Radio - Git
Radio - Git
Radio - Git
Why do clinicians request for imaging of the abdomen or the entire When the patient is in a supine position, the cassette is at the back
GIT? and the x-ray beam is in front of him. So, you will be able to see air
Primarily, when during physical examination, they can within the bowels.
palpate a mass or the patient can palpate a mass on
himself.
Patient complains of tenderness.
If, clinically, clinicians are suspecting obstruction.
If the patient is a trauma patient and they are looking for
possible ischemia.
Chest x-ray
Why is a CXR included?
The beam is nearer the area of the Contrast goes through the gastroesophageal
diaphragm. In cases of minimal junction to the esophagus. Dapat wala kayong
pneumoperitoneum or air within the makikitang reflux or no barium going back the
peritoneum, if the patient is standing, the air esophagus. It should be in the stomach already
will go upwards. Since the diaphragm is the because gastroesophageal junction closes. Yan ung
delineation of the thorax and abdomen, in cases of GERD. What you see there is the lumen of
hanggang dun lang sa ilalim ng diaphragm the esophagus.
magle-layer o magpupunta ung air. That’s
why you have to take a CXR. The beam of the
x-ray is nearer the focus of the diaphragm.
You may also see that in a plain upright
abdominal film but may missed minimal
pneumoperitoneum dahil nacocover siya ng
ibang organs.
Barium enema is for the colon. You will see the entire
colon. The tube is inserted in the rectum, and then the
barium will be pushed inside. It will run from the sigmoid,
to the descending colon, to the transverse, up to the
cecum.
OTHER IMAGING MODALITIES FOR THE GIT Two indications to know if you are already done
with the study:
Upper gastrointestinal series (UGIS) You will see the appendix.
Includes imaging from the mouth up to the small intestines. If there is no appendix, you must have a
Patient is asked to ingest a contrast medium called barium. reflux into the small intestine.
Barium, when subjected to x-ray, puti ang itsura niya. So,
that will cover the lumen of the GIT.
I. Ascites
Abnormal fluid collection within the peritoneal cavity
Vertebra
It is in the posterior portion of the patient.
Liver
On the right side
Stomach
With air inside (magenblase)
Aorta
Normally, it should not be that white. If the
CT scan is contrast-enhanced, meaning nag-
inject ng contrast sa veins, all the vessels will
light up. Nagiging maputi.
Spleen
On the left side
Kidneys
They are hyperdensed. It means that it is a
contrast-enhanced study. This is a plain abdominal film of a child. You see that
the air within the bowels is concentrated at the
Coronal view (parang plain x-ray din siya na nakaharap sa center of the abdomen. Bakit nasa center? Because
inyo ung patient) the bowels are air containing and, if you imagine, you
have lots of fluid surrounding that, lumulutang na
lang sila. So, they are floating at the center. This is
your indication that likely you have a massive ascites.
You also look at the flank stripes. They are already
effaced because of massive fluid collection.
In the ultrasound, fluid is black. What you see is fluid
within the peritoneal cavity.
In the CT scan, you can also see a fluid collection
within the peritoneal cavity.
In MRI, depending on what sequence, fluid will
present as white.
III. Pneumoperitoneum
Air collection within the abdominal cavity.
If you are entertaining pneumoperitoneum, request
for a CXR because you will be able to see the air just Lymph node calcification
below the diaphragm. Irregular, ill-defined calcifications
You will see lucency in the entire abdominal cavity Scattered
which looks like a football. So, that is what we call
football sign in massive pneumoperitoneum.
Gallstones
Calcifications below the liver shadow
LIVER
Urinary bladder calcification In ultrasound, you see black structure. Those are the hepatic veins.
Veins are filled with fluid (blood) kaya siya itim.
In contrast-enhanced CT scan, liver is white.
In MRI, it is the same as CT scan. Take note that the border of the
liver is very smooth. Hindi siya corrugated. Hindi siya wavy. It looks
like a sponge.
Hepatomegaly
There are several ways to measure the liver.
By x-ray, ultrasound (mas maganda), or CT scan
But if you are given an x-ray like this, you will notice
an abnormality. Air in the bowels is displaced
because of very large liver.
Metastasis
You have a primary malignancy somewhere else. Liver is
Cirrhosis by plain CT scan shows the wavy, nodular border one of the most common organs for metastasis.
of the liver. Adjacent the liver is the fluid collection You have there hypoechoic nodules and masses in the liver.
(ascites).
Hepatocellular carcinoma
If the malignancy is primarily in the liver, you see
heterogenous masses within the liver.
If you are dealing with mass anywhere else in the body, you
should request for contrast-enhanced CT scan because
malignancies are always vascular. There is something
supplying that mass, kaya siya lumalaki, and it is a vessel.
For you to be able to know if that’s really a malignancy, you
request for contrast-enhanced and you will see the mass
enhances. Pagnag-enhance, ibig sabihin pumuputi. This
means that this is vascular. More often than not, it is
malignant.
Hemangioma
Hemangioma is benign. It is a vascular malformation. It can
be seen anywhere in the body, commonly seen in the liver.
And if it is seen in the liver, it will present as hyperechoic.
Meaning maputi. Usually, it is well defined.
If you really want to know if it was hemangioma, you may
ask for a triple phase CT scan. Triple phase means you get
arterial scan, then a follow up venous phase, and then a
delayed phase. Because hemangioma involves arteries and Note that in a cyst, margins are vey well-defined. So, it is
veins. So, if you do a triple contrast study, you will see that benign. If the border is irregular, ill-defined, or thickened, it
the contrast will have peripheral delayed enhancement. is malignant.
Trauma
Spleen and liver are usually involved.
Look for signs of trauma. Liver has lacerations. You also
have hematoma.
Cholangiocarcinoma
It is a malignancy involving the biliary tree.
In MRCP, it is white all over. The proximal biliary duct is
already dilated and tortuous because of obstruction.
If you request for a CT scan, you will see the dilated ducts
which are fluid-filled.
Gallstone / Cholelithiasis
You see that the gallbladder has something inside. It is
white.
In CT scan, you will see lucency within the liver that is not
extending beyond the periphery. Likely, it is air in the biliary
tree and not in the portal vein. If it is in the portal vein, it
reaches up to the periphery of the liver. Cholecystitis
Inflammation of the wall. The wall is thickened. Normally, it
should be less than 3 mm.
The lumen is black.
There is also fluid outside the gallbladder. We call it
pericholecystic fluid. That is already ascites.
GALLBLADDER
Malignancy
Rare
You will see a solid, irregular, ill-define lesion within the
gallbladder.
Chronic pancreatitis
Inflammation of the pancreas secondary to alcoholism.
X-ray will show calcifications in the midupper abdomen.
CT scan also shows calcification.
PANCREAS
Hemangioma
Well-defined hyperechoic nodule
SPLEEN Benign
Request for a triphasic CT scan
Organ in the left portion
Ultrasound shows that the spleen is adjacent the left kidney.
Splenomegaly
Intravenous pyelogram shows compressed pelvic calices in
the left kidney. Compression is caused by an enlarged
spleen.
If the patient did not undergo intravenous pyelogram, you
will just think of staghorn calculi in the right kidney.
Lymphoma
Hypoechoic masses within the spleen
Achalasia
Narrowing of the distal portion of the esophagus and
dilatation of the proximal part.
Lower esophageal sphincter does not relax
Diverticulum
Outpouching of the esophagus
Contrast or food will go to the diverticulum
Esophagitis Zenker’s diverticulum
May be secondary to inflammation or caustic substance Upper portion of esophagus is involved.
ingestion Epiphrenic diverticulum
Lumen is narrow because the wall is inflamed. Distal portion of esophagus is involved.
Cause dysphagia
Malignancy
Hernia New growth within the esophagus
Anything that goes out of the area of the normal structure Irregular border
Sliding hiatal hernia Lumen is narrow.
Gastroesophageal junction is above the
hemidiaphragm. Napull siya upward.
Part of the stomach is already up outside the
abdominal cavity.
Varices
If patient has portal hypertension secondary to liver
cirrhosis.
Veins around the esophagus become tortuous.
Irregularity of esophageal wall
STOMACH AND DUODENUM
Stomach
Fundus, body, antrum
Trauma
Intact esophagus in the upper portion.
There is spillage of contrast outside the esophagus.
Likely that the distal esophagus is perforated.
Polyps
New growths that are benign
This will present as filling defects in UGIS.
Ulcer
Abrasion / ulceration of the mucosa Malignancy
Small mound in the UGIS You can see filling defects in UIGS with irregular border.
Malignancy In CT scan, there is thickening of the wall of the stomach.
Irregular border
Benign
Smooth border
Chronic ulcer
There is spillage of contrast outside the stomach in
nontrauma patients.
The stomach is perforated.
Diverticulum
Outpouching in the descending segment
Fistula
Caused by chronic gastric perforation
From the stomach, you can visualize the colon without
seeing the small intestine.
Duodenal carcinoma
Irregular narrowing of lumen
SMALL INTESTINES
Jejunum
Occupies LUQ
Ileum
Occupies RLQ Crohn’s disease
Valvulae conniventes Ulceration of the bowel
Mucosal folds within the small intestine Chronic inflammatory changes involving the terminal ileum,
cecum, ascending colon and part of the transverse colon.
In CT scan, you can see thickened wall.
Nonhodgkin’s lymphoma
Thickening of the wall of the small intestine
Lumen is narrow.
Ulcerative colitis
Inflammation involving the colon
Lumen is narrow.
Parasitism
Lumen should be white but there are tubular lucencies
occupying the lumen.
Ascaris sp.
Malignancy
New growth from the wall and may go to the lumen
Filling defect in barium study
Irregular wall
Narrowing of the lumen because of an apple core deformity
secondary to colon cancer.
COLON
Barium enema only or double contrast barium enema for the colon
Patient is lying on a left decubitus position. Catheter is inserted into
the rectum and barium is injected into the entire colon.
With haustrations
Ascending colon, hepatic flexure, transverse colon, splenic flexure,
descending colon, sigmoid colon, rectum
Visual colonoscopy to see the lumen, haustrations, lumps within
the colon
Closed-loop obstruction
Obstruction secondary to twisting of the colon (volvulus)
In sigmoid volvulus, it looks like a coffee bean.