Dxi Iii Abdomen And Cacifications

Front 1

free air w/in peritoneal cavity

Back 1

pneumoperitoneum

Front 2

types of pneumoperitoneum

Back 2

laparotomy w/in 3-7 days
spontaneuous
traumatic

Front 3

m/c cause is perforation of gastric or duondenal ulcer

Back 3

spontaneous pneumoperitoneum

Front 4

secondary to diagnostic studies
perforation fm barium enema/colonoscopy
severe external trauma

Back 4

traumatic pneumoperitoneum

Front 5

free air under hemidiaphragm

Back 5

radiographic signs of a pneumoperitoneum

Front 6

intraluminal and extraluminal air outlining both surfaces of bowel wall

Back 6

double wall sign AKA Rigler's sign

Front 7

triangular gas density projected over superior margin of right kidney
represents air trapped dorsally under liver

Back 7

Morrison's pouch sign

Front 8

two closely approximated loops of bowel mimic a Rigler sign

Back 8

double wall finding

Front 9

gas filled loop on intestine between liver and diaphragm

Back 9

Chilaiditis syndrome

Front 10

gastric air bubble is under right hemidiaphragm

Back 10

situs inversus

Front 11

fat under diaphragm

Back 11

subdiaphragmatic fat or extraperitoneal fat

Front 12

Mucosal folds in sm intestine normally 1-2mm in width & regularly spaced

Back 12

valvulae conniventes

Front 13

small bowel rule of 3

Back 13

no more than 3 air/fluid levels
no more than 3 cm of bowel distention
no more than 3 mm between folds

Front 14

small bowel obstruction clinical findings

Back 14

nausea, vomiting, cramping, abdominal pain, distention

Front 15

may be partial or complete
adhesions fm surgery m/c
hernias
neoplasms
intussusception
strictures fm Crohn's disease
volvulus

Back 15

mechanical bowel obstruction

Front 16

sm bowel tries to force obstruction out by strong peristaltic contractions
may be seen as dynamic motion on surface of abdomen

Back 16

Dynamic Ileus

Front 17

bowel becomes exhausted and stops peristalsis
air collects in dilated loops of bowel

Back 17

Adynamic Ileus

Front 18

fairly common in adults occasionly children
indirect>direct M>F
presence of enlarged scrotum that contains multiple loops of air filled bowel

Back 18

Inguinal hernia

Front 19

common in adults
stomach herniates thru diaphragmatic hiatus

Back 19

hiatal hernia

Front 20

gastroesophageal junction remains fixed and gastric fundus herniates

Back 20

Paraesophageal (1%) hiatal Hernia

Front 21

m/c (95%) gasatroesophageal junction slides upward

Back 21

Sliding hiatal hernia

Front 22

three types of hiatal hernia

Back 22

sliding
paraesophageal
mixed

Front 23

gastroesophageal junction at 2 cm above diaphragm
soft tissue mass or air fluid level in middle/posterior mediastinum (retrocardiac region)

Back 23

radiographic findings for hiatal hernia

Front 24

two types of pathological calcifications

Back 24

metastatic
dystrophic

Front 25

refers to calcium deposition in normal tissue
result of hypercalcemia/elevated pH
not frequent in abdomen
apppears as a cloud of calcium deposits
described as tumoral calcinosis

Back 25

metastatic calcification

Front 26

occurs in local tissue damage or stone formation
normal calcium/pH
very common in abdomen

Back 26

Dystrophic calcification

Front 27

dystrophic calcification classifications

Back 27

morphological features
location
mobility

Front 28

radiographic features of dystrophic calcifications
what to look for

Back 28

shape, border sharpness, marginal continuity, internal architecture

Front 29

four types of dystrophic calcifications

Back 29

concretions
conduit wall
cyst wall
mass

Front 30

called stone or calculus
calcified mass that forms inside tubular or hollow structures
forms like pearl

Back 30

concretion

Front 31

sharp
clearly defined external margins
continuous
internal architecture:laminations, eccentric area of lucency, homogenously dense

