Radiography of the Abdomen - univet.hu OKTATASI ANYAGOK... · 2012-01-07 · Radiology of theAbdomen Attila Arany-Tóth 3 Radiography of Abdomen Abnormalities in density Increased

Radiology of the Abdomen

Attila Arany-Tóth 1

Radiography of the Abdomen

Radiography of the Abdomen

Attila ARANY-TóTH

Radiography of Abdomen

Standard projectionsRadiography of Abdomen

Standard projectionsLaterolateralLaterolateral



Standard projectionsVentrodorsalVentrodorsal



Standard projectionsDorsoventralDorsoventral



Radiographic opacitiesRadiographic opacities

• Metal

• Bone

• Soft tissue/fluid

• Fat

• Gas

• Metal

• Bone

• Soft tissue/fluid

• Fat

• Gas

LiverKidneySpleenUrinary bladderFluid filled stomach and intestine

LiverKidneySpleenUrinary bladderFluid filled stomach and intestine

Border effacement


Boundaries of the AbdomenRadiography of Abdomen

Boundaries of the Abdomen

Radiography of AbdomenRadiography of Abdomen

Abdominal hernia: a protrusion of abdominal contents into the subcutis through a natural or acquired opening of the abdominal wall.


Abdominal herniasRadiography of Abdomen

Abdominal hernias


Abnormalities in densityRadiography of Abdomen

Abnormalities in densityIncreased radiopacity (loss of abdominal detail):- decrease in intraabdominal fat (young (





Abnormalities in density

Increased radiopacity (loss of abdominal detail):- decrease in intraabdominal fat (young, kachexia)- abdominal effusion (transudate, exudate, hemorrhage, urine etc.)







Intraabdominal gas accumulation- ruptured hollow viscus- postlaparotomy (3-7 days)





Radiographic signRadiographic sign: : increased visualisation increased visualisation of serosal surfaceof serosal surface









Radiography of the LiverRadiography of the Liver Radiography of the LiverRadiography of the Liver



Homogenous opacity, sharp edge

Liver does not exceed costal arch

Relatively bigger in case of:- small breed dog- in Young- in exspiration- right lateral recumbency

Homogenous opacity, sharp edge

Liver does not exceed costal arch

Relatively bigger in case of:- small breed dog- in Young- in exspiration- right lateral recumbency

Radiography of the LiverRadiography of the Liver

Abnormalities in sizeAbnormalities in size


Enlargement (Hepatomegaly)Enlargement (Hepatomegaly)


Causes:Causes:-- tumortumor-- congestioncongestion-- hepatitishepatitis

Decreased Liver SizeDecreased Liver Size


Causes:- cirrhosis- portosystemic vascular shunts

Radiography of the SpleenRadiography of the SpleenSpleenSpleen



SpleenSpleen

L L

SplenomegalySplenomegalySpleenSpleen

Splenic massSplenic massSpleenSpleen Abdominal massesAbdominal masses

Abdominal massesAbdominal masses Radiography of AbdomenRadiography of the Pancreas


Radiography of the Pancreas




Radiography of the PancreasRadiography of Abdomen

Radiography of the PancreasNormally not seen !Normally not seen !

PancreasPancreasPancreatitis, pancreatic massPancreatitis, pancreatic mass

- soft tissue radiopacity in the epigastrium


Radiography of the StomachRadiography of Abdomen

Radiography of the StomachAnatomy

(ventrodorsal)Anatomy

(ventrodorsal)Shape

dog catShape

dog cat

StomachStomach

StomachStomachLocation

(laterolateral)Location

(laterolateral)

Radiographic anatomyRadiographic anatomy

Depends on contents and recumbency!Depends on contents and recumbency!

