Abdominal Radiology for the Small Animal Practitioner - 1st
Edition
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Preface
Interpretation of abdominal radiographs is complicated by the lack
of contrast compared to other body systems. In the thorax, fluid-
opaque structures such as the heart are clearly contrasted against
the air-filled lungs. There is an obvious difference between the
fluid-opaque muscles and the mineral-opaque bones of the muscu-
loskeletal system. In the abdomen, however, virtually all struc-
tures are fluid-opaque and are recognizable only by the fat that sur-
rounds them and by their relationship to surrounding organs. To
be successful in interpretation, one needs to think in terms of
opacities and must reconstruct a 3-dimensional picture from a 2-
dimensional image.
It is the hope of this book to help the reader learn to transform a
radiograph from a flat black and white picture to a 3-dimensional
image with multiple shades of grey to visualization of the abdomen
which it represents. This text will describe the normal appearance of
the abdomen, ways in which the radiographic appearance changes to
reflect disease, basic radiographic techniques, and common abdomi-
nal disorders. The text is meant to be a handy “cookbook” which can
be quickly grabbed from the shelf rather than a comprehensive vol-
ume which would require intensive study. Many comprehensive
texts have been used to compile this Made Easy book and they are
gratefully listed in the Recommended Readings.
Judy Hudson
William Brawner
Merrilee Holland
Margaret Blaik
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Table Of Contents
Section 1 Introduction and
Radiographic Technique
Some Helpful Hints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Indications for Abdominal Radiography . . . . . . . . 4
Role of Radiology in Patient Management. . . . . . . 4
Steps to Good Film Reading . . . . . . . . . . . . . . . . . . 4
Step One: Technical Factors for
Abdominal Radiography . . . . . . . . . . . . . . . . . . . . . . . . .5
Step Two: Using a System for Interpretation . . . . . . . . .5
Step Three: Roentgen or Radiographic Signs . . . . . . . .6
Step Four: Differential Diagnoses . . . . . . . . . . . . . . . . . .8
Step Five: What’s Next? . . . . . . . . . . . . . . . . . . . . . . . . .9
Section 2 Normal Radiographic
Anatomy of the Abdomen
Viewing the Film . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Duodenum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Cecum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Spleen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Lymph Nodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
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Section 3 Peritoneal Cavity
Normal Appearance. . . . . . . . . . . . . . . . . . . . . . . . . . 26
Increased Peritoneal Opacity. . . . . . . . . . . . . . . . . 26
Terminology – Synonyms . . . . . . . . . . . . . . . . . . . . . . .28
Decreased Peritoneal Opacity–Gas . . . . . . . . . . . . 29
Causes of Intraluminal Gas Accumulation . . . . . . . . .29
Causes of Extraluminal Gas Accumulation . . . . . . . . .29
Radiographic (Roentgen)
Signs of Extraluminal Gas . . . . . . . . . . . . . . . . . . . . . .29
Decreased Peritoneal Opacity–Fat . . . . . . . . . . . . 31
Causes of Abnormal Fat Opacities . . . . . . . . . . . . . . .31
Radiographic (Roentgen) Signs . . . . . . . . . . . . . . . . . .31
Disruption of Borders of the Peritoneal Cavity . . . 32
Diaphragmatic Hernia . . . . . . . . . . . . . . . . . . . . . . . . .32
Hiatal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Peritoneopericardial Hernia . . . . . . . . . . . . . . . . . . . . .34
Inguinal or Ventral Hernia . . . . . . . . . . . . . . . . . . . . . .37
Perineal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Section 4 Intra-abdominal Masses
Evaluation of an Abdominal Mass . . . . . . . . . . . . 42
Gastric Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Generalized Hepatomegaly . . . . . . . . . . . . . . . . . . 42
Focal Hepatomegaly . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Differentiate the Stomach . . . . . . . . . . . . . . . . . . . . . .45
Renal Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Adrenal Mass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Diffuse Splenomegaly. . . . . . . . . . . . . . . . . . . . . . . 48
Focal Splenomegaly . . . . . . . . . . . . . . . . . . . . . . . . 48
Mesenteric/Enteric Masses. . . . . . . . . . . . . . . . . . . 51
Pancreatic Masses . . . . . . . . . . . . . . . . . . . . . . . . . 53
Ovarian Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
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Masses Involving Urinary Bladder . . . . . . . . . . . . 55
Prostatic Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Uterine Masses. . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Caudal Sublumbar Masses . . . . . . . . . . . . . . . . . . . 58
Section 5 Alimentary Tract
Contrast Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Barium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Ionic Organic Iodine . . . . . . . . . . . . . . . . . . . . . . . . . .63
Non-Ionic Organic Iodine Preparations . . . . . . . . . . .63
Esophageal/Gastrointestinal Contrast Procedures . . 63
Radiography of the Esophagus . . . . . . . . . . . . . . . . . . .64
Contrast Examination of the Esophagus–Esophagram . .64
Esophagram Technique . . . . . . . . . . . . . . . . . . . . . . . .64
Disorders of the Esophagus . . . . . . . . . . . . . . . . . . . . . 66
Esophageal Foreign Bodies . . . . . . . . . . . . . . . . . . . . . .66
Megaesophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Vascular Ring Anomalies . . . . . . . . . . . . . . . . . . . . . . .69
Esophageal Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Radiography of the Stomach and Small Intestine 71
Survey Radiographs . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Contrast Examination of the
Stomach and Small Intestine–Indications . . . . . . . . .72
Upper Gastrointestinal Series . . . . . . . . . . . . . . . . . . .72
Normal Upper GI Series . . . . . . . . . . . . . . . . . . . . . . .74
Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Small Intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Differences in Cats . . . . . . . . . . . . . . . . . . . . . . . . . .78
Principles of Interpretation . . . . . . . . . . . . . . . . . . . . .78
Other Contrast Procedures . . . . . . . . . . . . . . . . . . . . .78
Upper GI Series with Iodine . . . . . . . . . . . . . . . . . .78
Pneumogastrogram . . . . . . . . . . . . . . . . . . . . . . . . . .80
Double Contrast Gastrogram . . . . . . . . . . . . . . . . . .80
Disorders of the Stomach . . . . . . . . . . . . . . . . . . . 80
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Gastric Foreign Body . . . . . . . . . . . . . . . . . . . . . . . . . .80
Gastric Torsion/Dilatation . . . . . . . . . . . . . . . . . . . . . .82
Pyloric Outflow Obstruction . . . . . . . . . . . . . . . . . . . .82
Gastric Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Gastroesophageal Intussusception . . . . . . . . . . . . . . . .86
Disorders of Small Intestine . . . . . . . . . . . . . . . . . . . . . 87
Ileus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Mechanical Obstruction . . . . . . . . . . . . . . . . . . . . . . .88
Foreign Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Intussusception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Inflammatory Diseases Without Ulceration . . . . . . . .92
Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
Infiltrative Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
Radiography of the Large Intestine . . . . . . . . . . . . 95
Contrast Radiography of the Large Intestine . . . . . . .96
Pneumocolography . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Barium Enema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Double Contrast Barium Enema . . . . . . . . . . . . . . . . .98
Disorders of the Large Intestine . . . . . . . . . . . . . . 99
Obstipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
Ileocolic Intussusception . . . . . . . . . . . . . . . . . . . . . . .99
Cecal Inversion . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
Infiltrative Diseases . . . . . . . . . . . . . . . . . . . . . . . . . .102
Mucosal Diseases (Colitis) . . . . . . . . . . . . . . . . . . . . .102
Section 6 Urinary Tract
Selection of Appropriate Contrast Procedure . . . 106
Contrast Examination of the Urinary Bladder
(Cystography) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Positive Contrast Cystogram . . . . . . . . . . . . . . . . . .106
Negative Contrast Cystogram (Pneumocystogram) . .107
Double Contrast Cystogram . . . . . . . . . . . . . . . . . . .107
Vesicoureteral Reflux . . . . . . . . . . . . . . . . . . . . . . . . .108
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Disorders of the Urinary Bladder. . . . . . . . . . . . . 110
Urinary Calculi . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Ruptured Bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Cystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114
Emphysematous Cystitis . . . . . . . . . . . . . . . . . . . . . . .114
Urinary Bladder Neoplasia . . . . . . . . . . . . . . . . . . . . .116
Contrast Examination of the Urethra (Urethrography) 117
Disorders of the Urethra . . . . . . . . . . . . . . . . . . . 118
Urethral Calculi . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
Obstructive Uropathy . . . . . . . . . . . . . . . . . . . . . . . .121
Ruptured Urethra . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
Contrast Examination of the Kidneys and
Ureters–Excretory Urogram . . . . . . . . . . . . . . . . . . . . 122
Normal Excretory Urogram . . . . . . . . . . . . . . . . . . . .124
Arteriogram Phase . . . . . . . . . . . . . . . . . . . . . . . . .124
Nephrogram Phase . . . . . . . . . . . . . . . . . . . . . . . . .124
Pyelogram Phase . . . . . . . . . . . . . . . . . . . . . . . . . .125
Cystogram Phase . . . . . . . . . . . . . . . . . . . . . . . . . .125
Disorders of the Kidneys and Ureters . . . . . . . . . . . 127
Chronic Renal Disease . . . . . . . . . . . . . . . . . . . . . . . .127
Renal Dysplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
Transitional Cell Carcinoma of the Urinary Bladder . .127
Hydronephrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
Renal Calculi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
Pyelonephritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
Renal Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
Polycystic Renal Disease . . . . . . . . . . . . . . . . . . . . . .133
Perirenal Pseudocyst . . . . . . . . . . . . . . . . . . . . . . . . . .133
