Small 

Animal Abdominal Radiography
Matthew Paek, VMD, MS, DACVR
Email: Matthew.Paek@SynergyVIP.com

7/30/2018 1

Lecture Outline

• Radiographic technique

• Introduction to systematic review and principles of 
interpretation

• Basic abdominal radiographic anatomy

7/30/2018 2

Radiographic Positioning
• Multiple projections should always be obtained
• 2‐D image of 3‐D structures → Superimposi on, Summa. on, and 
Silhouetting of structures
• Obtain at least 2 orthogonal (90o) views
• Important for lesion localization
• Additional projections can be helpful

7/30/2018 3
 Radiographic Positioning
• For the abdomen, typically 2 projections obtained
• Ventrodorsal (VD)
• Lateral projection – Left (preferred) or Right (GDV) Lateral

• Remember – Projections named for the direction of the x‐
ray beam through the patient to the film
• Ventrodorsal: Dorsal recumbency
• Dorsoventral: Sternal recumbency 
• Right lateral (Left‐Right lateral): Right side down
• Left lateral (Right‐Left lateral): Left side down

7/30/2018 4

Radiographic Positioning
• Include the entire abdomen
• Cranial extent: Diaphragm
• Caudal extent: Greater trochanter
• Large dogs: May not fit on a single 
radiograph
• Radiograph the cranial and caudal aspects 
separately for each view

7/30/2018 5

Radiographic Projection
• Projection obtained at maximal (end) expiration
• Less superimposition of structures
• Longer respiratory pause
• Goal: Take the radiograph with no movement

versus Thoracic radiographs

• Obtained at maximal (peak) inspiration

7/30/2018 6
 Trough
Positioning Aids

• Sandbags • Troughs
• Foam blocks or • Tape Tape

wedges • Rope
• Sedation

7/30/2018 7
Puppy – VD projection

Radiographic Positioning

• Proper positioning is important!
• Aids in recognition of normal versus pathology

Poor radiographs are

at best inconclusive and
at worst misleading.

7/30/2018 8

So now you have a radiograph…
• Confirm appropriate positioning and technique
• Entire abdomen included
• Patient is straight
• VD/DV:  Dorsal spinous process on midline superimposed over the
vertebrae
• Lateral: Transverse 
processes, ilium, and
rib heads superimposed

(mildly rotated)

7/30/2018 9
 So now you have a radiograph…
• Check for artifacts
• Positioning aids, Markers, IV tubes, ECG wires, Collars, etc…
• Wet hair
• Motion

7/30/2018 10
Cat – Wet Hair Artifact Cat - Motion Artifact

Possible Search Methods
Be Consistent
• Organ systems
• Body condition → Structures outside of 
the abdomen → Abdominal wall → 
Serosal detail, Peritoneal and 
retroperitoneal spaces → Liver → Spleen 
→ Kidneys → Urinary bladder → (Prostate, 
Uterus) → Gastrointes nal tract

7/30/2018 Dog 11

Possible Search Methods
Be Consistent
• Organ systems
• Body condi on → Structures outside of the 
abdomen → Abdominal wall → Serosal 
detail, Peritoneal and retroperitoneal 
spaces → Liver (&GB) → Spleen → Kidneys
→ Urinary bladder → (Prostate, Uterus) → 
Gastrointestinal tract

7/30/2018 Dog 12
 Possible Search Methods
• Organ systems Be Consistent
• Body condi on → Structures outside of the 
abdomen → Abdominal wall → Serosal 
detail, Peritoneal and retroperitoneal 
spaces → Liver (&GB) → Spleen → Kidneys 
→ Urinary bladder → (Prostate, Uterus) →
Gastrointestinal tract

Cecum

Colon

7/30/2018 Dog 13

Roentgen signs:
Systematic Approach 1. Location
2. Number
Describe the radiographic signs 3. Opacity
(any changes or abnormalities) 4. Size
 Roentgen signs 5. Shape
 Radiographic opacities 6. Margin
 Skipping this step and going straight to a  7. Function or
diagnosis may lead to misdiagnosis! functional
Establish a “Radiographic diagnosis” implications
Make a list of differential diagnoses Radiographic
Opacities:
1. Air
2. Fat
3. Soft-tissue / Fluid
4. Mineral
7/30/2018 145. Metal

Factors Affecting Visualization of 
Abdominal Organs
• Projection
• Differences in radiopacity
• Normal variations

