How to read CT of the Abdomen and Pelvis 

thats what its all about. helping you understand what goes down in the trenches. thanks for watching - sg

Very disturbed: came to see how the radiologist and urologist SHOULD have identified the kidney stone they missed 4 months ago leading me to 4 months of pain and lack of diagnosis, unnecessary tests procedures and referrals. My stone was not visible in the axial view but was very clear in the front/back view. (exactly where I as the patient told them my symptoms were). You also ONLY looked at uretors via axial. So apparently you would also have missed a simple 1-2mm (in the image) of symptomatic kidney stone(s). In the end about 3 small fragments came out 3+ months after symptom onset, end even though I saw them, felt them, looked at them with a magnifying glass, I was not believed because of the CT reading. Only when I insisted on a final meeting with the urologist - me insisting that sones hadn’t been ruled out, and he pulled up the old scan again and looked at the front view did he see OBVIOUS Stone that even I could see.

​@@GreenMyrtle wow, incredible how incompetent these doctors are. We should read our own CTs as patients. That's gonna go well.

+neurotik yea those are great ideas. those were things i wish i had wheni was starting, what is triple phase ct, what is pancreatic protocol, what is adrenal protocol, etc.

thanks for the comment. yeah i have an idea for a 'how to start rads' type video. the short story is get a good intro book like "core radiology " or "crack the core" and try to split rads up into all the different specialties. also give it time. its a hell of a lot easier for me to learn how to read an ankle MRI now than it was 4 yrs ago. best, sg

thanks for your comment, will do - sg

+Catherine Folkman Whitford thank you for your kind comment and please let me know if there is any other way my site can be more helpful. i've tried to make my videos information rich and edit out the non-essential portions

I'm using Osirix Mac as a Dicom viewer with camtasia Mac to screen record. The latter is what allows for me to zoom and highlight different areas

hey i man i hear ya. brain ct and mr is hard. just keep opening up the cases and trying to make findings. it gets easier over time. sit with an attending that you like and ask questions. re. lymph node sites. its still hard to remember. i always pull up radiology assistant for the thoracic lymph node stations: www.radiologyassistant.nl/en/p4646f1278c26f/mediastinum-lymph-node-map.html it gets easier over time. i guarantee in 4 yrs, you will not be as worried. you will actively take on new challenges in radiology best, sg

+Rasanga Peiris Yes its in the plans. Any thing in particular you are interested in?

haha yes those are in the works. I also want to update this video. Thanks for watching. If you want to see a guide of how a mediport is placed (IR), watch How to place a chest port catheter (mediport insertion) 2014 HD

+TheHallucinati hey wow sorry saw this late. interesting story, i'm glad you were able to find out what was going on. on average 10-15 minutes to look at a scan, can range from 3 min to 1 hr depending on the complexity. unfortunately, all radiologists are human and miss important findings from time to time. i'm glad my video helped you diagnose your own problem. best- sg

+Sarel Gaur MD cool name as well

Thanks for your comment. Those punctate hyperdensities just lateral to the prostate and seminal vesicles are phleboliths, calcifications forming in small diameter slow moving pelvic veins. These are very common and benign. The calcification inside the prostate parenchyma itself is a prostatatic calcification, another common and usually benign finding. I disagree with you re. the possible diverticula. Those look like hastrual contractions to me with circumferential narrowing of the colonic lumen. Diverticula are small outpouchings usually seen more proximally in the sigmoid, very common in patients older than 50. These will look like little grape like clusters extending slightly beyond the normal margins of the colon, usually multiple. Please see radiopaedia.org/cases/colonic-diverticulosis

I think I see what you are referring to, at approx 5:56. If you also look, theres a similar appearing area more distal and also some similar areas in the transverse colon. These areas are almost certainly haustral contractions, areas where the colon is contracting for peristalsis and not an actual lesion. Colon carcinoma is an adenocarcinoma, meaning it begins at the mucosal level. The bowel wall is a laminate of mucosa, submucosa, muscle layers, and the serosa (covering). To fully evaluate for colon cancer, you need to get the mucosa on profile, with good internal distension, so the mucosa is thinned out and you can evaluate for subtle masses. Otherwise, you risk over calling cancers or bowel wall thickening on a standard ct abdomen pelvis scan where the colon is not usually well distended. Think of the difference in thickness of a baloon when and when not fully inflated. The CT colonography is being used in some centers to screen for colon cancer. In this method, they distend the colon with large amounts of air to thin out the mucosa and evaluate for subtle mucosal disease. This technique is more accurate for detecting colon cancers. Colonoscopy, where they can get a high resolution color video image of the mucosa, is a sensitive technique for detection of colon cancer. For patients referred to evaluate for metastatic disease in a setting of known colon cancer, even then it can be difficult to detect the original mass lesion on a standard abdominopelvic ct scan. In short, its good to see those findings and be suspicious. Part of radiology (which I'm learning) is to know the limits and capabilities of the modality and which diseases can be diagnosed confidently and which cannot. In this case, your finding is most compatible with a haustral contraction.

Thanks for your comment. I'm working on some more videos including a video on noncontrast CT ab/pel to evaluate for renal colic. In regards to your question, usually solid organs (liver, spleen, pancreas, kidneys, adrenals, and GU organs) are not well evaluated as the parenchyma is not enhanced (increased in density) due to lack of IV iodinated contrast. This makes it difficult to evaluate for focal abnormalities in these organs. Also inflammatory disorders are usually characterized by hyperemia/enhancement and these can be under evaluated without contrast.

hey great question, has to do with the number of 'post IV contrast' phases or scans are performed. I actually made a video about this here: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-i9pVTMoRecA.html i've read the books but trust me videos are better - sg

ok ... but the noncontrast adquisition isnt considered as a phase?? thanks!

re. hiatal hernia- yes would be seen on CT abdomen+pelvis. Re. lungs- you always will see the lung bases on a Ct abdomen pelvis because its part of the upper aspect of the abdomen. you can't see the entire lung but you can definitely make some lung findings, just as in my video above. ultrasounds of abdomen and pelvis are helpful but usually somewhat inconclusive depending on what is being sought. Keep in mind a large fraction of what we find are considered "incidental findings" which are findings that are seen and are hard to ignore but are unlikely to cause serious harm. best - sg

depending on the complexity of the case it can take anywhere from 3 to 30 minutes, sometimes more, and depends on how much work you have to go thru. A private practice radiologist might read 50 CTs / day

thanks for your comment. I will try to repost a louder version soon

hey any specifics. its meant to be for a early yr resident level

+Kent Rieske aite kent, the msgs are scrapped. why? cuz you wanted it scrapped. as for the ads: nothing free in this world. a skippable ad is a small price to pay for decent content. please seek out my competitors...but i have a feeling you will be back if i'm going too fast, let me know what parts you need focus on and maybe you'll see it in an upcoming vid- SGMD

+Sarel Gaur MD I had advertisements on some of my videos that never paid a penny, so I canceled them all.

keep at it. for me its not about the money but seeing the dollar value of my content so i can grow it

He gave a disclaimer that this shouldn't be used for medical use.