1. BASIC GI RADIOLOGY THE “FLAT” PLATE
Michael Maristany, MD
Janis Letourneau, MD
After: Robert S. Perret, MD

2. KUB/Abdominal plain film
Most common abdominal radiograph
Patient supine
Often combined with upright (CXR)

3. KUB

4. Normal
KUB

5. KUB K kidney U ureter B bladder
Term KUB indicates that the kidneys, ureters, and bladder are on the film
But these organs are not necessarily seen on the image

6. K K u u
KUB –
Backwards u u B

7. KUB Paradoxically, organ system of greatest interest is often GI tract
Small bowel situated centrally
Large bowel located on periphery

8. colon
small
bowel
colon
rectum

9. Contrast filled
stomach and
small bowel

10. Contrast filled
Colon

11. Miller-Abbott
decompression tube
For intestinal
obstruction

12. KUB

13. KUB’s Why order them, anyway?
> 85% (for pain, colic, nausea, etc)
KUB will be non-contributory or normal

14. Why can KUB be useful? Bowel gas pattern characterization
Detection of free air
Abnormal calcifications
Detection of organomegaly
Discovery of abdominal masses
Evaluation of bony structures
Surgical / other medically relevant history

15. Bowel Gas Pattern Four major patterns Ileus Obstruction Gasless Normal
“Free” air

16. Abnormal Bowel Gas Pattern: Small Bowel Obstruction
Dilated loops of bowel
SBO – (small bowel obstruction)
Adhesions
Less likely inflammatory/neoplastic
Colonic obstruction
More often of malignant etiology

17. Small Bowel Obstruction
Dilated loops of small bowel (>3 cm) KUB
With air/fluid levels on upright view
Stair-step pattern to air/fluid levels
Gasless colon

18. Normal
Abnormal

19. Dilated small bowel - KUB
Air/fluid levels on upright

20. PFs => SBO
CT ABDOMEN: SBO
Transition point – luminal caliber

21. Normal
KUB

22. What’s likely dx?
Common etiologies?

23. FREE (INTRAPERITONEAL) AIR
KUB is not the best exam; upright or LLQ views helpful
Think also of CT; not only good for detection, but for cause

24. KUB – Abnormal Ca++ Calcifications Gallstones Kidney stones Vascular
Masses with calcifications (myoma, AAA)
20% < will be calcified
>75% will be calcified

25. KUB - gallstones

26. KUB - Porcelain Gallbladder
(or very large calcified stones)

27. ERCP Gallstones? Most gallstones will not be seen on KUB
– not sufficiently calcified

28. KUB - kidney stones Kidney stones will often be visualized
Related to extent of calcification
Detection limit 1-2 mm
Overlying intestinal gas limiting
Obesity limiting

29. Kidney Stones

30. Other Calcified Abnormalities
Uterine myomas
Pancreatic ductal calcifications
Vascular calcification
Appendicolith
Neoplasms
sarcoma, testicular cancer, neuroblastoma
Old hematomas

31. Uterine Myoma

32. CHRONIC PANCREATITIS

33. Calcified
Uterine arteries

34. Appendicolith

35. Splenic hematoma
Injection granulomata

36. Patient
Detained
Miami International

37. Non-calcified mass or mass effect
Major limitation of plain films
Organomegaly (multifocal dz vs diffuse)
Neoplasm, abscess, hematoma
Free peritoneal fluid (distribution of SB)
Difficult to differentiate
Relatively homogeneous
Soft tissue density
Merit of CT and MRI

38. Non calcified mass effect

39. OTHER GI IMAGING MODALITIES
Esophagram
Upper GI Series
Small Bowel Follow-Through
Barium Enema (or Contrast Enema)
CT and CT Colonography
ERCP
MRCP US

40. UGIS and SBFT

41. AC Barium Enema

42. UNKNOWN CASE
52 yo man from Boston
Bloody diarrhea
Following half-marathon
(CCC and poor training)

43. Thumb-printing: colonic wall edema
Inflammation, ischemia, diffuse mural infiltration

45. CONSIDERATIONS UNKNOWN (REAL) CASES
Patient age and gender
Clinical symptoms
Underlying diseases
Including psychiatric (case of gym sock)
Need for additional views (one at least)
Localize mass or foreign body
Deductive reasoning……….

46. Not the usual “stacked” coin appearance

47. And not causing GOO

48. More typical “stacked” coins