abdomen CT pathologies

2. FIGURE 2. Liver Laceration.
Axial CECT shows jagged linear
low attenuation areas within the
right lobe of the liver (arrow) with
associated blood around the
liver consistent with a liver
Can occur as a result of
blunt or penetrating
abdominal trauma, as a
complication of surgery, or
an interventional
procedure.
The patient may
experience hypovolemic
shock that is caused from
an inadequate blood
volume & Abdominal pain..
CT with IV contrast is the
imaging modality of choice
in its evaluation.
LIVER LACERATION

3. CT
A noncontrast study may not reveal the injury.
Contrast enhancement will assist in demonstrating the
laceration as a hypodense area.
May show subcapsular hematoma.
May show hemoperitoneum.
Liver Laceration. CT of the abdomen with
IV contrast demonstrates a large
hypodense area of the anterior aspect of
the right lobe of the liver consistent with a
laceration and hematoma.

4. Renal Laceration
• Motor vehicle accidents are the most common
cause of blunt abdominal trauma. Falls,
assaults, including penetrating injuries, are less
common.
• Hematuria, flank pain, hematoma, fractured
lower ribs, and hypotension may also be seen.

5. CT
 CT with IV contrast modality of choice for patient with blunt or
 penetrating abdominal trauma.
 Can better evaluate organs with three different window settings (soft
 tissue, lung, and bone).
 Shows other related trauma to abdomen and pelvis.
 Shows active arterial extravasation.
 Shows extent of hematoma (low-density area).
 Used to confirm two kidneys are present if nephrectomy is considered.
FIGURE 1. Renal Laceration. Axial (A)
and coronal MPR (B) CECTs
show a linear hypodense band through the
right kidney (arrow) with
mixed attenuation fluid surrounding the
kidney. This is consistent with a
renal laceration and associated
surrounding hemorrhage and extravasated
urine.

6. Spleen laceration
• Injuries such as lacerations occur as a result
of blunt or penetrating trauma to the
abdominal region.
• The patient would probably present with
abdominal pain, possible open wound, and
symptoms associated with hypovolemic
shock
• (i.e., low blood pressure and rapid pulse).
• CT of the abdomen with IV contrast is the
best way to evaluate splenic injuries and also
to evaluate other viscera.

7. CT
 Noncontrast CT may not demonstrate a hematoma or laceration.
 IV contrast CT shows an irregular linear hypodensity of a splenic
laceration and perisplenic hematoma.
 There may also be a hemoperitoneum (blood in the peritoneal
cavity).
CT of the abdomen with IV contrast shows
low-density areas (arrow) within the
posterior aspect of the spleen consistent
with a deep laceration and hematomas.
Axial CECT shows a jagged low
attenuation area through the spleen
(arrow) with free fluid surrounding it in a
trauma patient. This is characteristic of a

8. Adrenal adenoma
 Is a common benign tumor arising from the cortex of the
adrenal gland.
 Since the adrenal gland is the fourth most common site for
metastasis, it is important to determine whether an adrenal
mass is benign or malignant.
 A normal adrenal gland typically appears in the shape of the
letter H, L, Y, T, or V. The adrenal gland is usually about 4 cm in
length and 1 cm in width.
 Noncontrast CT, contrast-enhanced CT with washout, and MR
with chemical shift imaging are useful in differentiatin between
adenomas and nonadenomas.

9. CT
• Appears as a well-circumscribed
mass.
• Homogeneous in attenuation and
enhancement patterns.
• 10 HU or less (without IV contrast)
is a diagnostic indication for
adrenal adenoma.
• Relative percentage enhancement
washout (RPW) greater than 40%
is indicative of a benign tumor. FIGURE 1. Adrenal
Adenoma. Axial CECT shows
a smooth, welldefined, low
attenuation round mass in the
left adrenal gland (arrow).

10. • Adrenal metastases are usually considered to
be asymptomatic. With bilateral metastatic
involvement, hypoadrenalism may occur.
• The patient may then present with nonspecific
faintness, dizziness, weakness, fatigue, and
weight loss.
• Usually bilateral, but may be unilateral.
• Tumors may vary in size and are less well
defined. Larger tumors may have central
necrosis and hemorrhages may be seen.

11. CT
• Typical
attenuation of
20 HU or
greater on
unenhanced
examination.
• Below 10 HU
indicate benign
adenoma on
unenhanced
examination. Axial CECT shows a small hyperenhancing right
adrenal metastasis (arrow).

12. Aortic Aneurysm (Stent-Graft)
• Interventional radiology is used to place the stent-
graft into the normal diameter aorta above and
below the aneurysm, in an effort to isolate the
aneurysm from circulation.
• The stent-graft provides a new, normal-sized
lumen to maintain blood flow.
• The majority of aortic aneurysms occur secondary
to atherosclerosis. Other causes include infection,
inflammation, trauma, and Marfan syndrome.
• In patients presenting with back, abdominal, or
groin pain in the presence of a pulsatile abdominal
mass, the aorta should be evaluated.
• Ultrasound may be useful in screening.

