Pocket Tutor Abdominal Imaging

232 Pages·2011·27.675 MB·English

by  Rakesh Sinha

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Abdominal
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Abdominal
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Rakesh Sinha FRCR FICR MD
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Consultant Radiologist and Assistant Professor
Warwick Hospital and Medical School u
Warwick, UK
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© 2011 JP Medical Ltd.
Published by JP Medical Ltd, 83 Victoria Street, London, SW1H 0HW, UK
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ISBN: 978-1-907816-04-8
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Preface
With the advent of new imaging modalities the field of ab-
dominal imaging has undergone rapid changes in recent
years. However, traditional examinations such as abdominal
radiography and barium studies are still used for a variety of
conditions. A good working knowledge of common manifesta-
tions of disease in both older and new modalities is therefore
vital for students and clinicians.
This book starts with a concise overview of abdominal
anatomy, then provides a step-by-step guide to interpreting
normal imaging results before demonstrating the appearance
of key abnormalities. The book then presents concise, practi-
cal information on common abdominal conditions that may
be encountered in routine medical or surgical practice, each
one illustrated by radiological images of the highest quality.
Key facts and treatment information are provided for each
condition, and a list of key imaging features is included. To
facilitate visual understanding, these features are labelled on
the corresponding images, along with anatomical landmarks
and other notable aspects.
It is hoped that the book will serve as a handy companion
for quick reference during teaching and ward rounds, and as a
revision tool before examinations. Although primarily aimed at
medical students and radiology trainees, the book will also be
useful to all physicians and surgeons requiring a pocket-sized
guide to abdominal imaging.
Rakesh Sinha
v
Contents
Preface v
Acknowledgements and Dedication ix
Chapter 1 First principles
1.1 Anatomy 1
1.2 Imaging modalities 13
Chapter 2 Understanding normal results
2.1 Abdominal radiographs 25
2.2 Abdominal ultrasound 33
2.3 Barium studies 38
2.4 CT and MRI 40
2.5 CT Angiography 47
Chapter 3 Recognising abnormalities
3.1 Fat-line abnormalities 49
3.2 Gas shadow abnormalities 50
3.3 Calcifications 54
3.4 Abnormalities on barium examinations 57
3.5 Solid organ abnormalities 59
Chapter 4 Gastrointestinal system
4.1 Achalasia 63
4.2 Appendicitis 66
4.3 Coeliac disease 68
4.4 Colorectal cancer 69
4.5 Diverticulitis 72
4.6 Gastric cancer 75
4.7 Gastro-oesophageal reflux disease 77
4.8 GI tract haemorrhage 79
4.9 Ischaemic colitis 82
4.10 Inflammatory bowel disease – Crohn’s disease 84
4.11 Inflammatory bowel disease – ulcerative colitis 86
4.12 Obstruction – small bowel 88
vi
4.13 Obstruction – large bowel 90
4.14 Oesophageal cancer 92
4.15 Oesophageal perforation (Boerhaave’s syndrome) 94
4.16 Oesophageal varices 96
4.17 Peptic ulceration 98
4.18 Perforation of the GI tract 100
4.19 Pseudomembranous colitis 104
4.20 Scleroderma 105
4.21 Tuberculosis of the GI tract 107
4.22 Volvulus of the colon 109
Chapter 5 Genitourinary system
5.1 Renal artery stenosis 113
5.2 Renal cell carcinoma 115
5.3 Renal failure 118
5.4 Trauma – renal injuries 120
5.5 Urolithiasis (renal tract stones) 123
5.6 Testicular cancer 125
5.7 Testicular hydrocoele 126
5.8 Testicular torsion 128
5.9 Testicular varicocoele 130
5.10 Prostatic cancer 132
5.11 Benign prostatic hyperplasia 134
Chapter 6 Hepatobiliary system
6.1 Cholecystitis 137
6.2 Cholangiocarcinoma 141
6.3 Cirrhosis 143
6.4 Gallbladder cancer 145
6.5 Haemangiomas 148
6.6 Hepatitis 150
6.7 Hepatocellular carcinoma 151
6.8 Hepatic metastases 154
6.9 Pancreatic cancer 156
6.10 Pancreatitis 159
6.11 Portal hypertension 163
6.12 Trauma – hepatosplenic injury 165
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Chapter 7 Paediatrics
7.1 Cryptorchidism 169
7.2 Hypertrophic pyloric stenosis 170
7.3 Intussusception 172
7.4 Necrotising enterocolitis 174
7.5 Congenital renal anomalies 176
7.6 Common paediatric tumours – neuroblastomas 179
7.7 Common paediatric tumours – Wilms’ tumour 181
7.8 VACTERAL syndrome 183
7.9 Vesicoureteric reflux 185
Chapter 8 Gynaecological disorders
8.1 Ectopic pregnancy 189
8.2 Endometriosis 191
8.3 Fibroids 193
8.4 Ovarian cancer 196
8.5 Ovarian cysts 199
8.6 Pelvic inflammatory disease 201
Chapter 9 Miscellaneous disorders
9.1 Abscess (intra-abdominal) 203
9.2 Abdominal aneurysm 205
9.3 Ascites 207
9.4 Abdominal hernias 209
9.5 Lymphoma 211
9.6 Penetrating and projectile injuries 213
9.7 Adrenal tumours – phaeochromocytomas 216
Bibliography 219
Index 221
viii
Acknowledgements
I would like to thank my colleagues at the Radiology Depart-
ment, Warwick Hospital and also colleagues at South Warwick-
shire Foundation for their encouragement, help and advice.
I would especially like to thank the editorial team at JP Medi-
cal, London for their expertise and help during the production
of this book.
Finally I would like to thank my wife and family for their help
and support during the writing and production of this book.
Dedication
This book is dedicated to Dr Jogendra P Sinha, Emeritus Profes-
sor of Radiology, a role model for generations of residents over
several decades.
ix
chapter
1
First principles
1.1 Anatomy
For convenience the abdominal cavity is divided into nine
segments (Figure 1.1). These regions can be demarcated on
an abdominal radiograph by drawing a horizontal line through
the 9th ribs and the pelvic brim, and two vertical lines from the
centre of the costal cartilage of the 9th rib to the middle of the
inguinal ligament. The organs (Figure 1.2) contained in these
segments are as follows:
• Right hypochondrium: gallbladder, right lobe of liver, duo-
denum, hepatic flexure of colon, upper pole of right kidney
and pancreatic head
• Epigastrium: stomach, pancreatic body, left lobe of liver
• Left hypochondrium: spleen, splenic flexure of colon, and
upper pole of left kidney
• Right lumbar region: ascending colon and right kidney
Figure 1.1 The nine
abdominal segments. Note
normal calcification of the
costal cartilages.