Diagnostic Imaging

Gastric Bubble

common normal finding

Abdominal Radiograph

Constipation

mottled appearance of fecal material

Abdominal Radiograph

Pneumoperitonem

free air under the diaphragm
abnormal finding, perforated until proven otherwise

Abdominal Radiograph

Organomegaly

abnormal finding

Abdominal Radiograph

Valvulae

travel entire width of the small bowel

3cm for small bowel is normal width

Abdominal Radiograph

Haustra and Plicae

travel partial width of large bowel/colon

6cm for colon and 9cm for cecum is normal width

Abdominal Radiograph

Small bowel obstruction (SBO)

dilation and multiple bubbles, air fluid levels

Abdominal Radiograph

Small bowel obstruction (SBO)

“string of pearls” finding

Abdominal Radiograph

Cecal volvulus

section of twisted bowel causing obstruction and strangulation

Abdominal Radiograph

Sigmoid volvulus

“coffee bean” sign

section of twisted bowel causing obstruction and strangulation

Abdominal Radiograph

KUB (kidney, ureter & bladder)

XRAY optimized to assess the urogenital system ± GI system

Abdominal Radiograph

IVP (IV pyelogram)

XRAY using IV contrast material to assess kidney, ureters and bladder (less commonly used)

*CT Urogram is more common for assessing flank pain

Abdominal Radiograph

CT urography

CT scan using an IV contrast material to assess kidney, ureters, and bladder

Abdominal Radiograph

E-FAST (Extended Focused Assessment with Sonography in Trauma)

bedside ultrasound protocol design to detect peritoneal fluid, pericardial fluid, pneumothorax and/or hemothorax in trauma patient

RUSH Exam

ultrasound to quickly assess any patient with undifferentiated shock and hypertension

Appendix

“doughnut sign” or “bullseye sign” of ______ on ultrasound due to concentric alternating echogenic and hypoechoic bands

Cholelithiasis

formation of gallstones in gallbladder

Cholecystitis

inflammation of the gallbladder

transverse

Which CT view?

sagittal

Which CT view?

coronal

Which CT view?

Acute appendicitis

CT Abdomen/Pelvis IV contrast

Diverticulitis

CT Abdomen/Pelvis IV contrast

Intra-abdominal abscess

CT Abdomen/Pelvis IV contrast

Colonic mass

CT Abdomen/Pelvis IV contrast

Pyelonephritis

CT Abdomen/Pelvis IV contrast

Renal cell carcinoma

CT Abdomen/Pelvis IV contrast

Mesenteric ischemia

CTA Abdomen/Pelvis IV contrast

Abdominal aortic aneurysm (AAA)

CTA Abdomen/Pelvis IV contrast

Trauma: Liver

CTA Abdomen/Pelvis IV contrast

Trauma: Spleen

CTA Abdomen/Pelvis IV contrast

CT abdomen non-contrast

What imaging is used to visualize gallstones?

CT urogram

Which imaging is used to visualize ureteral stricture?

Upper GI Series (Barium swallow)

What imaging is used to assess for esophageal stricture or dysphagia (difficulty swallowing), may include fluoroscopy?

Lower GI series (Barium enema)

What imaging to assess for obstructions in large bowel?

Scintigraphy

Which imaging to assess for gastric emptying for gastroparesis?

radioactive scrambled eggs ☢

Esophagogastroduodenoscopy (EGD)

Which imaging to assess the upper GI tract including esophagus, stomach, and duodenum looking for ulceration?

Flexible sigmoidoscopy

visualize part of the colon using less sedation and cleanout prep

Colonoscopy

visualize the entire colon looking for polyps, malignancy, diverticulitis, requires full sedation and cleanout

T1 weighted

Which type of CT contrast highlights fat and anatomy: fat is bright; water is dark?

T2 weighted

Which type of CT contrast highlights fluid and pathology: water is bright, fat is bright

ERCP

-invasive, involves sedatives, radiation and more costly
-can cause pancreatitis, infection, bleeding
-diagnostic and therapeutic (stent, remove gallstones)
-gold standard for diagnosis of biliary obstruction

MRCP

-noninvasive, without anesthesia or radiation, cheaper
-improved visualization
-contraindicated with pacemakers and cochlear implant
-diagnostic but NOT therapeutic (delays treatment)

Positron emission tomography (PET)

nuclear medicine study that uses injectable radiotracer with a scan to evaluate function (blood flow, O2 use, glucose metabolism) visualizing uptake of radiotracer and look for metastasis
-assesses ischemic areas of heart
-used in neurology to evaluate tumors, seizure

Radiographs (KUB and ABD series with upright chest)

What imaging is used to assess for foreign body, bowel gas patterns, and obstruction?

Ultrasound

What imaging is used to visualize the gallbladder, appendix, complete abdomen, kidneys and lungs for pneumothorax (eFAST/RUSH), skin and soft tissue?

Computerized Tomography (CT)

What imaging is used to assess:
-with contrast (IV/ ± PO or rectal: vasculature, bowel, trauma
-without: stone protocol, spine trauma can also get reconstructions

*AVOID IV contrast with suspected perforation

Barium Studies

Which imaging can be fluoroscopy (real time) or radiographs?
-barium swallow: dysphagia, esophageal stricture
-barium enema: intussusception, other
-upper and lower endoscopy

Magnetic Resonance Imaging (MRI)

Which imaging includes:
• MRCP (choledocholithiasis)
• Pregnancy abdominal pain (appendicitis)