Normal CT chest, abdomen, and pelvis

Contributed by: Ed Boas

This is my general search pattern for a CT of the chest, abdomen, and pelvis (everyone's search pattern is a little different).  The search pattern should be tailored based on the history.  For example, for a trauma patient, you would spend more time looking for fractures, vascular or organ injury, pneumothorax, etc.  For an oncology patient, you would spend more time looking for lymph nodes and metastases.

Scout film: General overview.  Good view for checking lines and tubes.

Vessels:

Above the aortic arch - Look for lymph nodes, which are typically near blood vessels.

Pulmonary artery level - Look for pulmonary embolism, aortic aneurysm or dissection.

Heart - Look for cardiomegaly, ventricular hypertrophy, pericardial effusion, right heart strain (if the patient has a PE).

Middle mediastinum - Look for hilar, paratracheal, subcarinal lymph nodes, and esophageal wall thickening.

Axilla - Check for lymph nodes.

Check for pleural effusion and chest wall masses.

Lungs - Switch to thin slices and lung windows to look for nodules, masses, consolidation, ground glass, bronchiectasis, bronchial wall thickening, emphysema, etc.

Liver - Look for cirrhosis (nodular liver contour, ascites, varices), masses, portal vein thrombus, biliary dilation.

Gallbladder - Look for wall thickening, stones (ultrasound is more sensitive for gallstones).

Pancreas - Look for masses, pancreatic ductal dilation, pancreatitis (inflamed fat or fluid around the pancreas).

Spleen and adrenal glands - Look for adrenal nodules.

Kidneys - Look for masses, pyelonephritis, stones, hydronephrosis.

Bladder and prostate - Look for bladder wall thickening.

Bowel - Look for obstruction (dilated proximal bowel with a transition point to decompressed bowel), ileus (dilated large and small bowel without a transition point), wall thickening, wall enhancement, inflammation of the surrounding fat.

Coronal images are good for looking at the common bile duct and mesenteric lymph nodes.

Sagittal images are good for looking at the spine and aorta.

Now that you know what normal looks like, here are some examples of common pathology:

Other anatomy modules: