Monday, September 10, 2018

How To Read An Abdomen-Pelvis CT

Abdominal pain is a very common chief complaint, especially among ER patients. While the truism of "look at every organ on every image" applies, this is the reading pattern I have developed for myself over time.
  • Bones - look in sagittal and axial. Make note of any pars defects around L5. For trauma cases, consider looking in coronal as well for femoral and sacral pathology.
  • Lung bases / lower thorax - look in lung windows. Glance at heart/pericardium 
  • Aorta / Retroperitoneum -  look for aneurysms, dissection, and lymphadenopathy
  • Liver / Gallbladder - scroll from inferior to superior, looking at the right hepatic parenchyma and hepatic veins. Then scroll from superior to inferior looking at the left hepatic lobe. Scroll back through the gallbladder and biliary ducts. Lastly, scroll inferiorly from the right and left portal veins to the portal vein down the SMV.
  • Pancreas - after you scroll through the portal veins, scroll back up the pancreas from the uncinate process through the head, body, and tail.
  • Spleen - look from pole to pole.
  • Stomach / Duodenum - look from the gastroesophageal junction through the third portion of the duodenum.
  • Adrenals
  • Kidneys - look in axial and coronal planes to exclude any exophytic lesions.
  • Bladder / Pelvis - scroll down from the kidneys along the ureters to the bladder
  • Colon - look at rectum, sigmoid, descending, transverse, ascending colon, cecum, and appendix in that order. 
The advantage of this scan pattern is that you mostly scroll continuously, avoiding jumps between different areas of the abdomen/pevis. Of course, specific chief complaints will lead to a focus on other particular areas of interest. Compare any findings with any prior comparison studies available. 

This post is derived from notes I took during training. Any images are copyright their respective owners.



No comments:

Post a Comment