E4980. Pitfalls of Bowel Interpretation on “Routine” Abdominal and Pelvic CT
Authors
Miltiadis Tembelis;
NYU Langone Hospital - Long Island
Margarita Revzin;
Yale School of Medicine
John Hines-; ;
Donald and Zucker School of Medicine at Northwell/Hofstra
Michael Patlas;
University of Toronto
Douglas Katz;
NYU Langone Hospital - Long Island
Background
Abdominal and pelvic pain accounts for 8% of emergency department visits in the United States and has many potential etiologies. CT of the abdomen and pelvis is often the first diagnostic examination performed in nonpregnant adults. In the emergency setting, a protocol without or with IV contrast, depending on the suspected diagnosis, typically without oral contrast, is currently used. Other than possible NPO status, generally no bowel preparation is performed, or specific attempts to optimize bowel assessment, making evaluation difficult.
Educational Goals / Teaching Points
The purposes of this presentation are to (1) review the literature of these potential pitfalls when evaluating the luminal gastrointestinal (GI) tract on “routine” CT of the abdomen and pelvis, as opposed to, e.g., CT enterography or CT colonography; (2) discuss the potential causes and mimics; and (3) offer guidance in the differentiation and interpretation of these entities.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
GE junction: true mass vs. a pseudomass; esophageal leiomyoma vs. GIST; gastric food vs. bezoar vs. true mass; gastritis vs. linitis plastica vs. under-distension; gastric ulcer disease vs. tumor; commonly missed ulcers; pancreatitis vs. primary duodenal PUD; normal jejunum vs. thickening; peristalsis/under-distention vs. inflammatory small bowel stricture or mass; pathological vs. incidental intussusception; and colonic diverticulitis vs. colitis vs. neoplasm
Conclusion
Patients with acute abdominal and/or pelvic pain often undergo routine CT of the abdomen and pelvis for a workup of an acute abdomen and other circumstances. The absence of oral contrast for these examinations, which is increasingly the case, combined with the absence of any bowel preparation, especially in the emergency setting, leads to under-distention of the luminal GI tract, causing difficulty in assessment for the radiologist. Fortunately, assessing both luminal and extraluminal findings can otherwise help distinguish between normal anatomy and abnormal and potentially missed entities, even when the bowel is collapsed, although definite assessment may not be possible.
