Abdominal Imaging Dr Catherine Grierson Consultant Abdominal Radiologist University Hospital Southampton Abdominal Imaging • Specific presentations – Gastrointestinal bleeding – Inflammatory bowel disease – Sepsis • Imaging strategies.
Download ReportTranscript Abdominal Imaging Dr Catherine Grierson Consultant Abdominal Radiologist University Hospital Southampton Abdominal Imaging • Specific presentations – Gastrointestinal bleeding – Inflammatory bowel disease – Sepsis • Imaging strategies.
Abdominal Imaging Dr Catherine Grierson Consultant Abdominal Radiologist University Hospital Southampton Abdominal Imaging • Specific presentations – Gastrointestinal bleeding – Inflammatory bowel disease – Sepsis • Imaging strategies Presentations GASTROINTESTINAL BLEEDING Gastrointestinal bleeding • Acute – Haematemesis – Melaena – ‘Bright rectal bleeding’ – Collapse • Chronic – Anaemia Acute gastrointestinal bleeding ENDOSCOPY IMAGING CT angiography Conventional angiography CT CT angiography • Detects acute bleeding – Patient needs to be actively bleeding (0.3ml/min) – Requires rapid injection of large bolus of IV contrast (120 mls at 5 mls/sec) • Consider: – Renal function – IV access CT angiography • Detects focus of bleeding in a blood-filled colon • Identifies small bowel source • Clarifies upper GI or colonic origin • Guides selective catheterisation for interventional radiologists CT angiography Conventional angiography • Advantages over CT angiography – View of vessels over longer time-period – Bleeding may be evident as inject contrast into individual vessels THERAPEUTIC – Inject coils, glue, embolic particles – Place covered stents Conventional angiography Abdominal CT • May be useful outside the context of active bleeding to find cause • Particularly relevant in patients who cannot tolerate endoscopy • Relatively insensitive Causes of acute GI bleeding Colorectal adenocarcinoma Causes of acute GI bleeding Varices Causes of acute GI bleeding Linitis plastica Ulcerated gastric tumour Causes of acute GI bleeding Small bowel adenocarcinoma Causes of acute GI bleeding Splenic artery pseudoaneurysm Chronic gastrointestinal bleeding • Looking for underlying malignancy • Predominantly – Colon – Small bowel • Patients in whom optical colonoscopy not possible CT colonography • ‘Virtual fly-through’ • Sensitivity rates approaching those of colonoscopy for tumour and polyps > 6 mm CT colonography • Requires bowel preparation and ‘faecal tagging’ – Picolax + Omnipaque – Gastrografin • Carbon dioxide insufflation • Buscopan IV CT colonography Supine acquisition (+ IV contrast) Prone acquisition (low dose) CT colonography • 2D review CT colonography • 2D review • 3D ‘fly through’ (x4) CT colonography Current utilisation in UHS: – Needs request by gastroenterologist or colorectal surgeon – Indications: • • • • Failed colonoscopy (immediately or electively) Warfarin Patient request Frailer patients CT colon • ‘Minimal preparation’ CT colon • 5 x 25 mls gastrografin over 3 days • Faecal tagging CT colon CT colon (Extraluminal findings) Groin lymph nodes Abdominal aortic aneurysm Gallstones and GIST Small bowel CT • Oral mannitol – ‘Negative’ – 1500 mls – Osmotic • IV contrast – Portal venous phase – +/- Arterial phase • (Buscopan) Presentations ACUTE INFLAMMATORY BOWEL DISEASE Inflammatory bowel disease • Known IBD – Complications – Extent • New diagnosis – Make diagnosis – Type – Distribution Diagnosing colitis Acute colitis on AXR Diagnosing colitis Chronic colitis on AXR Diagnosing colitis Colitis on CT: Type? Diagnosing colitis Colitis on MR Diagnosing Crohns disease Terminal ileitis on ultrasound Diagnosing Crohns disease Crohns disease on fluoroscopy Diagnosing Crohns disease Distal ileitis on CT Diagnosing Crohns disease Small bowel involvement on MR Complications of IBD Terminal ileitis and abscess Complications of IBD Perforated Crohns disease on CT Complications of IBD Inflammatory mass on CT Presentations SEPSIS Biliary sepsis Cholecystitis on ultrasound Biliary sepsis Biliary obstruction Biliary sepsis Portal venous occlusion on ultrasound Biliary sepsis Gallbladder empyema Biliary sepsis Liver abscess and biliary dilatation Biliary sepsis MRCP Urinary sepsis Hydronephrosis on ultrasound Urinary sepsis Renal calculi on US Ureteric calculi on CT Sepsis of unknown origin Diverticulitis Psoas abscess CONCLUSIONS Conclusions • Diverse uses for abdominal imaging in acute medical presentations • Needs precise matching of modality to clinical question for maximum benefit Any questions?