Lecture 8- Intro to Abdominal Xrays Slides

7/31/2019 Lecture 8- Intro to Abdominal Xrays Slides

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Introduction to Normal

om na a ograp c



De artment of Radiolo

Vancouver General Hospital

Dr. Savvas Nicolaou

Director of ER/Trauma Radiology

[email protected]



Objectives

GI Tract• Stomach• ma n es ne

• Large intestine• Liver• Spleen

GU System• Kidneys

• Bladder

Bones• Sacroiliac joint, Symphysis Pubis, Iliac crest, Femoral heads , Hip Joint• Vertebral bodies

• Pedicles, Transverse process, spinous process

Muscles• Psoas ma or

Be able to identify which abdominal organs are intraperitoneal andretroperitoneal



Anatomy Review



Anatomical Planes

Sagittal

Axial/Transverse



Basic Abdominal Anatomy

• Abdomen extends from inferior margin of

thorax to the superior margin of pelvisand lower limb

• Peritoneum lines the abdominal cavity

• Forms the mesenteries thatsuspen s v scera



Basic Abdominal Anatomy



BOWEL



Basic Radiographic Terminology

• Attenuation describes the absor tion of X-ra s as the

traverse structures

Lucency = low attenuation

appear black

e.g., air

pac ty = g attenuat on appear white

. .,



Abdomen



Radiography

radiographs, and are

demonstrated on this ima e

Soft Tissue

Fat

Air - fat - water - bone - metal

MetalBone

Lower HigherAttenuation

• Note that THICK structures

Air

THIN structures of the same

composition



Patient Positioning

Supine

Erect



GASTROINTESTINAL SYSTEMInterpreting the Abdominal Radiograph

Routine “3 Views”:

Supine AP abdomen Erect AP abdomen Erect chest x-ray





Supine AP abdomen

• Most useful for detecting bowel

gas patterns

• Eg. dilated bowels, intra-abdominal luid





• Most useful for detecting free air,

Erect AP abdomen

air-fluid levels and bowel gas

patterns• Eg. Bowel obstruction





• Most useful in detecting intra-

Erect chest x-ray

peritoneal air (air under the

diaphragm)• May demonstrate thoracic

disease causing abdominal pain



Normal gastric air bubble with air fluid level

Air Under the Diaphragm PathologyNormal gastric air bubble with air fluid level



APPROACH TO EVALUATING A PLAIN ABDOMINAL FILM

3 :

SOFT TISSUES – ABDOMINALVISCERA

BOWEL GAS PATTERN

BONES- SKELETAL ELEMENTS



LiverSpleen

Stomach

Left kidneypedicle

Hepaticflexure

Left psoas

margin

p nous process

Left sacroiliac joint

Left hi oint

Symphisis pubis



Soft Tissue

LiverSpleen

Left kidne

Stomach

Hepaticflexure

Left psoas



ENLARGED SPLEEN



Bone

Spinous

Pedicle

Right iliac

crest

Left

Right

acetabulum

sacroiliac joint

Right femoral

head



Bowel Gas

Bowel Gas



GAS PATTERN – Air Inside the Bowel Lumen

Property Small Bowel Large Bowel

Location Central Peripheral (Picture Frame)

Circular Folds Haustra , sacculations

Folds Uninterrupted folds cross entire width(Valvulae Conniventes)

Interrupted: folds do not crossentire width

Maximumdiameter

3cm9cm at cecum,10cm or more abnormalMax 6cm transverse colon if morethan 6 abnormal

Maximum foldthickness

3mm 5mm

Rarely contains solid fecal material Commonly contains solid fecal



LARGE BOWEL SMALL BOWEL



Small vs. Large Intestine

Small Intestine Large Intestine



Multiple

dilated loopsof small bow el

indicat in a

Valvulae conniventes –

small bow el mucosal

small bow el

obstruction

folds



Valvulaeconn ven es –

small bow elmucosal folds

small bow el obst ruction

numerous small bow el airfluid levels



Small bowel mucosal folds circumferential valvulae conniventes (plicaesemicircularis)



Large bowel folds - haustra



Spleen

Left kidney

Stomach

Spinousprocess

Left

e c e

Left

joint

Rectum



Liver

Hepatic

flexure

Right iliac

crest

Ri ht

acetabulum

head

R di h 3D R t ti



Radiograph vs. 3D Reconstruction

3D Reconstruction



3D Reconstruction

1. Liver

2. Spleen

3. Kidneys

4. Psoas muscle

5. Sacrum3

1

36. Rectum

7. Vertebral Body

8. Femoral Head

4

7

4

5

68 8

Radiograph Superimposition on 3D Reconstruction




1. Liver

2. S leen21

3

3. Kidneys

4. Psoas muscle

3

1

3

4

.

6. Rectum

7. Vertebral Body4

7

4

5

.

5

668 8





1. Liver

2. S leen

3. Kidneys

4. Psoas muscle

2

3

1

3 .

6. Rectum

7. Vertebral Body4

7

4

.

9. Ilium

5

99

68 8





1. Liver

2. S leen

3. Left kidney

4. Psoas muscle

34

.

6. Rectum

7. Vertebral Body

47

5

.

9. Ilium9

9

6 88

Radiograph vs 3D Reconstruction




3D Reconstruction



3D Reconstruction

.2. Vertebral Body

3. Ilium4. Sacrum

1 1

5. Femoral Head2

33

5




g p

11

.2. Vertebral Body

3. Ilium4. Sacrum

25. Femoral Head

33

5




211. Liver

2. Spleen

33

3. Left kidney

4. Psoas muscle5. Sacrum

47

6. Rectum

7. Vertebral Body

8. Femoral Head

59

9

9. Ilium

68

8



Coronal view

31

3

2 4

7

6

4

6

1. Liver 5. Descending colon.

3. Stomach

4. Small intestine

.7. Ascending colon



Coronal view

11 3

2

2

. omac2. Psoas muscles

3. Spleen



Coronal view

2

21

3

44

3

57

66

1. Liver 5. Gluteal muscles.

3. Left kidney

4. Psoas muscle

.7. Sacrum

C l i



Coronal view

21

1 23

3

4

5

6

.2. Spleen3. Left kidney

.5. Illium6. Femoral Head

FINAL REVIEW OF PLAIN XRAY ANATOMY



LiverSpleen

Stomach



Stomach

Left kidneypedicle

Hepatic

flexure

Left psoas

margin

p nous process

Left sacroiliac joint

Left hi oint

Symphisis pubis

Lecture 8- Intro to Abdominal Xrays Slides

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