StomachStomachStomachStomach

Solid Gas







StomachStomachStomachStomach StomachStomachStomachStomachRadiographic anatomyRadiographic anatomy


StomachStomachStomachStomach


Depends on contents and recumbency!Depends on contents and recumbency! 1. Plain/survey (position, contents)2. Contrast radiography

- negative

- positive (gastric emptying)

- double

1. Plain/survey (position, contents)2. Contrast radiography

- negative

- positive (gastric emptying)

- double

StomachStomach

1. Survey (position, content)1. Survey (position, content)StomachStomach

2.A. Negative contrast2.A. Negative contrastStomachStomach



2.B. Positive contrast- BaSO4 (liquid) suspension , 10 ml/kg p.os- shows the route of chymus along the GI tract

- series of regular bilateral view projections

- evaluation of

2.B. Positive contrast- BaSO4 (liquid) suspension , 10 ml/kg p.os- shows the route of chymus along the GI tract

- series of regular bilateral view projections

- evaluation of

StomachStomach

gastric emptying process anatomy

Gastric emptying process:Gastric emptying process:

- starts 5-10 minutes after feeding- usually complete emptying in 4 hours- 4 h < : delayed gastric emptying

Causes: - hypertrophy of the pyloric muscle- hyperplasia of the mucosa- fibrosis of the pyloric wall- pyloric tumor- pyloric foreign body

Causes: - hypertrophy of the pyloric muscle- hyperplasia of the mucosa- fibrosis of the pyloric wall- pyloric tumor- pyloric foreign body

stenosis of the stenosis of the pyloric canalpyloric canal

2 hours4 hours

0. min 1 hour

Normal emptying

1.hplain 15. min 30. min

2. h 4. h 12. h 24.h

Pyloric stenosis – delayed gastric emptyingPyloric stenosis – delayed gastric emptying

Morphologic abnormalitiesMorphologic abnormalities

2.C. Double contrast (BaSO4 + air)

dose: 2 ml/kg BaSO4+10 ml/kg air

2.C. Double contrast (BaSO4 + air)

dose: 2 ml/kg BaSO4+10 ml/kg air

StomachStomach



Gastric DilatationGastric DilatationStomachStomach

Content: Food

Gastric DilatationGastric DilatationStomachStomach

Content: Gas (tympania ventriculi)

Gastric dilatation and volvulusGastric dilatation and volvulus

L R

StomachStomach

- acute, life threatening disease of large breed dogs

rightleft

Gastric dilatation and volvulusGastric dilatation and volvulus

L

R

R

L

Gastric Foreign BodyGastric Foreign BodyStomachStomach

radiopaque


radiopaque




radiopaque


radiolucent

Gastric NeoplasiaGastric Neoplasia

StomachStomach Radiography of AbdomenRadiography of the Small Intestine


Radiography of the Small Intestine

Small IntestineSmall Intestine

SurveySurvey

Contents !


SurveySurvey

Normal diameter: dog: body of L2cat: 2xL4

Normal diameter: dog: body of L2cat: 2xL4



Contrast radiographyContrast radiography


- to prove/rule out ileus- barium sulphate liquide p. os, 2-3 ml/kg- control in 12 hours

Ileus: failure of intestinal contents to pass through the small intestine .

Ileus: failure of intestinal contents to pass through the small intestine .

Ileus

Survey:

1. foreign body sometimes visible 2. gas-filled, unequally distended portions of the small intestine3. sometimes no radiographic evidence4. further duobt: ultrasound or contrast study

ObstructionObstruction


Small Intestinal ObstructionSmall Intestinal ObstructionSmall IntestineSmall Intestine

Small Intestinal ObstructionSmall Intestinal ObstructionSmall IntestineSmall Intestine

Small Intestinal ObstructionSmall Intestinal Obstruction


plainSmall Intestinal ObstructionSmall Intestinal Obstruction


contrast



Small Intestinal ObstructionSmall Intestinal Obstruction


contrast

IleusIleusSmall IntestineSmall Intestine

Subileus:partial obstruction or narrowing (adhesion, scar)


Subileus:partial obstruction or narrowing (adhesion, scar)

Caused by Linear Foreign BodyCaused by Linear Foreign Body


- string, fishing line, recording tape, dental floss etc.- intestine becomes pleated/plicated- partial/complete obstruction

