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Download General Abdominal Radiography - North Carolina State University
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General Abdominal Radiography Tony Pease, DVM, MS Assistant Professor of Radiology North Carolina State University Objectives • • • • • Acquisition of radiographs Abdominal radiographic anatomy Radiographic patterns of abdominal disease Determine normal compared to abnormal Determine further evaluations needed Reading • Chapter 38 – Pages 483-493 Abdominal Radiography • Generally being replaced with ultrasound – Ultrasound does not give a global picture • Radiographs are a snapshot of disease – 1/120th of a second picture • Ultrasound is real time Abdominal Anatomy • A lot of organs in a small space • Rely on location Acquiring radiographs • Relatively high kVp (70) – Moderate image contrast – Some of shades of grey – More than bone less than thorax • Moderate mAs – Minimizes motion artifact – Maximizes contrast • Enemas and fasting are helpful Positioning • Include caudal thorax • Try to include greater trochanter of femur • Center beam just caudal to the last rib Large patients • May need two films per view – Four films per study – Make sure to overlap images Ventrodorsal • • • • • Liver Spleen Left Kidney Right Kidney Stomach and duodenum Left lateral • • • • • • • • Esophagus Pylorus Duodenum Liver Spleen Left kidney Right kidney Urinary bladder Right lateral • • • • • • Fundus Liver Spleen Left kidney Right kidney Urinary bladder Normal cat abdomen Deep circumflex iliac artery Sometimes confused for medial iliac lymph nodes or ureteral calculi Positional radiographs • Remember gas rises • Can manipulate the animal Can you see the gas? Lateral horizontal beam Horizontal beam • Place the animal in left lateral – Puts the fundus of the stomach down – Smaller pylorus is high • Gas accumulates near the diaphragm Some incidential findings • Lucency on the ventral aspect of L3-4 • Cholesterol granulomas • Spondylosis deformans Lack of ventral aspect of L4 • It is where the diaphragm attaches Cholesterol granuloma • Generally in cats Smooth bridging bone Spaces of the abdomen • Retroperitoneal – Dorsal to the colon – Contains kidneys, adrenal glands, lymph nodes – Continuous with mediastinum • Peritoneal – Surrounds visceral organs – Generally a potential space Can compare spaces Retroperitoneal space Good detail Peritoneal space Poor detail Loss of serosal detail • • • • • • Poor radiographic technique Fat content of a puppy or kitten Peritoneal fluid (many types) Carcinomatosis Lack of fat Peritonitis Peritoneal fluid • • • • Soft tissue and fluid are similar opacity Therefore lose detail in the abdomen Ultrasound superior for peritoneal fluid Emaciation and fluid cause similar appearance, except for overall size of abdomen Peritoneal fluid • Multiple causes – Increased hydrostatic pressure – Decreased plasma colloid oncotic pressure – Capillary permeability • Radiographs very insensitive for detecting • Cannot tell fluid type from radiographs Mild Severe Severe Lack of fat cause loss of detail Is there peritoneal fluid? Retroperitoneal space • Only thing that is dorsal to the colon Don’t forget that other view Abdominal lymph nodes • Many lymph nodes in abdomen • Generally not seen radiographically – Even if large • Medial iliac lymph nodes are the exception • Ultrasound more useful for lymph nodes Medial iliac lymph nodes Don’t forget about goats • Can help diagnose caseous lymphadenitis Pneumoretropertioneum • Retroperitoneum communicates with the mediastinum • Therefore usually associated with: – Subcutaneous emphysema – Pneumomediastinum Need large volume of gas • Ruptured trachea • Ruptured esophagus – Need aerophagia Pneumoretroperitoneum • Not generally clinically important • Just a sign of another disease Even in the cow! Pneumoperitoneum • Can persist 10-14 days after surgery • Rupture of a hollow viscus – Gastrointestinal perforation – Surgical emergency!! • External puncture wound Several places to look What about large animal? Foals and calves • Can image abdomen – Usually standing – See fluid layers • Can do barium enemas – Strictures or atresia ani Ileus Traumatic reticuloperitonitis Traumatic reticuloperitonitis All about the belly in 1 hour! • • • • Good general overview Over the next 3 weeks will be focused Radiographs are a good overview Helpful even if large animal Questions?