Compensatory Hypertrophy . . . . . . . . . . . . . . . . . . . .134
Functional Evaluation of the Kidney . . . . . . . . . . . .134
Ruptured Ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136
Ureteral Ileus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136
Ureteral Calculi . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
Primary Ureteritis . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
Ectopic Ureter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
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Section 7 Reproductive Tract
Female: Uterus and Ovaries . . . . . . . . . . . . . . . . . . . . 142
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Disorders of the Female Reproductive Tract . . . . 142
Pyometra and Other Causes of
Uterine Enlargement . . . . . . . . . . . . . . . . . . . . . . . . .142
Dystocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Fetal Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Ovarian Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Disorders of the Male Reproductive Tract . . . . . 147
Retained Testicles and Prostate Gland . . . . . . . . . . .147
Testicular Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
Prostatic Enlargement . . . . . . . . . . . . . . . . . . . . . . . .147
Benign Prostatic Hyperplasia . . . . . . . . . . . . . . . . . . .148
Prostatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148
Prostatic Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
Prostatic Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . .149
Prostatic and Paraprostatic Cysts . . . . . . . . . . . . . . . .149
Section 8 Anomalies
Microhepatica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Renal Agenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Malpositioned Kidneys . . . . . . . . . . . . . . . . . . . . . . . . 153
Kartagener’s Syndrome . . . . . . . . . . . . . . . . . . . . . . . . 154
Recommended Readings . . . . . . . . . . . . . 157
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Section 1
Introduction
and Radiographic
Technique
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Introduction
The goals of this book are to help the reader acquire
good techniques for making and interpreting radiographs of the
abdomen, and to give the reader a good basic knowledge of special
procedures available to gain additional diagnostic information.
Although ultrasonography has added immeasurable diagnostic
capability, abdominal radiography frequently can yield additional
information by providing a panoramic view of the abdomen and by
allowing examination of tissues hidden from the ultrasound beam
by bone or gas.
Some Helpful Hints
The following icons are used in this book to indicate important
concepts:
✓ Routine. This feature is routine, something you should know.
♥ Important. This concept strikes at the heart of the matter.
Key. This concept is a key one and is necessary for full
understanding.
Stop. This statement appears to be simple but is more
important than you might think.
A companion CD is available for purchase by calling
877-306-9793. The CD contains the full text, figures, and
tables of this book formatted for easy search and retrieval.
The CD symbol indicates that additional images of a topic
are available on the CD.
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Indications for
Abdominal Radiography
✓ Vomiting
✓ Abdominal pain
✓ Regurgitation
✓ Palpable abdominal mass
✓ Diarrhea
✓ Hematuria/dysuria
✓ Tenesmus
✓ Herniations
✓ Rectal bleeding
✓ Suspected foreign body
✓ Staging of neoplasia
✓ Geriatric examination
✓ Others by clinical judgement
Role of Radiology in
Patient Management
1. Diagnosis
✓ One of many diagnostic aids
✓ Expand or reduce differential diagnosis
✓ Precise diagnosis not always possible
2. Prognosis
3. Evaluate course of disease with or without therapy
Steps to Good
Film Reading
1. Evaluate technical factors
2. Read the whole film
✓ Fight clinical bias
Perform a systematic interpretation.
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3. Describe the film in terms of roentgen or radiographic signs
e.g., opacity, size, shape, position, margination, intraluminal,
extraluminal
4. Assess signs and list differential diagnoses
5. What happens next?
Step 1: Technical Factors for
Abdominal Radiography
✓ Proper preparation–fasting and enema if possible
✓ Adequate restraint
♥ Always two views (ventrodorsal or dorsoventral and lateral)
✓ Include diaphragm and pelvic inlet
✓ Use grid when abdomen is greater than 9 cm thick
Determine technique chart and be consistent.
✓ Make the exposure at the expiratory pause to avoid
motion artifact.
Step 2: Using a System
for Interpretation
Whether you use a regional or organ system approach is unim-
portant, but you must cover the entire film.
✓ In the regional approach, you read from the center out, from
periphery in, or from side-to-side, or some other variation to
cover all regions of the film.
✓ In the organ system approach, organs are listed and identified
and unusual opacities are noted.
✓ Spine, caudal thorax, and other intra-abdominal structures
should be examined first.
✓ It may be helpful to begin examination of the abdomen with
large solid organs like the liver, spleen, kidneys, etc.
✓ Then identify visible portions of the GI tract.
✓ Mentally check off organs that are not usually seen and look
for them.
✓ Look for unusual opacities that cannot be readily identified.
