Clinic II:  Pelvis CASE STUDY

Format: PowerPoint (Minimum of 14 Slides)

Exam (Include Pictures)

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PATIENT History

PATIENT Preparation (Include PT safety)

PATIENT Positioning

Technical Parameters (i.e. kvp, mAs, SID, angle if applicable)

Images of Exam

Findings/Clinical Indications

Post Exam Instructions

Be Creative!

CT of the Abdomen and Pelvis with Contrast by Kanika Mosley

1

Patient History

Male, Age 51

Weight: 225 pounds

Diagnosis: Left lower abdominal pain

History of hepatic steatosis (non-alcoholic fatty liver disease)

IV Contrast allergy: Negative

Diabetic

2

Patient History

Contrast Screening Form indicated use of Metformin

Labs results within 30 days

Creatinine: 0.9; within normal range for Adult male of 0.70 – 1.20 mg/dL

eGFR: 60 mL/min/1.73m2; within normal range of >60 mL

3

Patient Preparation

Patient was advised of procedure and provided written informed consent for intravenous contrast.

Patient fasted for 2 to 6 hours before exam.

Oral Contrast provided 30 minutes prior to exam

Contrast Agents

138 mL of Isovue-370

70 mL of saline flush

4

Patient Preparation

Venipuncture

22 gauge needle

Gauze

Tourniquet

Bioclusive

IV access: Right Accessory Cephalic Vein

5

Patient Positioning

Supine

Arms raised above head

Patient instructed to suspend on respiration (breath hold)

6

Scan Parameters

DFOV (Display Field of View): 32

Slice thickness: 1.25 mm/1.25 mm

120 kVp; 288, mA

Delayed Scan

Portal Venous Phase

60 second delay

7

Scan Parameters

SFOV: Large body

WW: 400

WL: 40

Noise Index: 13.0

8

Images

Scouts

AP

Lateral

9

Images

Smart Prep

ROI: Liver

ROI

10

Abdomen Axial Images

1st Slice

WW: 400

WL: 40

11

Abdomen Axial Images

Slice 22

WW: 400

WL: 40

Liver

Stomach

Spleen

Descending aorta

Portal Venous Phase (60 seconds) for optimal visualization of the abdomen and pelvis.

12

Abdomen Axial Images

Slice 34

WW: 400

WL: 40

Right Kidney

Left Kidney

Superior mesenteric vein

Superior mesenteric artery

The kidneys are well visualized. The patient has been instructed to drink plenty of water to flush contrast out kidneys.

13

Pelvis Axial Images

Slice 58

WW: 400

WL: 40

Cecum

Sacrumm

Ilium

Ileum

Jejunum

Psoas muscle

Erector spinae muscle

There is a significant amount of gas in the colon.

14

Pelvis Axial Images

Slice 82

WW: 400

WL: 40

15

Tolerance

Patient was very tolerable of examination.

Patient was monitored for a few minutes after exam for reaction to contrast agent.

16

Findings

Colonic diverticulosis

Small, bulging sacs of the inner lining of the intestine that become inflamed.

No bowel obstruction found

Improvement in hepatic steatosis (fatty liver)

17

Post Exam Instructions

Resume taking Metformin after 48 hours.

Drink plenty of water.

18

Reminders

Always remember to use ALARA.

Obtain pertinent patient history and check chart.

Pledge “Image Gently.”

Refer ACR for ordering exams.

“Do No Harm.”

 
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