Back 31

radiographic appearance of concretions

Front 32

found in appendix
associated w/current or future perforation
associated w/pain 90% chance of acute appendicitis

Back 32

appendocolith

Front 33

RUQ
solitary or multiple
"bag of Diamonds"
only 10-15% calcify & show up on xray
can be multifaceted

Back 33

cholelithiasis
gallstones

Front 34

m/c associated w/pancreatitis d/t alcoholism
caused by long standing ductal obstruction/inflammation
multiple,tiny, dense,discreet opacities
cross midline at L1-2

Back 34

pancreatic calculi

Front 35

m/c calcification in pelvis
calcified thrombus w/vein
normal variant
multiple/bilateral
do not cross midline

Back 35

phleboliths

Front 36

multiple calcifications ,various sizes, behind pubic symphysis in males
prior prostatitis
asymptomatic usually

Back 36

prostatic calculi

Front 37

seen in: renal calyces, renal pelvis, ureters, bladder
most calcify 85-95% visualized on xray
chronic low-level dehydration/infection
mineral deposit embedded in inorganic material
asymptomatic til obstruct
calcium phosphate, calcium oxalate, magnesium phosphate
(struvite) m/c

Back 37

urinary tract calculi

Front 38

large stone occupies renal collecting system forming cast of major calyces and renal pelvis
usually struvite (triphosphate)
may cause chronic hydronephrosis
leading to renal failure

Back 38

staghorn calculus

Front 39

seen on plain film present w/ low back pain, flank/groin pain
look in kidney, ureters, bladder
m/c lodged in uteropelvic junction, bifurcation of iliac vessels, uterovesical junction

Back 39

radiographic findings for renal stones

Front 40

round
central lucency
below ischial spine
DOES NOT MOVE

Back 40

phlebolith

Front 41

irregular shape
uniformly dense
above ischial spine
Moves w/time

Back 41

renal stone

Front 42

caused by obstruction/infection
may be migrant renal stone
50% may be seen on plain film
stellate referred to as "jackstone"

Back 42

bladder stone

Front 43

stellate bladder stone

Back 43

jackstone

Front 44

tubular structures thru which fluids are conducted
calcifications confined to tubular walls
m/c arterial walls

Back 44

conduit wall calcifications

Front 45

parallel, linear opacities (tract-like)
dot-dash appearance
may see vessel branch pattern
seen on end appear as ringlike

Back 45

radiographic finding for conduit wall

Front 46

m/c result of atherosclerosis
*smoking, diabetes,hypertension
m/c below renal arteries
NOT contraindication to manipulation
Not always an aneurysm

Back 46

Abdominnal aorta calcification

Front 47

m/c athersclerosis
M 4:1
older pts 95% 60-80yrs
asymptomatic
pain in low back,buttock, down leg
abdominal mass or pulsation
abdominal pain

Back 47

aneurysms

Front 48

3cm-3.8cm=dilation
>3.8-suggests aneurysm
4.5cm-6cm=surgical consult
>7cm=immediate consult

Back 48

Abdominal aortic size

Front 49

abdominal ultrasound
CT

Back 49

diagnostic for aneurysms

Front 50

second m/c site for arterial calcification
easy to recognize
may undergo aneurysmal changes
second to abdominal aorta

Back 50

iliac artery calcification

Front 51

arise fm abdominal aorta at or near L1 and extend laterally
athersclerosis or diabetes
typically aorta calcified as well

Back 51

renal artery calcification

Front 52

frequently calcifies
serpentine course in LUQ
very tortuous (may appear ringlike)
may be dilated or aneurysmal

Back 52

splenic artery

Front 53

duct that carries sperm fm epididymis to urethra
m/c associated w/diabetes
bilateral/symmetric
forms "V" shape
parallels pubic rami

Back 53

vas deferens calcification

Front 54

calcium deposition w/in wall of abdominal fluid filled structure
smooth, curvilinear rim opacity
complete or incomplete borders
displace or distort adjacent vessels/organs