7/30/2018 15
 Factors Affecting Visualization of 
Abdominal Organs
• Projection
• Structures closer to the detector better evaluated
• Changes in position of gas and fluid
• Gas goes up, Fluid goes down
• Alterations from interventions and disease

7/30/2018
Dog 16

Factors Affecting Visualization of 
Abdominal Organs
• Differences in radiopacity
• Most abdominal organs are so   ssue opacity → Low subject contrast
between structures in the abdomen

Metal
Bone Air
Bone
Soft tissue
and Fluid

Fat

Air
Dog7/30/2018 Fat Metal 17

Factors Affecting Visualization of 
Abdominal Organs
• Differences in radiopacity
• Abdominal and retroperitoneal fat prevents silhouetting of adjacent soft 
tissue structures 
→ Increased

Metal
Bone Air
Bone
Soft tissue
and Fluid

Fat
ST
Air
Dog7/30/2018 Fat Metal 18
 Factors Affecting Visualization of 
Cats
Abdominal Organs Fat Content
← Obese
Good subject 
contrast

Emaciated →
Very poor 
subject 
contrast

7/30/2018 19

Factors Affecting Visualization of 
Abdominal Organs
• Normal variations
• In SIZE
• Stomach, Colon, Urinary bladder
• Canine: Spleen
• In CONTENT
• Of the GI tract:  Gas, Fluid, Food, Feces
• Body conformation
• Species, Breed
• Body condition
• Respiratory phase

7/30/2018 20

Interpreting the Radiograph

7/30/2018 21
Abdomen
Dog

7/30/2018 22

Abdomen as a Whole

• Body condition
• Affects subject contrast and therefore visualization of organs

• Abdominal wall
• Abdominal distension
• Body wall defects

7/30/2018 Cats 23

Abdomen as a Whole

• Peritoneum
• Serosal detail

• Retroperitoneum
• Demarcated ventrally by the parietal peritoneum & dorsally by the 
sublumbar musculature
• Extends caudally to the pelvic inlet
• Kidneys, ureters, adrenal glands, aorta, caudal vena cava, sublumbar lymph 
nodes cisterna chyli

7/30/2018 24
 Serosal Detail
• “The ability to see the serosal margins of abdominal viscera due to the 
presence of outlining fat”
• Alterations may be focal or diffuse

7/30/2018 25 Dog

Serosal Detail

Fat Cat
Very good serosal detail

Very Thin (Cachectic) Cat

7/30/2018 Poor serosal detail 26

Serosal Detail
• Causes of decreased serosal detail
• Poor technique – Underexposure
• Immaturity
• Young dogs and cats due to “brown” fat
• Lack of abdominal fat
• Thin or poor body condition, Emaciation, Cachexia
• Peritoneal effusion (any type of fluid)
• Mass effect
• Mass or enlarged structure results in displacement and 
silhouetting of adjacent organs
• Peritonitis
• Carcinomatosis

7/30/2018 27
 Serosal Detail
• Mottled serosal detail
• “Ground‐glass” appearance
• Differential diagnoses:
• Peritonitis
• Carcinomatosis

Ground glass Dog

7/30/2018 28

Serosal Detail
• Increased Serosal Detail (free abdominal gas)
• Differential diagnoses:
• Perforated Intestine
• Gas‐Producing Bacteria
• Penetrating Wound
• Recent Laparotomy

Ground glass Dog

7/30/2018 29

8 year old Germ Shep

PC: abdominal distension and retching Intestinal Perforation

7/30/2018 30
 Abdominal Organs
• Visible organs
• Gastrointestinal tract
• Portions of the stomach, small intestines, and large intestine
• Liver
• Ventral and caudal ventral margins
• Spleen
• Especially in dogs
• Kidneys
• In dogs, especially the left
• Urinary bladder
• Prostate (Intact male dogs)

7/30/2018 31

Abdominal Organs

• Not routinely visualized
• Gallbladder
• Pancreas
• Sometimes seen in fat cats on VD projection
• Lymph nodes
• Adrenal glands 
• Ovaries 
• Uterus
• Prostate (Cats or neutered dogs)

7/30/2018 32

Gastrointestinal Tract

•Stomach
•Small intestines
•Colon

7/30/2018 33
 GI Tract ‐ Stomach
• Cardia and Fundus
• Left craniodorsal abdomen
• Caudal to the left diaphragmatic crus
• Body
• Ventral
• Pyloric antrum (canal)
• Right ventrolateral abdomen

7/30/2018 34

GI Tract ‐ Stomach

•Appearance depends on
•Radiographic projection
•Species and Body conformation
•Gastric contents

