A clinical case can be viewed as a jigsaw puzzle to be solved, with each part of the investigation representing a piece of the bigger picture. There is a temptation, especially in referral hospitals to gather as much information as possible about every patient: ideally we should only be performing a diagnostic test if it is likely to have a significant influence in the management or outcome of the case. Although advanced imaging techniques such as CT can rapidly provide a definitive diagnosis in some patients, these investigations may be unnecessary, inaccessible or out-with the financial reach of the owner.
Radiography is still the first line of investigation for many abdominal disorders and in each of the examples above, delivers part of the information we need to form a diagnosis. In both cases ultrasound is indicated to provide more information, allowing a decision to be made about whether surgery is appropriate.
What can we expect from radiography and ultrasound? These imaging modalities are complementary and neither one can completely replace the other. Using radiography we can obtain an impression of gastrointestinal dysfunction through the presence of dilated bowel loops, unusual gas patterns or abnormal luminal content and we may be able to detect the presence of a foreign body or mass.
Ultrasound has the advantage of direct visualisation of the internal structure of the abdominal organs in real time without the need for ionising radiation. We can assess gastrointestinal wall architecture, luminal content and to some extent function, however the diagnostic value of gastrointestinal ultrasonography is influenced by operator expertise and dependent on the availability of suitable equipment.
Join us for a day of discussion and discovery on 17th November in Harrogate to share your views on these cases and find answers to many other imaging questions.
Mairi Frame BVMS DVR MRCVS DipECVDI FHEA PgCertDigEd