13. Aortic Aneurysm. Axial CECT shows a large abdominal aortic aneurysm with mural
thrombus and calcification before (A) and after (B) stent-graft repair.
CT
• CTA has replaced conventional angiography in preoperative
evaluation. Less invasive and faster than conventional catheter-
based angiography. Superior to ultrasound in evaluating rupture
or leak.
• Follow-up CT examinations are usually performed at 1, 6, and
12 months, and then yearly to ensure the graft is intact and
accomplishing its intended goal.

14. FIGURE 2. Aortic Aneurysm. CECT coronal MPR shows an aortoiliac stent-graft.
• Provides 3D
images.
• Used to
evaluate the
placement of
the stent-
graft.

15. Hernia: Hiatal Hernia
• A condition where part of the stomach protrudes
through the esophageal hiatus and enters into
the chest cavity.
• There are two main types: sliding (most
common) and paraesophageal.
• May be either an acquired or a congenital defect.
• Larger hiatal hernias may cause heartburn, belching,
difficulty in swallowing, pain in the chest or abdominal
region, feeling of fullness, or vomiting.

16. • Usually an acquired defect due to decreased
abdominal muscle tone and increased
pressure within the abdominal cavity.
Individuals who are obese, pregnant, have
repetitive vomiting issues or are frequently
constipated may be more at risk.
• Aging weakens the elasticity of the
esophageal hiatus

17. CT
• Usually presents as a retrocardiac mass with or
without an air-fluid level.
FIGURE 1. Hiatal Hernia. Axial CT image shows
large retro cardiac hiatal hernia containing
portion of the stomach, large bowel, and
mesenteric fat.
FIGURE 2. Hiatal Hernia. Coronal
MPR showing bowel in thoracic cavity.
Note: IVC filter.

18. Hiatal Hernia. Sagittal MPR showing
bowel in thoracic
cavity (arrow).

20. INGUINAL HERNIA
• A hernia is an abnormal opening or defect through which
organs or tissue may protrude through.
• An inguinal hernia is a hernia in the inguinal (groin area) region
of the body. is the most common type of abdominal wall hernia.
• There are two types of inguinal hernias: indirect or direct.
• Determining whether the specific type of inguinal hernia is
indirect (those appearing lateral) or direct (those appearing
medial) will depend on their relationship to the inferior epigastric
vessels.
• In addition to these two types of inguinal hernias, a third hernia
(i.e., femoral hernia) may also present in the inguinal (groin
area) region.
• Indirect inguinal hernias are associated with a defect in the
abdominal wall (internal inguinal ring).

21. • This represents an area of potential weakness that
the small intestine may protrude through into the
inguinal canal and into the scrotum in males.
• In the female, the hernia follows the course of the
round ligament of the uterus to the labia majora.
• Heavy lifting may also result in an inguinal hernia.
• Risk Factors Include incarceration, strangulation, or
obstruction of the bowel.
• Dull ache or burning pain in the abdomen, groin, or
scrotum. Bulge or lump in the abdomen, groin, or
scrotum. This may be present while coughing or
straining and disappear when lying down.
• CT is the gold standard for diagnosis.

22. CT
• A lateral crescent sign. The compression and
displacement of the inguinal canal contents such as
the vas deferens, testicular vessels, and fat to form a
semicircle of tissue that resembles a crescent moon
lateral to the hernia.
• This is useful in diagnosing a direct inguinal hernia.

23. A) Axial CT, (B) coronal MPR, and (C)
sagittal MPR showing right inguinal hernia
containing bowel (arrows).

24. Spigelian hernia
• Occurs in a defect in the aponeurosis between the
transverse abdominal and rectus abdominal muscles.
• What is known as the Spigelian hernia belt and where the
majority of Spigelian hernias occur is found in a transverse
band (approximately 6 cm wide) located between the
umbilicus and a line running between both anterior superior
iliac spines (ASIS).
• Also known as a lateral hernia. The orifice of a Spigelian
hernia is located in the Spigelian fascia (aponeurosis), along
the lateral border of the abdominal rectus muscle and the
transversus abdominis muscle.
• Signs are poor bowel function or constipation, dull ache, and
recurring pain usually associated with bending or stretching.
It does not produce a noticeable bulge in the abdominal
wall.
• Herniation may appear to contain bowel or fat.

25. CT
1. CT allows accurate identification of hernias
and their contents.
2. CT with coronal and sagittal MPRs are very
useful in identifying the hernia.
3. Good for pre- and postoperative evaluation.
Axial CT showing point of
herniation through the left
abdomen wall (arrow)
containing a portion of the
descending colon (arrow).
Portion of the descending
colon is seen in the hernia sac
(open arrow).