7/30/2018 35

GI Tract ‐ Stomach
• Radiographic projection
• Location of the gas and fluid changes with patient position
• Anatomy
• Gravity ‐ Gas goes up, Fluid goes down
• Can help identify the projection

RIGHT LEFT

7/30/2018 36
 Right Lateral Radiograph
RLR

Gas in
Fundus

Fluid in
Antrum

7/30/2018
←Cr 37

Left Lateral Radiograph

Gas in
Antrum

Fluid in
Fundus

←Cr
7/30/2018 LLR 38

DV versus VD
Gas in Fundus Gas in body
(+/- antrum)
Fluid in body Fluid in Fundus
& Antrum

DV
7/30/2018 VD 39
 GI Tract ‐ Stomach
•Species ‐ Cats
• VD/DV projection:
• “J” shaped
• The pyloric antrum is on or slightly to the right of midline
on the VD/DV

Cat Dog

7/30/2018 40

GI Tract ‐ Stomach
• Gastric axis
•Line from the fundus to the
antrum
• Lateral view:  Perpendicular
to the spine or parallel to the
ribs
• VD/DV:  Perpendicular to the
spine

7/30/2018 41

GI Tract ‐ Stomach Barrel-

Chested

•Body conformation –
Dogs
•Gastric axis
• Barrel‐chested breeds: Average
Parallel with the ribs 
• Deep‐chested breeds:
Perpendicular to the spine

Deep-
Chested

7/30/2018 42
Lateral VD View
GI Tract ‐ Stomach

•Gastric contents
•Type
•Volume (degree of gastric distension)
• Unless distended, it is normally within the costal arch (rib cage margin) and does not 
project caudal to the last ribs

Dog -
Stomach markedly
distended with food

7/30/2018 43

8 year old Germ Shep

PC: abdominal distension and retching

Gastric Dilatation
and Volvulus with
Gastric Pneumatosis

7/30/2018 44

7/30/2018 45
 Feline GDV

7/30/2018 46

Guinea Pig GDV

7/30/2018 47

8 year old Labradoodle

Vomiting and Inappetance

Gastric Outflow Obstruction – Fruit Pit

7/30/2018 48
 8 year old FS DSH
PC: Vomiting and Inappetance

Gastric Mass – Large Cell Lymphoma

7/30/2018 49

GI – Small Intestines

• Duodenum
• Right‐sided
• Proximally is against the caudal surface of the liver
• Descending duodenum courses parallel to the body 
wall
• Dogs: Lateral, adjacent to the body wall
Fat Cat
• Cats: More medial course than dogs

7/30/2018 50 Dog

GI – Small Intestines

• Jejunum & Ileum
• Variable position in the mid abdomen
• Distribution depends on:
• Body conformation
• Size, shape, and position 
of adjacent viscera 
• Distended organs and 
masses displace the SI –
“Mass effect”

What projection →
???

7/30/2018 51
 GI – Small Intestines
• Obese dogs and cats
• Intraabdominal fat tends to displace SI into the central midabdomen
• In obese cats, most located in the right mid‐abdomen

Cat 7/30/2018 52

13 year Lab PC abdominal

distension

Intraperitoneal Lipoma

Cat 7/30/2018 53

GI Tract – Small Intestines
Duodenum - Jejunum - Ileum
• Contains variable amounts of intraluminal gas
• Cats have less intraluminal gas
• Peristalsis
• Cats: “String of pearls”

What projection →
???

Cat –
7/30/2018
Barium Upper GI Study
54 R
 GI Tract – Small Intestines
Duodenum - Jejunum - Ileum
• Maximal Diameter (serosa to serosa)
• Dogs:
• < 1.6x the height of L5 at the midbody (narrowest)
• < 2‐3x the width of a rib
• < width of an intercostal space

b a
c
*The lateral projection is used to
evaluate vertebral body height

7/30/2018 55

GI Tract – Small Intestines
Duodenum - Jejunum - Ileum
• Maximal Diameter 
(serosa to serosa)
• Cats:
• < 2x the height of L4 at b a
the midbody
• < 2x the height of the
cranial L2 endplate
• < 12 mm (US)

*The lateral projection is used

to evaluate vertebral body
height

7/30/2018 56

GI Tract – Small Intestines
Duodenum - Jejunum - Ileum
• Maximal Diameter (serosa to serosa)
• Similar in diameter to each other
• Abnormal if > 1.5 – 2x (50‐100%) larger than other segments = “Two populations” 
(little/normal ones & big ones)
• (Duodenum may 
normally be mildly
larger than  other
segments)

