Radiology

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 HEPATOSPLENOMEGALY
Aban | Abe
Increase in radiopacity

Rounded liver
inferior tip
Inferior splenic tip
Radiologic Findings
Rounded hepatic angle.
Increase in radioopacity of the liver and spleen.
Displacement of the hepatic, splenic flexure and transverse colon
inferiorly, and the stomach medially.
Inferior spleen tip extending more caudally than the inferior liver
tip.

IMPRESSION: Hepatosplenomegaly
Dr Grasparil
• Largest organs in the upper portion are liver and spleen
• If you have soft tissue densities, think of masses involving the 2
organs
• Any myeloproliferative diseases result to hepatosplenomegaly
• In liver cirrhosis, the right lobe shrinks
• Gastric carcinoma can be exophytic
• Bowels, stomach, everything inferiorly displaced
 SMALL BOWEL OBSTRUCTION
Abu Hajar | Agustin | Amores | Aquino
8
Radiologic Findings
Distended bowel loops (>3cm) throughout the abdomen.
Valvulae conniventes are present.

IMPRESSION: Complete Small Bowel Obstruction

 SMALL BOWEL OBSTRUCTION
Bamba | Barbosa
Pneumoperitoneum

Step-ladder
appearance

Air Fluid Levels

>2 is abnormal

No gas in colon
 Dr. Grasparil
• The case is an example of a complete obstruction. Tell if it is dilated or not.
Measure from inner to inner, not the mucosa. Just measure the lumen from
end to end. If it’s more than 3cm - dilated.
• In the upright position, look for air-fluid level. If +, not automatically an
obstruction.
• Check for differential air-fluid level. See 3 (minimum). If just 2, ask for
follow-up. It might just be an ileus so don’t proceed to surgery.
• Check for rosary-bead sign, padami nang padami ‘yung tubig (not excreted),
air is resorbed. Eventually, air will be resorbed leaving just liquid in bowel –
gasless abdomen. White abdomen, on PE, very rigid, surgical. No gas in
abdominal x-ray doesn’t always mean it’s normal.
• Obstruction might be at the ileocecal junction, it can be TB, intussusception,
etc.
 GALLSTONE ILEUS
Batac | Bautista
Rigler’s Triad
Dilated small bowel
loops
Pneumobilia

Gallstone
Radiologic Findings
Dilated small bowel loops are present
Air in the biliary tree (Pneumobilia) is present
Right iliac fossa calcification (opaque gallstone) possibly lodged at
the ileocaecal valve

IMPRESSION: Gallstone Ileus

Dr. Grasparil

• Pneumobilia - accumulation of gas in the biliary tree. Seen

as linear branching gas within the liver most prominent in
central large calibre ducts as the flow of bile pushes gas
toward the hilum
• Portal venous gas - where peripheral small calibre
branching gas is usually seen due to the flow of blood
away from the hilum.
Volvulus
Betts | Briones
 Characteristic
COFFEE BEAN SIGN

19
 ● There are two dilated loops of gas-filled
large bowel in the lower midabdominal
region apparently folded on each other,
separated by thickened interserosal
space.
A ● (S) Massive dilation of the sigmoid
from the pelvis, aroung the abdomen.
● Haustral markings are absent.
● (A) Apex of the loop is directed to the
right upper quadrant.
● Diaphragm is obscured.
● The rest of the bowel loops are
nonobstructive in pattern .

IMPRESSION: Sigmoid Volvulus

S 20
 PORCELAIN GALLBLADDER
Canceran | Carandang
 ● Pyriform opaque mass with
curvilinear calcification
(white arrows) outlining the
gallbladder wall in the right
upper quadrant
GB
Dr. Grasparil

• The abnormality is at the right outer upper

quadrant.
• What other structures can present with this kind
of calcification? WALA NA. Hepatic calcification
due to TB (for example) will not present as ovoid
calcification. Calcified renal cyst, possible, but the
first thing to consider is a porcelain gallbladder.
ACUTE CALCULOUS CHOLECYSTITIS
Co | Concepcion
 Normal Sonography Case Sonography

van Breda Vriesman, A.C., Smithuis, R., van Engelen, D., Puylaert J.B.C.M.
(2006). Gallbladder - Wall Thickening. Radiology Assistant. retrieved 20
October 2018.
 Normal Sonography Case Sonography

van Breda Vriesman, A.C., Smithuis, R., van Engelen, D., Puylaert J.B.C.M.
(2006). Gallbladder - Wall Thickening. Radiology Assistant. retrieved 20
October 2018.
● Thickened
gallbladder wall (>3.5
mm) with striated
appearance
● Distended
gallbladder (>5 cm)
● Presence of impacted
cystic duct with
acoustic shadowing
Abdominal Sonography
Findings
● The gallbladder lumen is
distended measuring >5 cm
● The gallbladder wall is thickened
measuring >3.5 mm with
alternating hypoechoic region
between echogenic line
● Hyperechoic gallstone with
posterior acoustic shadowing
seen in cystic duct

