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Approach to abdominal imaging

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Abstract

Radiographs should always be examined under optimal viewing conditions; dim surroundings are preferable. Conventional radiographs should be displayed on an X-ray viewer, which provides even illumination over the whole field of view. A small film should be surrounded by black card or the illuminated area restricted by shutters. A ‘hot light’ can be useful for examination of small, relatively overexposed areas. Digital radiographs should be displayed on a high-resolution screen. Each radiograph should be examined systematically. Some advocate a zonal system, where each section of the radiograph is examined in turn, before considering the radiographic findings in light of the presenting clinical signs. Others prefer an integrated approach, where knowledge of the presenting signs informs and directs the order in which tissues and organs are inspected. Whichever approach is preferred, it is vital to ensure that all organs and the entire abdominal cavity, including its boundaries, are evaluated. Orthoganal views (lateral and ventrodorsal) are usually required in order to derive the maximum amount of information from an image. This chapter looks at the Overview of image interpretation; The ‘surgical’ abdomen; Contrast radiography; and Overview of additional imaging modalities.

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Figures

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1.1 Lateral radiograph of the mid-dorsal abdomen of a bitch. Note the rounded soft tissue structure (white arrow) lying just caudal to the two superimposed kidneys (black arrows), giving the illusion of three kidneys. This soft tissue structure was confirmed as an ovarian neoplasm.
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1.2 Lateral abdominal radiograph of an adult cat. The kidneys are superimposed but one (black arrows) appears much larger than the other (white arrows). This is due to a unilateral perirenal pseudocyst.
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1.3 Lateral abdominal radiograph of an adult dog taken a few minutes after administration of barium. The barium outlines the position of stomach, emphasizing the change in shape of the liver. The normal triangular shape of the liver has been replaced by an irregularly rounded mass. The final diagnosis was a hepatic carcinoma.
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1.4 Lateral radiograph of the caudal abdomen and pelvis of an adult cat after a road traffic accident. Contrast medium has been introduced into the urethra and bladder, confirming that the bladder has become displaced ventrally and caudally through a rupture in the abdominal wall.
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1.5 Lateral abdominal radiograph of the caudal abdomen of a dog. Note the mineralized, thin-walled, oval structure (arrowed), which is highly suggestive of a paraprostatic cyst.
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1.6 Lateral abdominal radiograph of a cat taken approximately 30 minutes after administration of contrast medium. Large volumes of air lie free within the peritoneal cavity, especially dorsocranially (black arrows). There has also been leakage of the contrast medium into the peritoneal cavity, especially caudoventrally (white arrows). These findings confirm gastrointestinal perforation; if this condition had been suspected prior to contrast medium administration, the use of barium would have been contraindicated.
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1.7 Lateral abdominal radiograph of an adult male dog, presented with collapse and abdominal pain. There is a marked reduction in abdominal detail with corrugation of the small intestinal loops caudally, suggesting peritonitis. In addition, there is the impression of an ill defined mass in the mid-ventral abdomen (arrowed). An ultrasound examination of this dog confirmed the presence of a mass. The mass was rounded in cross section and largely hypoechoic with an eccentrically positioned hyperechoic region within. This is typical of a mass of intestinal origin. The final diagnosis was small intestinal carcinoma with perforation and peritonitis.

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