How to read a CT of the abdomen and pelvis

Case contributed by Dr Michael P Hartung

Patient Data

Gender: Male

Labeled series

Annotated image

EXAMPLE REPORTING TEMPLATE WITH CHECKLIST:

LOWER CHEST: Lung bases are clear. No pleural or pericardial effusion

  • Lung bases

  • Pleural effusion

  • Pericardial effusion

LIVER AND BILIARY: Normal liver morphology and enhancement. No masses. Normal gallbladder morphology. Normal caliber intrahepatic and common bile ducts.

  • Morphology

  • Enhancement

  • Masses

  • Vasculature

  • Gallbladder

  • Intrahepatic ducts

  • Common bile duct

PANCREAS: Normal morphology and enhancement. No ductal dilation or masses. No peripancreatic fluid.

  • Morphology

  • Enhancement

  • Lesions

  • Ductal dilation/anatomy   

SPLEEN: Normal size and enhancement

  • Size

  • Enhancement

  • Lesions

ADRENALS: Normal morphology. No masses.

  • Morphology

  • Masses

KIDNEYS, URETERS, AND BLADDER: Normal renal size, morphology, and enhancement. No solid masses. No urolithiasis or hydronephrosis. Normal bladder wall thickness and enhancement.

  • Morphology

  • Enhancement

  • Masses

  • Stones

  • Collecting system

  • Ureters

  • Bladder

GI TRACT AND PERITONEUM: Normal morphology of the stomach and duodenum. Normal caliber small and large bowel. Normal appendix. No ascites.

  • Acute findings (SBO, appy, diverticulitis, enteritis, colitis, appendagitis, etc)

  • Distal esophagus and gastroesophageal junction

  • Stomach

  • Duodenum

  • Small and large bowel caliber, wall thickness, enhancement

  • Hernias (ventral, umbilical, spigellian, parastomal, lumbar, inguinal, femoral, obturator, sciatic)

  • Fluid collections

  • Free fluid

  • Free air

  • Peritoneal or omental implants

VASCULATURE: Portal, splenic, and superior mesenteric veins are patent. Visceral arteries are patent. No abdominal aortic aneurysm.

  • Portal, splenic, superior mesenteric veins

  • IVC

  • Abdominal aorta

  • Visceral arteries (celiac, splenic, common hepatic, renal, SMA, IMA)

  • Iliac, pelvic, and femoral arteries and veins

LYMPH NODES: No adenopathy.

  • Lower chest

  • Upper abdomen (gastrohepatic ligament, celiac, portocaval, porta hepatis)

  • Retroperitoneum

  • Mesentery

  • Pelvis (inguinal, mesorectal, sidewall)

  • Inguinal

REPRODUCTIVE ORGANS: Normal size and contours of the prostate and seminal vesicles.

  • Prostate

  • Seminal vesicles

  • Spermatic cord

  • Imaged scrotum and penis

Uterus present. No adnexal mass.

  • Uterus

  • Fallopian tubes

  • Ovaries

  • Cervix

  • Vagina

MUSCULOSKELETAL: No aggressive osseous lesion. No body wall masses.

  • Aggressive lesions

  • Benign lesions

  • Fractures

  • Vertebral body heights

  • Degenerative disease

  • Musculature and subcutaneous tissues

 

IMPRESSION:

Unlabeled images

CT

Same study without annotations. 

Case Discussion

A few comments about the scan:

  • this is a CT of the Abdomen and Pelvis, Enterography protocol
  • this is a higher quality study than a standard CT. It is performed with a higher radiation dose and larger dose of IV contrast, which helps to evaluate subtle areas of bowel inflammation.
  • the slice thickness is 2.5 mm. This provides an excellent look at the large and small bowel enhancement and vasculature, and also the solid organs.
  • this patient has a good deal of intrabdominal fat, which separates and surrounds structures, helping to see/differentiate better than in a thinner patient.
  • this patient does have hepatic steatosis and a tiny gallstone or cholesterol polyp. The study is otherwise normal.

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