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CT Abd NL

TECHNIQUE: Helical CT scan examination of the abdomen and pelvis was performed following the IV administration of 100 ml of non-ionic contrast Isovue-300. Oral contrast was given prior to the start of the study. Standard 5 mm axial images were obtained with coronal and sagittal reformations. Renal delay images were also obtained. FINDINGS: The visualized lungs demonstrate no mass, consolidation or pleural effusion. Limited views of the heart are unremarkable. Bilateral saline breast implants are also noted. The liver, biliary system, pancreas, spleen, adrenals and kidneys demonstrate normal morphology and enhancement without mass lesions. Enteric contrast extends to the [cecum, rectum]. There is no evidence of free fluid or free air in the peritoneal cavity. The hollow viscera are without evidence of wall thickening, mass or obstruction. There is no lymphadenopathy. Surgical clips in the right lower quadrant are compatible with prior appendectomy. The bladder is normal. The gynecologic organs are unremarkable, and better demonstrated on the comparison ultrasound. The remainder of the soft tissues and osseous structures are unremarkable. IMPRESSION: No evidence of acute intra-abdominal pathology. ----------------- Findings: The liver, spleen, pancreas, adrenal glands and kidneys are normal in appearance. There is no hydronephrosis. Enteric contrast has progressed to the ascending colon. A prominent amount of well-formed stool admixed with enteric contrast is noted in the proximal colon. The transverse and descending colon are predominantly collapsed. Prominent air is noted in the rectum. There is no obvious colonic mass given limitations of the exam. Scattered regions of questionable mild bowel wall thickening are most likely related to peristalsis. The bowel is otherwise normal caliber without evidence of intestinal obstruction. The appendix is not well visualized. No inflammatory changes are noted in the right lower quadrant at the expected location of the appendix. There is no intra-abdominal mass, pathologic fluid collection or lymphadenopathy. The uterus is surgically absent. The lung bases are clear. The heart is normal in size without pericardial effusion. Mild degenerative changes are noted in the spine. Six nonrib-bearing lumbar vertebrae are incidentally noted. There are no acute osseous abnormalities. IMPRESSION: 1. No evidence of diverticulitis as queried. 2. No acute intra-abdominal pathology. ************************ Search Pattern Scout Images Quick Coronal Scroll: for orientation Axial - Quick Scroll - Lungs by lobes: MIP 1st then compare w/ 1.25; from apices down; mass, consolidation, effusion, mets, septic emboli, Wegeners, bronchiectasis (cylindric, varicose, cystic, traction) - Lung window through the abdomen for pneumoperitoneum - Trachea, Bronchi (SCC, ACC, Carcinoid, Mets, Papilloma, Hamartoma, Saber-Sheath Trachea, Tracheobronchopathia Osteochondroplastica, Wegener granulomatosis, Relapsing Polychondritis, Fibrosing mediastinitis, Stenosis, Strictures, TB, Tracheomalacia, Amyloidosis, Mounier-Kuhn Tracheobronchomegaly) - Thyroid, Parathyroid: Thyroglossal duct cysts - Esophagus to stomach: hiatal hernia, masses, achalasia - Aorta Ascending, Arch, branches (Brachiocephalic, L Common Carotid, L subclavian), Descending (Coeliac, SMA, IMA), bifurcation, iliacs: Aneurysm, Coarctation, Dissection, Bovine heart - Veins on the way back, Femorals, Iliacs, IVC, Renal; SVC, Brachiocephalic, Pulmonary veins: duplications, thrombosis - Retroperitoneal paraaortic and caval aortic nodes - Pulmonary artery and branches: PE - Heart and carotids, Pericardium - Mediastinum: nodes - prevascular, paratracheal, subcarinal, aortopulmonary window, hilar, precardiac, internal mammary; non-Hodgkin, Granulomatous (BACCCH), TB, mets - Liver: contour, perihepatic fluid, density (fatty infitration), measurements and HU of masses, Liver window - Portal Vein: thrombosis, varices - GB: size, wall, stones - Cystic duct, Hepatic duct, CBD to Ampulla - Pancreas, panc duct, and splenic vein: atrophic, calcs, masses, cysts - Spleen: calcs - Adrenals: adenoma, fat, Myelolipoma - Kidneys, ureters track down to bladder, renal arteries and veins: spaces, fat stranding, hydroureteronephrosis - Stomach: GE junction, duodenum, jejunum, ileum - Mesentery: misty peritoenum (ground glass), nodes - Colon: bowel wall thickening, TI junction, ceacum, appendix, follow to rectum, Ischial fossa, - Pericolic gutters: ST masses, fat stranding, fluid attenuation - Contrast: extending to the rectum - Prostate, Seminal Vesicles, Uterus, Ovaries (measurements, HU), - Bladder, Wall, Urethra: Foley - Ilipsoas muscle - Pelvic Lymph nodes - Peritoneum: free fluid, free air (lung window), thickening, nodularity - Periphery: Chest wall (axillary LN), Abdominal wall (hernia) - Bone window: Spine, Ribs, Pelvis, Hips - lytic, blastic mets, osteomyelitis, fractures Compare findings on Coronal and specially look at - Lungs - Pulmonary veins: Scimitar sy, - Trachea, Bronchi: tracheal bronchus, paratracheal LA … - Aorta, Iliacs, Femorals, IVC, renals - Retroperitoneal LA: paraaortic, portocaval - Liver - Stomach: GE junction - Spleen Sagittal - Pelvic organs: inventory, sizes, masses, fluid - Spine: spondylolysis