 Session on how I look at a CT abdomen and pelvis. This is my search pattern This isn't necessarily the best search pattern. It's just what I've adopted over the past few years I add stuff to it all the time and I definitely make changes based on what the indication of the study is Maybe look a little closer at certain things So this is just my the basic search pattern. We're not going to get into any pathology or anything But this is just kind of what I do So first thing I look at is I just do a quick run-through of The entire study just to kind of get the lay of the land and see what I'm getting myself into Sometimes you can open these CTs and they're just absolute disaster post-op patients and Kind of want to mentally prepare for that Our next first thing I do is I look at the heart You will be able to catch a thrombus in the left atrium or ventricle if they Scan a little far enough up or down Next thing I do is I'll look at the long bases Look for any sometimes you can see some pulmonary nodules down here, and I'll take a stroll through the abdomen Make sure there's no free air And I'll go all the way back up and start my search pattern So first thing I do is I follow the GE junction or the distal esophagus down through the GE junction through the stomach Followed around to the duodenum And I followed the duodenum across midline Past later-minute trites to the first portion of the jujunum Then I check out my spleen over here Spleen looks good while I'm over here. I'll drop from the distal pancreatic tip thought along the body The head and the intonate Then I'll bring it back up to the top and look at my liver so with the liver what I do is I break it up into the Into both hepatic lobes. So I start with the left hepatic lobe I scan through this one time And back up Look for any masses or any Weird things that catch my eye. Next I'll go to the right hepatic lobe And then I'll switch on liver lindos Where it gives you a nice harsh contrast in the liver parenchyma that can make certain pathologies stand out Liver looks good. So then I'll go to my gallbladder if there is one a lot of people Are post-cholestectomy So you'll see little clips in the hyalum But for this one gallbladder looks good Next I'll check out the vasculature the liver just because I'm over here hepatic veins And I'll go to my left portal vein Right portal vein enter and post to your branches main portal vein The main portal vein superior mesentery vein confluence splenic vein Now I've essentially ruled out a thrombus in my porovina system Next thing I do is I go through the adrenal glands. So the medial and lateral Legs if you will of the adrenal glands the right adrenal left adrenal gland Looks good. Next I scroll through my kidneys Looking for any stones masses cysts Etc. What I like to do is switch to my coronal to look at the kidneys Sometimes you'll miss little tiny stones in here that you don't see on axial and you see them a little better on Chronal and the same with the you'll catch pylonephritis on the coronal versus the axial sometimes Then what I do is I follow my ureters down Still going down through here Now this is an ideal for to look for stones in the ureter because it is a contrasted study But you can catch a big stone in there if you see one You follow the right ureter up and as he comes across And then what I do is I go back down Look at the bladder make sure there's no bladder wall thickening or stone floating around in there Again, you can switch the chrono if you want to back to the axial here Next I look at the reproductive organs. So this is a male. So this is the prostate Now while I'm down here, I'll look at the penis and the imaged portions of the scrotum if I can catch them Seminal vessels all look good So next up I'll start at the rectum and check out the bowel now So I tend to go in a retrograde manner. So I started the rectum All the rectum up come across with a sigmoid This one takes a nice little turn backwards. We have our ascending colon coming up coming up now We're the splenic flexure They were coming across with the transverse colon here pack flexure descending colon now we come down to the heliocetyl valve and our nice little appendix down here There it is Then it's coming across. This is pretty long appendix. It comes all the way midline It comes down around here and in so it's a blind ending small tubular structure If you can't find the appendix on the axle, you can always go to the coronal. Sometimes it helps you out a little bit You can see it there Just resting on top of the psoas muscle coming across coming down Right there and that's the large bowel So next thing I do is I'll scroll through the vessels sometimes you can catch the athrombus in the catch a little DVT out in the visualized proximal femoral vein Which is always good to catch on both sides. So follow those vessels internal iliac vessels as they come together the common iliac vessels IVC aorta Bring it on up. Then I'll take a look at the celiac axis the SMV renal vein renal arteries The inferior mesenteric artery back down I'll look for lymph nodes along the course of these vessels. You'll see them along the pelvic side wall And along the retroperit neum Keep looking for all the lymph nodes around these regions and I'll stand back and forth a few times to look for them Next what I do is I'll come and look at my small bowel, you know overall picture of the small bowel You can't really trace it when it's collapsed The only time you can ever really trace the small bowel is if it's dilated like in a small bowel obstruction. It's really easy But I come through here look make sure I'm not missing any giant mesenteric lymph nodes or masses Take a look at the overall appearance of the small bowel Make sure we're not missing any infection or whatnot. So that's all good So next what I do is I switch to my soft tissues here, so I'll look at the anterior Soft tissues first coming up along the pelvic and anterior abdominal wall Here's the umbilicus. It's not too uncommon to see a little fact containing umbilical hernia here Super common. I don't even comment on it half the time But you'll see Sometimes you'll see bigger hernias along the anterior abdominal wall So we're all the way up to the top now the lungs. So then what I do now is I take the posterior I've done one wall soft tissues look at them all the way down Next what I do is I switch to my bone windows Take a look at the inferior pubic ramai left and right pubic sephesis superior pubic ramai femoral heads So I usually take out I go for the left hip first All the way up to the iliac Crest and then come back down. I go to my right hip Acetabulum femoral head iliac wing Then I come back down to look at my toxics And I scroll up looking at the sacrum Then I go up to the lumbar spine Making sure there's nothing in the spinal canal. All right. So that looks good. Next I go to the sagittal And I take a look at the bones on the sagittal projection Acetabulum femoral head iliac wing sacrum L5 all the way up Take a look make sure there's no big degenerative change or Osteos lesion You catch a little bit of the sacrum in the xyphoid process as well Also while I'm here, I'll take a look at the vessels and sagittal projection ciliac axis SMA aorta What I'll do is I'll take a quick run-through of the abdomen to make sure I didn't miss anything like the gallbladder It's easy to scroll through that because so many people have it don't have it I should say It's easy just to think it's not there So then I'll just take the overall look at the bow and appearance of the mesentery to make sure it in it miss anything on axial and Everything looks good. So that is it You have officially learned my search pattern for a CT abdomen and pelvis All you need to do is read a couple thousand more and you'll be on my level Or just do a radiology residency You'll be good to go So if you have any questions Leave a comment below and I'll try to respond to them