Back 54

cyst wall calcifications

Front 55

2/3 splenic cysts caused by echinoccocus (hydatid cyst disease)
uncommon in US
accidental oral ingestion of eggs
cysts form in solid organs:liver, spleen, lung, brain
may have daughter cyst

Back 55

echinococcal cyst (hydatid)

Front 56

calcification of gallbladder wall
d/t chronic inflammation
females ages 38-70yrs
10-20% develop gallbladder carcinoma usually aggressive poor prognosis

Back 56

porcelain gallbladder

Front 57

most diverse presentation of abdominal calcifictions
irregularly calcified borders & complex internal architecture
may occur anywhere in abdomen
central or peripheral , adjacent to or w/in organs

Back 57

solid mass calcification

Front 58

4 standard differential for masses

Back 58

calcified mesenteric lymph nodes
leiomyoma
dermoid cyst (teratoma)
injection granulomas

Front 59

occur along broad arch fm LUQ to RLQ w/in small bowel mesentery
multiple of varied sz
TB and Histoplasmosis m/c causes

Back 59

Mesenteric lymph node calcification

Front 60

m/c women
usually occur in uterus can be anywhere
benign tumor of smooth muscle
whorled type of calcification or flocculant
may demonstrate prominent bordering rim

Back 60

Leiomyomas

Front 61

subcutaneous fat necrosis secondary to intramuscular injections
m/c in hip soft tissue
solitary or multiple calcific spheres

Back 61

injection granulomas

Front 62

stone baby
calcified fetus body could not resorb

Back 62

lithopedion

Front 63

Stands for kidneys, ureters and bladder
Represents the “standard” radiograph
Sometimes referred to as a flat plate
70kVp if looking for calcification
90kVp if looking for a mass

Back 63

KUB study

Front 64

Taken with the same parameters as the KUB
Only the patient is lying on the abdomen (prone)
PA is anterior anatomy while a KUB is designed for the posterior anatomy

Back 64

PA abdominal study

Front 65

The very best to demonstrate free intra-abdominal air is the PA chest (erect)
Air will travel to the location of least resistance
Fluid will gather in the most gravity dependent area

Back 65

pneumoperitoneum study

Front 66

Patient lays on their side with their back up against the film
Patient should be on their side for a minimum of 5 minutes before exposure
Left Best demonstrates free air within the abdominal cavity in the area of the liver in the RUQ

Back 66

Lateral Decubitus Position

Front 67

Taken just like an AP lumbar film
70 kVp for calcifications
90 kVp for masses
Fluid sinks down to the pubic area
Air travels up to the diaphragms

Back 67

AP Abdomen—Erect

Front 68

Patient lays on their back with their side up against the film
Looks just like a lateral lumbar
Asses for free air/fluid and aneurysms

Back 68

Dorsal Decubitus

Front 69

Abnormal gas and mucosal patterns
Morphological abnormalities of the anatomy
Abnormal calcifications
Abnormal fluid (ascites)
Bone and joint abnormalities
Post-operative changes

Back 69

Pathological Considerations of abdomen

Front 70

Mostly located in the LUQ
Identified by the gas content or meganblase (gastric air bubble)
Relatively fixed position at the gastroesophageal junction while the rest is fairly mobile

Back 70

stomach

Front 71

Duodenum is primarily a fixed retroperitoneal structure
The descending (2nd) portion is closely associated with the head of the pancreas
Typically does not contain enough air to be visualized on plain film radiographs
Valvulae conniventes– are the circular folds

Back 71

small intestine

Front 72

Relatively well visualized because of its gas content
Haustra (semilunar folds)
Cecum usually found in the RLQ
Can be mobile
Ascending and descending portions are retroperitoneal
The rectum typically is seen with air within it
Presacral space—the distance between the anterior cortex of the sacrum to the posterior margin of the recutum
Should not exceed 2cm in adults
Exception in the extremely obese
Causes for increased: inflammation, ascites, blood, neoplasm
Seen on a lateral image

