ABDOMEN & PELVIS PATHOLOGY & SCANNING PROTOCOLS

PATHOLOGIES

ABDOMINAL MESENTERIC CYST

ABDOMINAL CYST An abdominal CT scan revealed a large right upper quadrant cyst measuring 14x17x21 cm ( lateral, anteroposterior and craniocaudal)There was mass effect upon the liver and duodenum. The cyst had a thin smooth wall with internal fluid and high density material consistent with a blood clot.

RENAL CYST NO CONTRASTCONTRAST

POLYCYSTIC KIDNEY DISEASE In PKD fluid-filled cysts develop giving the kidneys a honeycomb appearance. It is one of the most common inherited disorders, and the fourth commonest cause of kidney failure. In polycystic kidney disease many fluid- filled cysts develop in the kidneys. Gradually these cysts replace the normal kidney tissue enlarging the kidneys but making them less and less able to function normally. Eventually the kidneys fail completely

HEPATOMEGALY

ASCITES Ascites is the abnormal collection of fluid in the abdominal cavity, most often as a result of chronic liver disease.

SPLENOMEGALY

SPLENIC INFARCTION

APPENDICITS An axial slice of a CT scan done with the use of intravenous and oral contrast is presented. The arrow points to an area of soft tissue induration within the retrocecal fat. There is a rim like area of higher attenuation within this area. The structure is fluid filled. These features are compatible with a diagnosis of acute appendicitis and the presence of rupture cannot be excluded.

DIVERTICULITS Diverticulitis is inflammation or infection of small pouches, called diverticula, that develop along the walls of your intestines. The formation of the pouches themselves is a relatively benign condition known as diverticulosis. The pouches can develop anywhere on the digestive tract, but they most commonly form at the end of the descending and sigmoid colons, and they also frequently occur on the first section of the small intestine (although they rarely cause problems there ).

DIVERTICULITS

ABDOMINAL ABSCESS Psoas abscess (blue arrow), and abscess dissecting anteriorly in transversalis fascia.

BOWEL OBSTRUCTION

LIVER METS Lung cancer, small cell. Contrast-enhanced CT scan of the abdomen. Axial section through the liver shows multiple hypoattenuating areas in the liver. Poorly defined margins, attenuation greater than that of water, and scattered distribution in a patient with known lung cancer is most consistent with metastatic disease.

ESOPHAGEAL CANCER

WILMS TUMOR Wilms tumor, also called nephroblastoma, is a cancer that originates in the kidney. The disease gets its name from a German doctor, Max Wilms, who wrote one of the first medical articles about it in Ninety percent of all kidney cancers in children are Wilms tumor. The remaining ten percent are rare forms of childhood kidney cancers: clear cell sarcoma of the kidney, malignant rhabdoid tumor of the kidney, and occasionally renal cell carcinoma

WILMS TUMOR

ADRENAL METS

RENAL STONE

HYDRONEPHROSIS

BLADDER CANCER

KIDNEY CANCER Kidney cancer affects some 30,000 people in the United States each year, and close to 12,000 die from the disease. It is the eighth most common cancer in men and the tenth most common in women. Smoking is the major risk factor,

HORSESHOE KIDNEYS

PHEOCHROMOCYTOMA Pheochromocytoma is a tumor of the adrenal gland that causes excess release of epinephrine and norepinephrine, hormones that regulate heart rate and blood pressure

CIRRHOSIS

HEMANGIOMA

A cavernous hepatic hemangioma is the most common non-cancerous tumor of the liver. It is believed to be a congenital defect, and is usually not discovered until medical pictures are taken of the liver for some other reason.

CHOLELITHIASIS

CHOLECYSTITIS

PANCREATIC CANCER

PANCREATITIS

ABDOMINAL ANEURYSM

PROTOCOLS

SPONGE FEET FIRST OR HEAD FIRST

SCOUT: AP LANDMARK: XIPHOID TIP SCAN MODE: Spiral I.V. CONTRAST: ml/sec, ML SCAN DELAY: sec ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN, 200 ML JUST BEFORE SCAN BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 8-10 MM START LOCATION: LUNG BASES END LOCATION: ILIAC CREST FILMING: STANDARD, LUNGS, LIVER + BONE FOR TRAUMA & CANCER ABDOMEN STANDARD ROUTINE

SCOUT: AP LANDMARK: XIPHOID TIP SCAN MODE: Spiral NO ORAL CONTRAST NO IV CONTRAST BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 5MM START LOCATION: ABOVE KIDNEYS END LOCATION: S. PUBIS FILMING: STANDARD ABDOMEN-KIDNEY STONE