Impression: Acute calculous

cholecystitis
Dr. Grasparil
● Not all sonologists routinely do sonographic Murphy’s sign.
● If you have a very calcified stone, echo will go back to transducer,
casting a shadow patalikod. This happens to very dense calcifications.
● Cholesterol stones – soft stones, not very calcified, there’s no shadow at
all, BUT it’s moving, gravity-dependent, so you know it’s a stone.
● Not all stones give acoustic shadow.
● Pericholecystic fluid (+) if acute
● We do not measure the gallbladder wall of patients who did not fast. It
has to be six hrs minimum, pag ER 4hrs pwede na.
● Sonographic Murphy’s sign – itapat ang probe sa gallbladder.
 ESOPHAGITIS
Condes | Cordova
ESOPHAGITIS
Radiographic findings
on barium
swallow/upper GI
series
• Ring-like
contractions (black
arrows)
• Lung fields are
clear
• Osseous structures
are intact
FINAL IMPRESSIONS
● Ring-like contractions on proximal half
● Lung fields are clear
● Osseous structures are intact

Final Diagnosis:

Esophagitis, etiology for work-up

 ACHALASIA
Corpuz | De Loreto
 Air Fluid Level
Air Fluid Level
- Due to stasis in a thoracic
esophagus filled with retained
secretions and food

Bird’s Beak Appearance

- Tapered deformity at the LES
due to faiure of relaxation
Hurst
Phenomenon Hurst Phenomenon
sophagea - Temporary passage of the
Dilatation barium contrast thru GEJ as
the hydrostatic pressure of
barium overcomes LES
pressure
Bird’s Beak Appearance
 Esophageal
Dilatation

Lower esophageal
sphincter doesn’t
relax
(Bird’s Beak
Appearance)

Hurst
phenomenon
RADIOLOGIC FINDINGS
● Bird’s Beak Appearance of the LES
● Esophageal Dilatation proximal to the LES
● Presence of air fluid level at the upper
esophagus
● Temporary passage of barium through the
GEJ
IMPRESSION: ACHALASIA
Dr. Grasparil
• Primary achalasia – congenital; short segment
• Secondary achalasia – there is a primary lesion causing the
achalasia
HIATAL HERNIA
DENTE | DOMINGO
 Fundus (yellow dotted)
herniates through the
esophageal hiatus in the
diaphragm

Air fluid level

HIATAL HERNIA
● Occurs when part of stomach protrudes
into the thoracic cavity through the
esophageal hiatus of the diaphragm
DUODENAL MASS
DULDULAO | FERNANDEZ, J.
 A - stomach; radiopaque

1 - 1st part of duodenum; radiopaque

1 2 - 2nd part of duodenum; radiopaque

● Green arrows - plicae circularis

A
3 - 3rd part of duodenum

● Purple arrows - round filling defects

2 signifying obstruction by mass
● Radiologic sign: APPLE CORE
DEFORMITY

4 - 4th part of duodenum

3 4 ● Orange circle - traces of barium

IMPRESSION: MASS ON 3RD PART OF

DUODENUM
COLORECTAL MASS
FERNANDEZ, S. | GARDAYA | IBRAHIM | JIMENEA
● Yellow arrow - ascending
colon; radiopaque
● Blue arrow - transverse colon;
radiopaque
● Orange arrow - descending
colon; radiopaque
● Green arrow - luminal
narrowing of the sigmoid colon
● Pink arrow - radiolucent
mass/lesion causing a filling
defect
● Green arrows - the lumen of
the sigmoid colon is markedly
narrowed and radiolucent
● Blue arrows - rolled and
heaped up shoulders of the
sigmoid colon

● Yellow lines - “apple core”

sign; residual amount of barium
outlines this part of the colon
● Red arrows - radiopaque
proximal sigmoid colon due to
inability of contrast media to
pass through
RADIOLOGIC FINDINGS
Abdominal radiography: GI Series

Comparison: Single Contrast enema

Observations:

