Basic CT abdomen for Non Radiologists and New Comers Dr. Muhammad Bin Ziulfiqar

1
Basic CT Imaging of AbdomenFor Non Radiologist

• Dr. Muhammad Bin Zulfiqar
• PGR IV FCPS Services Institute of Medical
  Sciences / Hospital
• radiombz_at_gmail.com

2
Indications for Abdominal CT imaging

• To assess equivocal imaging findings
• Staging neoplasms of solid and hollow viscera
• Metastatic workup of primary malignancies
• Diagnosis of diffuse hepatic diseases
• Assessment of biliary disease and tumour.
• Congenital anomalies.
• Assessment of suspected post-traumatic injuries

3

• CT Anatomy

4

• Patient preparation
• Patient position
• Scanogram.frontal
  

No required preparation unless the patient is
going to be sedated or injected with contrast
material FASTING FOR 4 - 6 HOURS
5
Rt Ventricle
Rt Atrium
Lt Ventricle
IVC
Lt Atrium
Espohagus
Aorta
Azygous
6
Hepatic Veins
Liver
IVC
Aorta
7
Lt Lobe Liver
Lt Portal Vein
Diaphragm
Stomach
Rt Lobe Liver
Spleen
Falciform Ligament
IVC
8
Falciform Lig
Stomach
Rt Portal Vein
Spleen
IVC
9
Stomach
Pylorous
Gallbladder
Pancreas
Splenic artery
Portal Vein
Lt Kidney
Celiac Artery
IVC
Crura of diaphragm
10
Pylorous
Stomach
Splenic Flexure
GB
Pancreas
Splenic V
2nd part Duodenum
IVC
Lft Kidney
SMA
11
SMV
SMA
Splenic flexure
Hepatic Flexure
Pancreatic Head
Spleen
IVC
Lt Renal V
Lt Renal Artery
12
SMV
SMA
Jejunum
2nd portion duodenum
Pancreatic Head
13
Tran. colon
Mesentery
Des. colon
Asc. colon
3rd portion duodenum
14
Ileum
Des. Colon
Asc. Colon
Common Iliac Arteries
15
Ileum
Asc. Colon
Desc. Colon
Terminal Ileum
Lft Iliac Art
Lt Iliac V
16
Small Bowel
Ext Iliac Art
Iliopsoas
Glut. Minimus
Ext Iliac V
Glut. Medius
Glut. Max
Internal iliac A. V.
Pyriformis
Rectosigmoid
17
Bladder
Fem Artery
Prostate
Rectum
18
Ovaries
Uterus
Rectum
Sacrum
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
Hepatic pathology
Diffuse lesions
Benign lesions
Malignant lesions

• Hepatocellular carcinoma.
• Fibrolamellar carcinoma.
• Hepatoblastoma.
• Metastasis.

• Fatty liver
• Cirrhosis
• Storage diseases

• Liver cysts.
• Hemangioma.
• Adenoma.
• Focal nodular hyperplasia.

24
Hepatic cysts

• Congenital lesions but detected late
• Isolated or associated with congenital cystic
  disease
• Usually asymptomatic
• Complications rupture or hage lead to
  symptoms
• Few mms to several cms in size

Hepatic cysts
25
Hepatic abscess Pyogenic

• Frequently indolent with no signs of infection
• May present with profound septicemia
• Micro abscesses (gt2cm) cluster or scattered
• Macro abscesses Unilocular or multilocular
• Marginal enhancement 6 ?!
• Gas containing abscesses uncommon

26
Amebic abscess Peripheral edema is evident
27
Hydatid cyst
28
(No Transcript)
29
(No Transcript)
30
FNHFocal Nodal Hyperplasia
The arterial supply is derived from the hepatic
artery whereas the venous drainage is into the
hepatic veins. FNH does not contain portal venous
supply9.
31
Hepatocellular carcinoma

• Single or multiple masses that are hypo dense to
  normal liver
• Calcification may be seen
• After contrast injection should be Triphasic
  study
• Arterial phase Very early arterial perfusion.
• Portal phase contrast washout

32
Hepatocellular carcinoma

• Detects a greater number of HCC than usual
  scanning
• Detects intravascular thrombosis portal vein
• Better delineation of tumour capsule in
  capsulated lesions
• Detects early arteriovenous shunting sign of
  malignancy

33
Hepatoblastoma

• The most common 1ry hepatic neoplasm in children
  below 5 years
• Usually presents with abdominal mass with
  elevated AFP
• Large diffuse or multifocal hypodense lesion is
  seen on CT
• Matrix calcification and septations may be seen
  

34
Cholangiocarcinoma

• The 2nd most common primary malignant tumor
• Arise from bile duct epithelium 3 TYPES
• Intrahepatic arises from small ducts
• Or the major ducts near the helium
• Or at the bifurcation of the CHD Klatskin
  tumor

• HCC intrahepatic cholangiocarcinoma 101
• No strong association with cirrhosis
• No specific MR appearance

35
Hepatic deposits

• Most of hepatic deposits are hypo vascular
• Hepatic neoplasms receive most of their blood
  supply via hepatic artery
• Hyper vascular deposits should be assessed by
  dual phase CT or dynamic MRI
• CTAP and intra operative US are the most
  sensitive methods for detection of deposits

36
Diffuse Hepatic Disease

• Cirrhosis
• Fatty Changes
• Storage diseases(hemochromatosis hemosidrosis)
• Neoplastic diseases HCC , Deposits , Lymphoma

37
Cirrhosis

• Repeated episodes of hepatic injury ? fibrosis
  regeneration
• Small fibrotic right lobe with regenerative
  enlargement of the caudate and left lobe
• Caudate/ right lobe ratio 0.65 or more
• Portal vein diameter more that 1.3 cm
• Splenomegaly, ascites
• Dilated perisplenic collateral venous channels

38
Diffuse Neoplastic disease
Lymphoma 35 of patients with secondary hepatic
lymphoma show either diffuse or mixed pattern
(focal diffuse) Imaging findings are non specific
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
An abdominal and pelvic CT scan(IV contrast but
no oral contrast) showed marked lymphadenopathy
(arrows) in the retroperitoneum and mesentery .
43
Two metastatic para-aortic lymph nodes in a
49-year-old man with gallbladder cancer.
44
Computed tomography (CT) scan showing
para-aortic metastatic lymphadenopathy,
45
Lymphoma. A non-Hodgkin lymphoma has para-aortic
and mesenteric lymphadenopathy (arrows) along
with splenomegally (arrowhead), on a
contrast-enhanced, axial CT scan of the abdomen
46
CT IVU
47
Ectopic thoracic Kidney and contra-lateral
ureteral duplication.
48
Horse shoe kidneys (IVP and CT) with fusion of
the kidney anterior to the spine.
49
Congenital polycystic kidney disease.
50
(No Transcript)
51
Bilateral stag-horn stones.
Left renal stag-horn stone.
52

• Thank You