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 CONTRAST CONTRAST

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 1899. 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: 1.5-2 ml/sec, 100-150 ML

SCAN DELAY: 75-80 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 CONTRASTNO 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, 100-150 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-CONTRAST ARTERIAL

PORTAL

LIVER SINGLE PHASE

SCOUT: AP

LANDMARK: XIPHOID TIP

SCAN MODE: Spiral

I.V. CONTRAST: 1.5-2 ml/sec, 100-150 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, 100-150 ML

SCAN DELAY: 30-35 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, 100-150 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 + PELVISAPPENDICITIS OR DIVERTICULITIS

SCOUT: AP

LANDMARK: XIPHOID TIP

SCAN MODE: Spiral

I.V. CONTRAST: 1.5-2 ml/sec, 100-150 ML

SCAN DELAY: 75-80 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: 1.5-2 ml/sec, 100-150 ML

SCAN DELAY: 75-80 sec

ORAL CONTRAST: 500 cc 60-120 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: 1.5-2 ml/sec, 100-120 ml

SCAN DELAY: 120-180 sec (FULL BLADDER)

ORAL CONTRAST: 300-500 ml 1-2 HOURS BEFORE SCAN500 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