Duodenum

7/30/2018 57
 3 year old DSHA
PC: Vomiting

7/30/2018 58

4 year old Mixed Breed

PC: Vomiting

Linear foreign body anchored in the stomach

7/30/2018 59

3 Year Old Pitbull

PC: Vomiting

7/30/2018 60
 8 year old Germ Shep
PC: Vomiting, abdominal pain,
recumbent

7/30/2018 61

Mesenteric Torsion

http://www.fmv.utl.pt/

7/30/2018 62

GI Tract – Large Intestines

• Cecum (c): Right mid, Level of L3
• Dogs: “cork‐screw” or “C” shaped
• Often contains gas
• Cats: Small, Not usually visible
• Ascending colon (a):  Right mid to cranial
• Transverse colon (t): Caudal to stomach
Cat
• Descending colon (d): Left Dog

• Rectum (r): Pelvic canal and caudal

7/30/2018 63
GI Tract – Large Intestines

Colon
Cecum

7/30/2018 64

3 year old Jack Russel Terrier

PC: vomiting and inappetance. Recently
ate a cow bone

Signs and Symptoms:

7/30/2018 65

3 year old Jack Russel Terrier

PC: vomiting and inappetance. Recently
ate a cow bone

Post Pneumocolonogram
Mineral material within the ileum

7/30/2018 66
 7yo Lab
Straining to defecate and pacing

7/30/2018 67

7/30/2018 68

7/30/2018 69
 7/30/2018 70

Liver
• Cranial abdomen
• Caudal to and conforms to the 
diaphragm
• Caudoventral margin:
• Right lateral view: Right medial lobe
• Left lateral view: Left lateral lobe

7/30/2018 71

Liver
• Cranial abdomen
• Caudal to and conforms to the diaphragm
• Caudoventral margin:
• Right lateral view: Right medial lobe
• Left lateral view: Left lateral lobe

7/30/2018 72
 Liver
Quadrate -
Near midline, Left medial -
Ventral Cranial, Ventral

Right medial - Left lateral -

Cranial, Ventral Caudal, Ventral

Right lateral -
Cranial,
more dorsal

Caudate -
Caudal-dorsal

7/30/2018 73

Liver
• Assessment:
• Does not extend caudal to the costal arch
• Sharp caudoventral margins (not rounded)
• Normal gastric axis ‐ // to ribs or ┴ to spine

7/30/2018 74

Liver
• Assessment:
• Does not extend caudal to the costal arch (‐‐)
• Sharp caudoventral margins (not rounded)
• Normal gastric axis ‐ // to ribs or ┴ to spine

7/30/2018 75
 Liver
• Assessment:
• Gastric axis
• Normal: // to ribs, ┴ to spine

Normal

7/30/2018 76

Liver
• Assessment:
• Hepatomegaly: 
• Caudal displacement of antrum (gastric axis)
• Extends caudal to costal arch
• Rounded margins

Hepatomegaly

Normal

7/30/2018 77

Liver
• Assessment:
• Microhepatica:
• Cranial displacement of antrum (gastric axis)

Hepatomegaly

Normal Microhepatica

7/30/2018 78
 Case

• 11 year Mixed Breed
• PC: Vomiting, abdominal pain, clinician is suspicious of sepsis

7/30/2018 79

Hepatic Abscess with

Septic Peritonitis

7/30/2018 80

Gall bladder
• Right cranioventral abdomen
• Not usually seen
• Cats:
• When distended, may produce a bulge along the 
ventral hepatic silhouette

Cat

7/30/2018 81
 Gall bladder
• Right cranioventral abdomen
• Not usually seen
• Cats:
• When distended, may produce a bulge along the 
ventral hepatic silhouette
• Differential diagnosis: Hepatic nodule or mass

Cat

7/30/2018 82

12 year Mixed Small Breed

PC: Lethargy, tachypnea, recent
vomiting

Emphysematous Cholecystitis

7/30/2018 83

Spleen
• Flat, elongated
• Dorsal extremity
• Left, cranial, dorsal, lateral
• Caudal to the gastric fundus
• Ventral extremity
• Dogs: Variable
• Cats: Not seen ventrally on lateral projection
• Enlarged if seen along ventral abdomen

7/30/2018 Dog 84
 What projection ↓
Spleen ??? VD
• Flat, elongated
• Dorsal extremity
• Left, cranial, dorsal, lateral
• Caudal to the gastric fundus
• Ventral extremity
• Dogs: Variable
• Cats: Not seen ventrally on lateral projection
• Enlarged if seen along ventral abdomen