Back 72

large intestine

Front 73

Generally not seen unless pathological
Diagnostic ultrasound is the preferred method of investigation
CT has also been shown to be more sensitive and accurate
Traditional located in the RLQ

Back 73

appendix

Front 74

RUQ
Homogenous water density
There should be no gas separation between the liver and right hemidiaphragm or within the liver
Reidel’s lobe:
Congenital anomaly
Vertical elongation of the inferior margin
May extend down to the iliac crest
Common in tall thin females (3-30%)

Back 74

liver

Front 75

Closely associated with the anteroinferior aspect of the liver
One of the more common sites for abnormal abdominal calcifications
(cholelithiasis)
wall calcification may result in carcinoma
Not always visualized
RUQ
There is some variability

Back 75

gallbladder

Front 76

One of the more difficult organs to visualize
Head lies within the duodenal loop
The tail projects posteriorly and to the left
Chronic pancreatitis may demonstrate calcficiations

Back 76

pancreas

Front 77

Located within the LUQ
Superiorly it is bordered by the left hemidiaphragm
Only the lower pole casts a shadow on the radiograph
Vertical Height (8-12cm)
Measure 2cm up from the inferior pole for the horizontal measurement
Measurement should be no more than 4cm
When enlarges it will travel in an anterior and inferior direction
Measurements on plain film radiographs are not completely accurate

Back 77

spleen

Front 78

Bean-shaped
Located with in the retroperitoneum
Slight medial inclination towards the upper poles
Patient position and respiration can change the position
Superior pole is found at T12/L1
The length is no more than the combined height of 3.5 vertebral bodies
Left sits higher than right by 1-2cm
Dromedary Hump: Seen on the left Caused by the spleen pushing on the side creating a “hump”

Back 78

kidneys

Front 79

Bilateral V-shaped organs
Superior and somewhat anterior to the superior poles of the kidneys
Not demonstrated on plain film normally

Back 79

adrenal glands

Front 80

Not normally seen on plain film
Retroperitoneal
Most common site for symptomatic calculi
Three common sites for calculi to lodge
Ureteropelvic junction
The point where they cross the bifurcation of the iliac artery
Ureterovesicular junction

Back 80

ureters

Front 81

Comes off the transverse processes of T12 and descends to the iliac crest
What is actually seen is the interface between the actual muscle and the fat surrounding it
Non-visualization may reflect serious disease like inflammation or ascites as well as benign reasons
Excessive overlying gas
Curvature of the spine
Lack of surrounding fat

Back 81

Psoas shadow

Front 82

Outlines the margins of the abdomen lateral to the ascending and descending colon
It appears as a lucent line separating the soft tissues of the skin from the abdominal cavity
This line is often obliterated in inflammatory conditions of the abdomen such as
Appendicitis
Peritonitis

Back 82

flank stripes

Front 83

Seen as a water density immediately superior to the pubic symphysis
In females, the uterus may lay against the superior aspect causing an indentation

Back 83

bladder

Front 84

Located in the pelvic bowel
Between the rectum and bladder
Seen only if it indents the bladder
May contain calcifications within uterine fibroids

Back 84

uterus

Front 85

Located in the pelvic bowel
Exact location varies
Not typically seen on plain film

Back 85

ovaries

Front 86

Located with in the pelvic bowel
Not visualized unless calcified
Most often seen in diabetic patients
male

Back 86

vas deferens

Front 87

Lies just above the pubic symphysis
Normally not seen
Calcifications from prior inflammation
male

Back 87

prostate

Front 88

Runs along the left anterolateral aspect of the lumbar spine
Bifurcates into the iliac arteries at approximately L4/L5
Calcification more common in elderly
Upper limits of normal is 3.5cm

Back 88

abdominal aorta

Front 89

Branch at L4/L5
Extend down and out to the groin
Common site for calcification

Back 89

common iliac