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Basic CT Imaging of Abdomen—For Non RadiologistDr. Muhammad Bin ZulfiqarPGR IV FCPS Services Institute of Medical Sciences / [email protected]
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• 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
Indications for Abdominal CT imaging
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CT Anatomy
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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
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Rt Ventricle
Espohagus
Azygous
Rt Atrium
Lt Atrium
Lt Ventricle
IVC
Aorta
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Hepatic Veins
IVC Aorta
Liver
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IVC
Diaphragm
Lt Portal Vein
Rt Lobe Liver
Lt Lobe Liver
Stomach
SpleenFalciform Ligament
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Stomach
Rt Portal Vein
Falciform Lig
IVC Spleen
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Pancreas
Crura of diaphragm
Portal Vein
Gallbladder
Pylorous Stomach
IVC
Splenic artery
Lt KidneyCeliac Artery
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Pancreas
Lft KidneySMA
GB
Pylorous StomachSplenic Flexure
Splenic V2nd part Duodenum
IVC
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SMV
Pancreatic Head
IVC
Lt Renal Artery
Lt Renal V
Spleen
Splenic flexure
SMAHepatic Flexure
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SMV
2nd portion duodenum
Pancreatic Head
JejunumSMA
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Mesentery
Asc. colon
3rd portion duodenum
Des. colon
Tran. colon
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Ileum
Asc. Colon
Common Iliac Arteries
Des. Colon
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Ileum
Asc. Colon
Terminal Ileum
Lt Iliac V
Lft Iliac Art
Desc. Colon
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Small Bowel
Iliopsoas
RectosigmoidPyriformis
Glut. Minimus
Glut. Medius
Glut. Max
Ext Iliac V
Ext Iliac Art
Internal iliac A. & V.
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Bladder
Prostate Rectum
Fem Artery
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Ovaries
Uterus
Sacrum
Rectum
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Hepatic pathology
Diffuse lesionsBenign lesions
Malignant lesions
Hepatocellular carcinoma. Fibrolamellar carcinoma. Hepatoblastoma. Metastasis.
Liver cysts. Hemangioma. Adenoma.Focal nodular hyperplasia.
Fatty liver Cirrhosis Storage diseases
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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
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Hepatic abscess [ Pyogenic ] Frequently indolent with no signs of infection
May present with profound septicemia Micro abscesses (>2cm) cluster or scattered Macro abscesses :Unilocular or multilocular
Marginal enhancement 6% ?! Gas containing abscesses uncommon
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Amebic abscessPeripheral edema is evident
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Hydatid cyst
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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.
FNH—Focal Nodal Hyperplasia
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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
Hepatocellular carcinoma
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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]
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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
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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 = 10:1 No strong association with cirrhosis No specific MR appearance
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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
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Diffuse Hepatic Disease Cirrhosis Fatty Changes Storage diseases(hemochromatosis &hemosidrosis) Neoplastic diseases [ HCC , Deposits , Lymphoma ]
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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
Cirrhosis
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Diffuse Neoplastic disease Lymphoma 35% of patients with secondary hepatic lymphoma show either diffuse or mixed pattern (focal+ diffuse)Imaging findings are non specific
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An abdominal and pelvic CT scan(IV contrast but no oral contrast) showed marked lymphadenopathy (arrows) in
the retroperitoneum and mesentery .
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Two metastatic para-aortic lymph nodes in a 49-year-old man with gallbladder cancer.
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Computed tomography (CT) scan showing para-aortic metastatic lymphadenopathy,
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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
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CT IVU
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Ectopic thoracic Kidney and contra-lateral ureteral duplication.
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Horse shoe kidneys (IVP and CT) with fusion of the kidney anterior to the spine.
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Congenital polycystic kidney disease.
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Bilateral stag-horn stones.
Left renal stag-horn stone.
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Thank You