● Radioopaque colon with filling defect

● Focal narrowing of sigmoid colon

IMPRESSION: Colorectal mass

COLONIC DIVERTICULOSIS
JORGE | LABAO
Normal Colon Colonic Diverticulitis
Diverticular Sacs
● Gas-filled or contain barium
● May contain fecal material
● Lie outside the colon lumen
● Occur almost anywhere in the
colon but are usually more
common in the sigmoid colon
 Diverticular Disease
● Colonic diverticulosis
○ Acquired condition where the mucosa and muscularis mucosae herniate through
the muscularis propria of colon wall
○ produces saccular outpouching
○ Classified as:
■ False = sacs lacks all elements of normal colon wall
○ Major risk factor: low residue diet
○ Associated with thickening of muscularis proprIa
■ Both both circular and taenia coli
○ Affected areas: shortened in length -> crowding of the thickened circular muscle
bundles
○ Presentation: pain and tenderness without inflammation, painless bleeding
RADIOLOGIC FINDINGS
Abdominal radiography: GI Series

Comparison: Single Contrast enema

Observations:

● Sigmoid colon with multiple outpouchings

measuring 2-5 cm filled with contrast and forming a
meniscus

IMPRESSION: Colonic Diverticulosis

GALLSTONE, POLYP,
ADENOMYOMATOSIS
LARRACAS | LOYOLA | MACAM | MATTA | MILLA
GALLBLADDER WALL
GALLSTONE

- Appears within the

gallbladder lumen as a
hyperechoic object GB

ACOUSTIC SHADOW
- Hypoechoic shadow cast by
the gallstone
- Move with changes in patient
position
GALLBLADDER WALL
ADENOMATOSIS

- Hyperplasia of the mucosa

and muscularis propria
GB
ROKITANSKY-ASCHOFF
SINUSES

- Outpouchings of mucosa
into or through the
muscularis
GALLBLADDER WALL
ADENOMATOSIS

- Hyperplasia of the mucosa

and muscularis propria
GB
COMET TAIL

- echogenic intramural foci

from which emanate V-
shaped comet tail
reverberation artefacts
GALLBLADDER WALL
GALLBLADDER POLYP

- Fixed, or pedunculated
hyperechoic material
protruding in the lumen of
the gallbladder
- Does not demonstrate
acoustic shadow
- A cholesterol polyp shows as a mass
with similar echogenicity to the
gallbladder wall and with no shadow
cone

Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC335943
0/
HEPATIC HEMANGIOMA
MORALES | NAVARRO | NICOLAS
 Normal liver
UTZ
Kidney
Liver
Portal triad structures
Diaphragm
Case UTZ
 Case UTZ
Sharply marginated
homogeneous
hyperechoic mass
 Normal
abdominal CT
Reference CT
Discontinuous nodular
pattern of enhancement
from the periphery.
Case CT
 Case CT w/ Contrast

ARTERIAL PHASE PORTAL VENOUS PHASE EQUILIBRIUM PHASE

Shows discontinuous, Progressive peripheral Further irregular fill-in
nodular, peripheral enhancement with more and therefore iso-/hyper-
enhancement (small centripetal fill-in attenuating to liver
lesions may show uniform parenchyma
enhancement)
FINAL IMPRESSIONS

Final Diagnosis: Hepatic Hemangioma

NEPHROLITHIASIS
ONGTINCO | PALOMA
PLAIN KUB (Kidney, Ureter, Bladder)
Radiography
Arrow - Calyces
P - Renal pelvis
* - Ureters
B - Bladder

● Non-dilated calyces
● Patent renal pelvis
and ureter
● Settling of contrast
material at the
bladder
 POST-VOID IVP
Arrow - Left renal calyces
* - Ureters
B - Bladder
Dashed line - psoas muscle

● Dilated left renal

calyces
● Patent ureters
* *
● Non-settling of
contrast material at
the bladder
B
Arrow - Staghorn
calculi
● Radiopaque branching
densities that conforms or fill in
the shape of the renal pelves
and calyces
 POST-VOID IVP
Arrow - Left renal calyces
Arrow head - Right renal calyces
* - Ureters
B - Bladder
Dashed line - psoas muscle

● Presence of staghorn
calculi at the left renal
calyces
● Non-dilated right renal
* *
calyces
● Patent ureters
B
HYDRONEPHROSIS
PARAS | PAULINO
Right Kidney
● Dilated right renal pelvis
and calyces
● No excretion of contrast
in the right ureter.
Probable obstruction or
stenosis in the proximal
ureter in the ureteropelvic
junction
Left Kidney
● Normal left renal pelvis
and calyces
● Left ureter is not dilated
Right Kidney
● Contrast is not visualized
in the right kidney.
● Possible complete
excretion of the contrast
Left Kidney
● Filling defect in the left
ureterovesical junction.
The rest of the ureter is
dilated as well as the
renal calyces.
DOUBLE COLLECTING SYSTEM
RAVALO, REYES
Horseshoe Kidney
Salangsang | Salvadora | Samson | Santiago
 Horseshoe Kidney
• Most common renal fusion anomaly
• Lower poles of the kidneys are joined across the midline by a fibrous
or parenchymal band.
• Kidneys are malrotated with the renal pelvis directed more anteriorly
and lower pole calyces directed medially
• Low in position in the abdomen due to prevention of normal ascent
by IMA
• Renal arteries frequently multiple and ectopic
• Complications: increased susceptibility to trauma, urinary stasis
leading to stones and infection
Plain Abdominal
Radiograph

Observations:
Both lower poles of the
kidney are directed medially
towards the spine and are
fused

Impression:
Horseshoe Kidney
CT Scan

Fused kidneys with a

parenchymal isthmus at the
lower poles.

