Off on Radiology Tools for Abdominal Diagnosis

Full access? Get Clinical Tree
Get Clinical Tree app for offline access