SCOUT: AP LANDMARK: XIPHOID TIP SCAN MODE: SPIRAL I.V. CONTRAST: 4-5 ml/sec, ML SCAN DELAY: 1. NON-CONTRAST, 2. ARTERIAL 30 SEC. 3. PORTAL 70 SEC. ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN, 200 ML JUST BEFORE SCAN BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 4-5 MM START LOCATION: LUNG BASES END LOCATION: ILIAC CREST FILMING: STANDARD + LIVER ABDOMEN LIVER MASS-3 PHASE

NON-CONTRASTARTERIAL PORTAL

LIVER SINGLE PHASE SCOUT: AP LANDMARK: XIPHOID TIP SCAN MODE: Spiral I.V. CONTRAST: ml/sec, ML SCAN DELAY: 45 SEC ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN, 200 ML JUST BEFORE SCAN BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 8-10 MM START LOCATION: LUNG BASES END LOCATION: ILIAC CREST FILMING: STANDARD + LIVER + BONE FOR TRAUMA & CANCER

SCOUT: AP LANDMARK: XIPHOID TIP SCANNING MODE: SPIRAL I.V. CONTRAST: 2-4 ml/sec, ML SCAN DELAY: sec ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN, 200 ml 15 MINUTES BEFORE SCAN BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 3-5 MM THROUGH PANCREAS START LOCATION: LUNG BASES END LOCATION: ILIAC CREST FILMING: STANDARD + LIVER + BONE FOR TRAUMA & CANCER ABDOMEN- PANCREAS

BETTER VISUALIZATION OF PANCREAS- R. LAT. DECUB.

SCOUT: AP LANDMARK: XIPHOID TIP SCANNING MODE: SPIRAL I.V. CONTRAST: 2-4 ml/sec SCAN DELAY:1. NONCONTRAST: 2. ARTERIAL 30 SEC. 3. NEPHROGRAM 90 SEC.: 4. PYELOGRAM 3-5 MIN. ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN, 200 ml JUST BEFORE SCAN BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 8-10 MM, 5 MM THROUGH KIDNEYS START LOCATION: LUNG BASES END LOCATION: ILIAC CREST FILMING: STANDARD ABDOMEN- KIDNEYS

CTA OF THE ABDOMEN SCOUT: AP LANDMARK: XIPHOID TIP SCAN MODE: Spiral I.V. CONTRAST: 4-5 ml/sec, ML SCAN DELAY: 25 sec BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 3 MM START LOCATION: ABOVE AORTIC ARCH END LOCATION: BELOW ILIAC CREST FILMING: STANDARD + 3D + MPR

ABDOMEN + PELVIS APPENDICITIS OR DIVERTICULITIS SCOUT: AP LANDMARK: XIPHOID TIP SCAN MODE: Spiral I.V. CONTRAST: ml/sec, ML SCAN DELAY: sec ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN, 200 ML JUST BEFORE SCAN BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 8-10 MM UPPER + 5 MM LOWER START LOCATION: LUNG BASES END LOCATION: S. PUBIS FILMING: STANDARD 8 MM SCOUT: AP LANDMARK: XIPHOID TIP SCAN MODE: Spiral I.V. CONTRAST: ml/sec, ML SCAN DELAY: sec ORAL CONTRAST: 500 cc MINUTES BEFORE SCAN, 200 ML JUST BEFORE SCAN BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 8 MM + 3-5MM LOWER START LOCATION: LUNG BASES END LOCATION: S.PUBIS FILMING: STANDARD 5 MM

CTA ABDOMEN

CT COLONOSCOPY 2 SCANS- PRONE + SUPINE

SCOUT: AP LANDMARK: ILIAC CREST SLICE PLANE: AXIAL OR SPIRAL I.V. CONTRAST: ml/sec, ml SCAN DELAY: sec (FULL BLADDER) ORAL CONTRAST: ml 1-2 HOURS BEFORE SCAN 500 cc NIGHT BEFORE BREATH HOLD: SUSPENDED EXPIRATION SLICE THICKNESS: 8-10 MM, 3-5 MM IF AP OR DIVERTICULITIS START LOCATION: ILIAC CREST END LOCATION: SYMPHYSIS PUBIS FILMING: STANDARD PELVIS

DETECTION OF PROSTATE GLAND AND SEMINAL VESICLES ABNORMALITIES BLADDER OPACIFIED + RECTOSIGMOID COLON AND RECTUM OPACIFIED

VISUALIZATION OF VAGINAL CANAL + CERVIX AND UTERUS TAMPON INSERTED IN THE VAGINA DURING CT SCAN OF THE PELVIS