7/30/2018 Dog 85

8 year old Germ Shep

PC: Vomiting, abdominal pain

Splenic
Torsion

7/30/2018 86

Kidneys

Retroperitoneal
Ureters not seen
More mobile in cats
Dog

7/30/2018 Cat 87
 L1 L2 L3 L4 L5 L6 L7
Kidneys

Retroperitoneal
Ureters not seen
More mobile in cats
• Right kidney: Dog

• More difficult to visualize
• Adjacent to & silhouettes  L1 L2 L3 L4
L5 L6
with caudate liver lobe L7
• Cranial margin:
• Dog: ~ T13 – L1
• Cat: ~ L1 – L2

7/30/2018 Cat 88

L1 L2 L3 L4 L5 L6 L7
Kidneys

Retroperitoneal
Ureters not seen
More mobile in cats
• Right kidney: Dog

• Cranial margin:
• Dog: ~ T13 – L1 L1 L2 L3 L4
L5 L6
• Cat: ~ L1 – L2 L7

• Left kidney:
• Cranial margin:
• Dog: ~ 1 vertebral body 
caudal to Right kidney
• Cat: ~ L1 – L3
7/30/2018 Cat 89

Kidneys
• Kidney size:
• Ratio: Renal length to L2 body length
• VD projection
• Dog: 
• 2.5 – 3.5x length of L2
• Cats:
• Intact: 2.4 – 3.2x length of L2
• Neutered: 1.9 – 2.6x length of L2
Dog

7/30/2018 90
Cat
 Kidneys
• Kidney size:
• Ratio: Renal length to L2 body length
• VD projection
• Dog: 
• 2.5 – 3.5x length of L2
• Cats:
• Intact: 2.4 – 3.2x length of L2
• Neutered: 1.9 – 2.6x length of L2
Dog

7/30/2018 91
Cat

13 year old FS DSH
PC: Vomiting, Anorexia, Azotemia
Case

7/30/2018 92

13 year old FS DSH
PC: Vomiting, Anorexia, Azotemia
Case

Renal Lymphoma

7/30/2018 93
 9 yo MN DSH
Underlying 
GI IBD

Urinary
Bladder

Ectopic R
Kidney

7/30/2018 94

Adrenal Glands

• Retroperitoneal
• Craniomedial to kidney
• Not normally seen Lateral
• Cats: Incidental mineralization
• Dogs: Mineralization associated with 
neoplasia

Kidneys Cats

VD
7/30/2018 95
Lateral

13 year old Beagle
PC: Abdominal distension, PU/PD

Mineralized Adrenal Mass

7/30/2018 96
 Urinary Bladder
• Caudal ventral abdomen
• Cranial to pubis
• Ventral to descending colon and rectum

Cat

7/30/2018 97

Urinary Bladder
• Caudal ventral abdomen
• Round, Tear‐ or Pear‐shaped
• Variably sized
• Exerts mass effect when large

Cat

Mass
Effect

7/30/2018 98

12yo MN Scottish Terrier
PC: Recurrent urinary tract infections

7/30/2018 99
 12yo MN Scottish Terrier
PC: Recurrent urinary tract infections

Transitional Cell Carcinoma

7/30/2018 100

2yo MI Boston Terrier
PC: Straining to Urinate/Defecate with a 
perineal “mass”

What’s not there?

7/30/2018 101

2yo MI Boston Terrier
PC: Straining to Urinate/Defecate with a 
perineal “mass”

Perineal hernia with bladder herniation

7/30/2018 102
 Prostate Dog

• Caudal abdomen / Cranial pelvic 
canal
• Caudal to bladder, Ventral to rectum
• Not normally seen in cats or 
neutered dogs

7/30/2018 103

Prostate Dog

• Caudal abdomen / Cranial
pelvic canal
• Caudal to bladder, Ventral 
to rectum Prostate
• Fat triangle: between body  Bladder
wall (ventral), bladder 
(caudoventral margin), 
prostate (cranioventral 
margin), 
• Not normally seen in cats 
or neutered dogs

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Prostate

• Intact male dogs:
• Lateral: Length or height as % of Pubic brim to 
sacral promontory dimension
• Normal:  < 70%
(mean 56%)
• VD: < 50% of the pelvic inlet width

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 9yo MN Terrier Mix
PC: Straining to Urinate & Limping

Prostatic Mass with Metastatic Disease

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9yo MN Terrier Mix
PC: Straining to Urinate & Limping

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Thank You

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