26. Sagittal CT MPR showing point of
herniation through abdominal wall
(arrow). Incidental finding of a large
abdominal aortic aneurysm (open arrow)
is best seen on the sagittal image.
Coronal CT MPR showing point of
herniation through abdominal wall (arrow).

27. Hernia: Ventral Hernia
• include all hernias involving the anterior and lateral wall of the
abdomen. The most common type of ventral hernia is also
known as an incisional hernia.
• An incisional hernia occurs at the site of a previous surgery.
• May result as either a patient-related or surgery-related factor.
• Patient-related factors may result from conditions that increase
intraabdominal pressure such as obesity or ascites. Surgery-
related factors include the type and location of the incision.
• Risk Factors: Large abdominal incision, obesity, diabetes,
coughing, heavy lifting, pregnancy, and an increase in pressure
due to straining to use the bathroom.
• Protrusion in the abdominal area. Pain may be present
especially during physical activity or movement such as when
bending forward.

28. • CT allows accurate identification of hernias and their contents.
• CT with coronal and sagittal MPRs are very useful in identifying the
hernia.
• Good for pre- and postoperative evaluation.
Axial images of a ventral hernia. (A) Note the site where the intestine is protruding
through the abdominal wall. (B) The hernia sac with the intestine is anterior to the
abdominal wall.

29. FIGURE 2. Ventral Hernia. Coronal MPR of a ventral hernia. (A) Note the site where the
intestine is protruding through the abdominal wall (arrow). (B) The hernia sac with
intestine is outside and anterior to the abdominal wall.

30. Lymphoma
• Are malignant tumors involving the lymphatic system.
• Lymphomas are usually grouped into two groups: (1) Hodgkin
disease and (2) non-Hodgkin lymphoma (NHL). As a result of
its characteristic pathology (i.e., Reed-Sternberg cell), Hodgkin
disease is considered separately.
• All other malignant lymphomas are grouped under the term
non-Hodgkin lymphoma.
• Usually involves swelling or enlargement of lymphoid tissue and
glands and is painless.
• Symptoms develop specific to the area involved and systemic
complaints of fatigue, malaise, weight loss, fever, and night
sweats may be experienced.
• CT is the preferred modality for the diagnosis and staging of
lymphoma.

31. CT
• Used in the staging of lymphomas.
• Can also be used for CT-guided needle biopsies of lymphomas.
• Demonstrates enlarged retroperitoneal, para-aortic, and para-caval
• lymph nodes.
• Demonstrates enlarged mesenteric lymph nodes.
• Demonstrates enlarged liver and spleen.
CT of the abdomen with IV
contrast demonstrates
multiple enlarged
retroperitoneal para-aortic
and para-caval lymph nodes
(short arrows) as well as
enlarged mesenteric lymph
nodes (long arrows).

32. CECTs axial (A) and coronal MPR (B) of the chest show bulky mediastinal and axillary
lymphadenopathy (arrows) in this patient with lymphoma.

33. Soft-Tissue Sarcoma
• Soft-tissue sarcomas of the body consist of a group of
malignant tumors that originate in the connective
tissues.
• The signs and symptoms may vary depending on the
soft-tissue structure affected. Some patients may
present with a palpable mass. Some patients experience
pain, while other patients are asymptomatic.
FIGURE 1. Soft-Tissue Sarcoma.
Contrast-enhanced CT of the abdomen
shows large soft-tissue mass occupying
most of the left abdomen displacing bowel
loops to the right. There is no significant
contrast enhancement.

34. CT
• May appear as a solid, mixed, or pseudocystic mass.
• Enhancement with IV contrast may be variable.
FIGURE 3. Soft-Tissue Sarcoma. Axial
NECT shows a large soft-tissue sarcoma
with areas of low-attenuation central
necrosis and coarse dense calcifications
arising from the left paraspinal muscles.
FIGURE 2. Hydronephrosis. CT of the
abdomen with contrast shows
hydronephrosis of the left kidney (arrow)
secondary to obstruction of the left distal
ureter by the left-sided abdominal mass.

35. Splenomegaly
• Is an abnormal enlargement of the spleen.
• Splenomegaly may be associated with numerous conditions
• such as a neoplasm, abscess, cyst, infection, portal hypertension (cirrhosis),
and hematologic disorders (hemolytic anemia and leukemia).
• Signs and Symptoms: Depends on the causative agent. A palpable mass
may be detected in some cases, while splenomegaly may be an incidental
finding.
CT
• Shows enlarged spleen.
• Focal lesions may be present.
• Displacement of adjacent
• organs may be seen.
Axial NECT shows an enlarged spleen
in a patient with secondary
hemochromatosis.