Rad 2.02 Normal Radiographic Anatomy of The Abdomen and Pelvis
Rad 2.02 Normal Radiographic Anatomy of The Abdomen and Pelvis
Rad 2.02 Normal Radiographic Anatomy of The Abdomen and Pelvis
02
October 27, 2017
NORMAL RADIOGRAPHIC ANATOMY OF THE ABDOMEN AND PELVIS
Ma. Louven Urbano-Grasparil, MD
Department of Radiology
TOPIC OUTLINE Borders of a plain abdominal AP: part of chest (above) and femoral
I. Overview heads (below)
a. Plain AP View Abdomen Pelvis
b. Upright and Supine Views Liver Urinary bladder
II. Evaluation Stomach (gastric bubble) Uterus
a. Normal Bowel Gas Pattern Spleen (not seen unless enlarged) Prostate
b. Normal Calcifications Psoas muscle (on both sides of vertebra)
c. Soft Tissues Renal shadow (latera to psoas)
d. Osseous structures Parts of the colon
e. Extraluminal Air
III. Plain KUB Renal shadow is seen only if the patient was able to fast right
IV. KUB – IVP o Proper fasting is at least 8 with enema
V. Fluoroscopic Studies o For CT colonoscopy, 3 days fasting
a. Esophagogram o Removes the air and fecal material (both
b. Upper GI series radiopaque/white)
c. Small Intestine Series o If px is not properly fasted, fecal material covers the renal
d. Barium Enema shadow
o Renal shadows are lateral to the psoas shadow
UPRIGHT VIEW
OVERVIEW
Plain Abdomen AP View
SUPINE VIEW
EVALUATION
What to evaluate in an abdominal radiograph:
a. Bowel gas pattern
b. Calcifications
c. Soft tissues
d. Osseous structures
e. Extraluminal air
Normal Bowel Gas Pattern
Dilated or not – check diameter wall-to-wall
Stomach (+) air in upright, not always in supine
Few air fluid levels d/t air being resorbed
Air in the SI think of ileus or obstruction
Should be <3 cm in diameter, if >3 cm then it’s
Small bowels
dilated
Valvulae conniventes – complete rings in the SI
Centrally-located
(+/-) air d/t presence of gas-forming bacteria
Should be < 6 cm diameter
o Cecum can extend up to<9 cm
Large bowels (if >9 cm --> rupture)
Rectum – always (+) air
Haustrations – incomplete rings of the LI
Peripherally-located
**REMEMBER: 3-6-9 RULE (3 for Small, 6 for Large, 9 for cecum)
Calcifications
Know when it is normal vs abnormal
NORMAL CALCIFICATIONS
Costal Expected in the elderly
cartilage
Oval
Seen in cases of TB
Nodes have the same course as the ureters
Mesenteric o Mistaken for ureteral lithiasis confirm
lymph nodes with CT or US
o With ureteral lithiasis, you also expect
hydronephrosis (renal shadows are
enlarged)
Calcifications within the pelvic vein due to
venous stasis
Phleboliths
Have lucent centers
DDX: Ureteral stones
Mottled densities (radiopaque/white) are fecal material in the Prostate Expected in the elderly, abnormal in the
bowels gland younger adults
Urinary bladder is not well-delineated if it is collapsed or if it is filled concretions Seen in the pelvic brim
with urine (becomes white)
Phlebolith
s
Soft Tissues
For the soft tissues, you look for organ enlargement
LIVER – RUQ, displaces the bowel if enlarged
Osseous Strustures
Lower rib cage – you can see up to the 9th rib
Lumbar spine – look for degenerative changes
Sacrum, Pelvis, Hip joints
Extraluminal air
Air in the abdomen are normally inside the stomach and the bowels
Air outside these organs: pneumoperitoneum
FLUOROSCOPIC STUDIES
Used less frequently d/t high radiation
a. Esophagogram/ Barium Swallow
b. Upper GI series
c. Small Intestine Series
d. Barium Enema
Esophagogram/Barium Swallow
Uses barium solution or non-ionic/water soluble contrast solution
Px is asked to swallow the solution under fluorospy, a series of
xrays will be taken (AP/Lateral views)
From oropharynx to GE junction
Normal:
o Smooth mucosa
o No narrowing or obstruction
o Unimpeded flow of contrast
Upper GI Series
Barium swallow patient drinks carbonated drink gas forms in
the stomach stomach distends contrast adheres to mucosal
folds/rugae better view
From esophagus stomach duodenum
jejunum
ileum
HF SF
AC
TC
DC
SC