Impression:
Horseshoe Kidney
CROSSED RENAL ECTOPIA
SANTOS | SAYO | SORIANO | SUAREZ
Crossed renal ectopia
● Rare congenital anomaly consisting of the
transposition of a kidney to the opposite side
● Left-to-right transposition is more common
● Usually asymptomatic; may present as an
abdominal mass if the two kidneys are fused
(Brant & Helmes, 2012)
● Empty left renal fossa
● Two renal pelvis located
at the right renal fossa
● The pelvis and ureters
are not dilated
● Ureters insert in their
normal locations in the
trigone
● Empty right renal fossa
● Two renal pelvis located
at the left renal fossa
● Dilated ureters
● Ureters insert in their
normal locations in the
trigone
URINARY BLADDER
DIVERTICULUM
SY | TAMONDONG
Normal vs Urinary Bladder Diverticulum
Urinary Bladder Diverticulum
● Bladder mucosa herniates through a defect in the bladder wall
○ Fluid-filled mass communicates with the main bladder lumen
through a small orifice
○ Wall of the diverticulum lacks a muscle layer and is thinner
than the bladder wall
● Most are located posterolaterally near the ureterovesical junction
● May contain stones or tumor and occasionally do not fill on
cystograms
● Complications: urinary stasis, infection, stone formation,
vesicoureteral reflux, and bladder outlet obstruction
Radiologic Findings
● Blue circle: Narrow neck of
diverticulum is apparent
● Red arrow: Fluid-filled sac
that projects to the urinary
bladder
APEX BASE
● Yellow arrow: Ureters
NECK
URINARY BLADDER MASS
VALENCIA | VALERIO
URINARY BLADDER MASS

● Ureters are filled and not

distended
● Smooth and well-defined
border
● Presence of filling defect at
the near the right bladder
wall
URINARY BLADDER MASS

● Right Ureter is filled and not

distended
● Left Ureter is not visualized
● Smooth and well-defined
border of the right bladder
wall
● Presence of filling defect at
the near the right bladder
wall
NEUROGENIC BLADDER
VIDUYA | VILLANUEVA
 NEUROGENIC BLADDER
Neurogenic bladder is the dysfunction of the bladder caused by neurologic damage
● Spastic
● Atonic
 Normal
RETROGRADE CYSTOGRAM
 Damage above T10
SPASTIC
BLADDER
Detrusor-sphincter dyssynergia
Detrusor hyperreflexia

WALL HYPERTROPHY
TRABECULATION
MARKED SUCCULATION

“CHRISTMAS TREE BLADDER”

 Damage at S2-S4 ATONIC BLADDER

Detrusor areflexia

FULL, NON-CONTRACTING
BLADDER
 CASE CYSTOGRAM NORMAL RETROGRADE
CYSTOGRAM

CASE
CYSTOGRAM
CASE CYSTOGRAM

● Tapers superiorly
● Increase in vertical dimension
inferiorly
● Trabeculated wall

“Christmas tree bladder”

Radiologic Findings
Elongated bladder that tapers superiorly
and with increased vertical dimension
inferiorly
Trabeculated bladder wall with marked
succulation

IMPRESSION: Neurogenic bladder

CYSTOCELE
MAUTE | PALCON | REDILLAS
Normal Female Pelvis
(Sagittal)
 Cystocele
● Anterior prolapse or prolapsed bladder
● Occur due to the weakness of the wall
between vagina and bladder and is often
associated with the following:
○ torn/weakened during childbirth
○ History of lifting heavy object
○ Obesity
○ Constipation
○ Age
○ Connective tissue disorder
○ hysterectomy
● Defects can develop due to one, two or three
vaginal wall attachment failures
○ midline defect
■ cystocele caused by the overstretching
of the vaginal wall
○ paravaginal defect
■ separation of the vaginal connective
tissue at the arcus tendineus fascia
pelvis;
○ transverse defect
■ when the pubocervical fascia becomes
detached from the top (apex) of the
vagina
● Blue dashed line - Prolapsed bladder
○ occurs when the supportive tissue
between a woman's bladder and
vaginal wall weakens and stretches

● Magenta line - Vagina

● Red oval - sigmoid colon
● Yellow Arrow - rectum