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Gastrointestinal Imaging

E2713. Blind Spots in the Abdomen and Pelvis: Where Are They Hiding?

Lodhi U,  Choy A. North Shore University Hospital, Manhasset, NY

Address correspondence to U. Lodhi (umairkhan.77@gmail.com)

Background Information: CT of the abdomen and pelvis has become the workhorse of abdominal radiology. It has revolutionized our ability to visualize fine anatomic detail and vastly expanded the pathology that we are exposed to. With experience, it has become clear that there are certain blind spots on a routine abdominal and pelvic CT where crucial findings can be missed if one is not in tune with the potential pitfalls. The purpose of this educational exhibit is to do a thorough review of blind spots in the abdomen and pelvis with examples of various pathologies.

Educational Goals/Teaching Points: Our educational goals are to increase the diagnostic confidence of young trainees as well as reinforce search patterns for the experienced abdominal radiologist. Additionally, we will view the breadth of abnormalities seen on abdominal and pelvic CT. In addition to highlighting common blind spots, we will demonstrate the importance of using wide or narrow windows as part of a routine evaluation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We will focus on key anatomic areas where blind spots are found in the abdomen and pelvis. These include the vessels, paraspinal musculature, soft tissues, gastroduodenal area, lateral segment of a prominent left hepatic lobe, sacral foramen, peritoneum, lung bases, and spinal canal. We will also highlight the importance of using lung and liver windows to visualize otherwise hidden abnormalities. Examples of this will include small inferior vena cava leiomyosarcoma, femoral deep venous thrombosis on unenhanced CT, colonic polyps seen with familial adenomatous polyposis, spinal cord metastasis, and skin nodules seen with neurofibromatosis.

Conclusion: There are certain blind spots in the abdomen and pelvis where key findings will be missed unless specifically evaluated. It is important to always be cognizant of these areas and to train one’s eyes to specifically evaluate these areas on every case.