- string, fishing line, recording tape, dental floss etc.- intestine becomes pleated/plicated- partial/complete obstruction









Mesenteric VolvulusMesenteric Volvulus


- severe acut clinical signs!- uniform gas-filled small intestine loops

Mesenteric VolvulusMesenteric Volvulus


- severe acut clinical signs!- uniform gas-filled small intestine loops

Paralytic ileusParalytic ileus


- decrased motility of the intestines of any origine- gas accumulation

Intestinal perforationIntestinal perforation


- gas/fluid in the peritoneal space

EnteritisEnteritis




- colon asc., transv., desc.- cecum


Radiography of the Large IntestineRadiography of Abdomen

Radiography of the Large Intestine

Cecum:- dog: helical-shaped- in the geometric midpoint of the abdomen- cat : not visible




Survey radiograph:- LL,DV

- contains gas or feces- location, contents- diameter: max small int. x 3, or length of L7







- contains gas or feces- location, content- diameter: max small int. x 3, or lenght of L7


- contains gas or feces- location, content- diameter: max small int. x 3, or length of L7




Contrast study:- 24 h withhold the food or enema 12 h before examination- general anaesthesia- BaSO4 enema- mucosal surface/ space occupying processes

Contrast study:- 24 h withhold the food or enema 12 h before examination- general anaesthesia- BaSO4 enema- mucosal surface/ space occupying processes






Positive contrast medimPositive contrast medim




Double contrast studyDouble contrast study







Constipation- dense, firm contents

MegacolonMegacolon




- motility/innervation disorder of the colon

- Space-occupying process in the colonal lumen (tumor)- endoscopy!!



Radiography of the Large IntestineRadiography of the Urinary System

- position: retroperitoneum (craniodorsal)

- same size (L2x2-3)

- well defined (retroperitoneal fat)

KidneysKidneys



Urinary bladderUrinary bladder

Urinary TractUrinary Tract

- sharply marginatedsoft tissue opacity- caudoventrally

- sharply marginatedsoft tissue opacity- caudoventrally

Urinary bladder - survey LLUrinary bladder - survey LLUrinary TractUrinary Tract

- appearance depends on amount of urine

Urinary bladder - survey VDUrinary bladder - survey VD

Urinary TractUrinary TractRadiography of the Urinary SystemRadiography of the Urinary System

Survey radiograph: not seenSurvey radiograph: not seen

Ureter, urethraUreter, urethraUreter, urethraUreter, urethra

1.Intravenous/Excretory Urography (IU, EU)

- intravenous application of water solubile iodinated contrast medium

- selective excretion by kidneys- dose: 300-600 mg I /kg iv.- morphological and functional examination

of kidney, ureters, bladder- sedation, withhold the food 24 h befor examination

1.Intravenous/Excretory Urography (IU, EU)

- intravenous application of water solubile iodinated contrast medium

- selective excretion by kidneys- dose: 300-600 mg I /kg iv.- morphological and functional examination

of kidney, ureters, bladder- sedation, withhold the food 24 h befor examination


Contrast examination of the urinary tractContrast examination of the urinary tract

1.Intravenous/Excretory Urography (IVU, EU)

Technique:- expositions: in the 1,5,10 min after injection LL, DV- contrast enhancement in:

- renal vasculature/parenchyma (nephrogram/parenchyma phase) 0-1. min

- renal collecting system, and ureters (pyelogram phase) 1-10. min

- urinary bladder (bladder phase) >10 min.

1.Intravenous/Excretory Urography (IVU, EU)

Technique:- expositions: in the 1,5,10 min after injection LL, DV- contrast enhancement in:

- renal vasculature/parenchyma (nephrogram/parenchyma phase) 0-1. min

- renal collecting system, and ureters (pyelogram phase) 1-10. min

- urinary bladder (bladder phase) >10 min.





Excretory urography - normal(nephrographic phase)

Excretory urography - normal(nephrographic phase)


Excretory urography - normal(pyelographic phase)

Excretory urography - normal(pyelographic phase)


Excretory urography - normal(bladder phase)

Excretory urography - normal(bladder phase)


2. Positive contrast (retrograde) cystography

- morphological examination of the urinary bladder

- bladder emptying prior to examination

- 5 ml /kg diluted iodinated contrast (300 mg I/ml) (1 part

contrast to 1-3 parts water) through catheter

2. Positive contrast (retrograde) cystography

- morphological examination of the urinary bladder

- bladder emptying prior to examination

- 5 ml /kg diluted iodinated contrast (300 mg I/ml) (1 part

contrast to 1-3 parts water) through catheter



2. Positive contrast retrograde cystography2. Positive contrast retrograde cystography



2. Positive contrast retrograde cystography2. Positive contrast retrograde cystography





3.Pneumocystography3.Pneumocystography


- bladder emptying prior to examination- 5-10 ml air (or CO2)/kg- indication: evaluation of the thickness of the bladder wall


3.Pneumocystography3.Pneumocystography



4.Double-contrast cystography4.Double-contrast cystography


- catheterize and empty the bladder- infuse gas to distent the bladder (5-10 ml/kg)- inject small volume iodinated contrast media

(1-2 ml/kg cat, 2-10ml/kg dog) - roll the animal 360°- indication: radiopaque cystoith, tumor

Contrast examination of the urinary tractContrast examination of the urinary tract Double-contrast cystographyDouble-contrast cystography


5. Positive contrast retrograde urethrography5. Positive contrast retrograde urethrography



- to demonstrate uretral stenosis- males: catheter 3-4 cm long into the uretra, manual compression- females: catheter with cuff- exposure: during continous injection

- to demonstrate uretral stenosis- males: catheter 3-4 cm long into the uretra, manual compression- females: catheter with cuff- exposure: during continous injection

Urinary Tract - AbnormalitiesUrinary Tract - Abnormalities

Kidneys

- survey, excretory urography

SIZE decreasedincreased



Hydronephrosis


Kidneys

Hydronephrosis


Kidneys

Renal calculiRenal calculi


Kidneys


Ureter- excretory urography

Dilatation of the ureter (hydroureter)Dilatation of the ureter (hydroureter)


Ureter- excretory urography

Rupture of the ureterRupture of the ureter


Ureter- excretory urography (+ negative contrast)

Ectopic ureterEctopic ureter

- young dog/cat- incontinency




Urinary bladder- positive contrast cistography- negative contrast cistography (+EU)- double contrast cistography- excretory urography

Urinary bladder- positive contrast cistography- negative contrast cistography (+EU)- double contrast cistography- excretory urography

Dilatation of the bladderDilatation of the bladder



Abnormal positionAbnormal position



Thickened bladder wallThickened bladder wall

- cystitis



CystolithiasisCystolithiasis











CystolithiasisCystolithiasis - double contrast urography



Rupture of urinary bladderRupture of urinary bladder



Neoplasia of the bladderNeoplasia of the bladder- irregular filling defect / thickening- irregular filling defect / thickening


UrethraUrethra

Urethral calculiUrethral calculi

- survey: radiopaque calculi- survey: radiopaque calculi


UrethraUrethra


- survey: radiopaque calculi- survey: radiopaque calculi


UrethraUrethra


- filling defect- filling defect




UrethraUrethra

Narrowing of the urethral lumenNarrowing of the urethral lumen


UrethraUrethra

Rupture of the urethraRupture of the urethra

Prostate Prostate Male genital systemMale genital system Prostate Prostate

Prostatomegaly

UB

Pr

UterusUterusFemale genital systemFemale genital system

- nongravid: not seen- gravid: 45. day – fetal skeleton

UterusUterusFemale genital systemFemale genital system

- nongravid: not seen- gravid: 45. day – fetal skeleton



PyometraPyometraFemale genital systemFemale genital system

tubular, soft tissue opacity in the hypogastrium

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Radiography of the Abdomen - univet.hu OKTATASI ANYAGOK... · 2012-01-07 · Radiology of theAbdomen Attila Arany-Tóth 3 Radiography of Abdomen Abnormalities in density Increased