Full download ebook at ebookmass.

com

Abdominal Imaging Joseph R. Grajo

For dowload this book click link below

https://ebookmass.com/product/abdominal-imaging-
joseph-r-grajo/

OR CLICK BUTTON

DOWLOAD EBOOK

Download more ebook from https://ebookmass.com

More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Abdominal Imaging: Expert Radiology Series 2nd Edition

Dushyant V. Sahani

https://ebookmass.com/product/abdominal-imaging-expert-radiology-
series-2nd-edition-dushyant-v-sahani/

Diagnostic Imaging: Pediatric Neuroradiology 3rd

Edition Kevin R. Moore

https://ebookmass.com/product/diagnostic-imaging-pediatric-
neuroradiology-3rd-edition-kevin-r-moore/

Imaging Physics Case Review 1st Edition R. Brad

Abrahams Do

https://ebookmass.com/product/imaging-physics-case-review-1st-
edition-r-brad-abrahams-do/

Imaging Anatomy: Head and Neck 1st Edition Philip R.

Chapman

https://ebookmass.com/product/imaging-anatomy-head-and-neck-1st-
edition-philip-r-chapman/
R All-in-One For Dummies 1st Edition Joseph Schmuller

https://ebookmass.com/product/r-all-in-one-for-dummies-1st-
edition-joseph-schmuller/

Maingot’s Abdominal Operations 13th Edition Michael

Zinner

https://ebookmass.com/product/maingots-abdominal-operations-13th-
edition-michael-zinner/

Neuroimaging Part II Joseph C. Masdeu And R. Gilberto

González (Eds.)

https://ebookmass.com/product/neuroimaging-part-ii-joseph-c-
masdeu-and-r-gilberto-gonzalez-eds/

ISE An Introduction to Business Ethics 7th Edition

Joseph R. Desjardins

https://ebookmass.com/product/ise-an-introduction-to-business-
ethics-7th-edition-joseph-r-desjardins/

Neuroimaging Part I Joseph C. Masdeu And R. Gilberto

González (Eds.)

https://ebookmass.com/product/neuroimaging-part-i-joseph-c-
masdeu-and-r-gilberto-gonzalez-eds/
Any screen.
Any time.
Anywhere.
Activate the eBook version
of this title at no additional charge.

Elsevier eBooks for Practicing Clinicians gives you the power to browse and search
content, view enhanced images, highlight and take notes—both online and offline.

Unlock your eBook today.

1. Visit expertconsult.inkling.com/redeem
2. Scratch box below to reveal your code
3. Type code into “Enter Code” box
4. Click “Redeem”
5. Log in or Sign up
6. Go to “My Library”

It’s that easy!

Place Peel Off
Sticker Here

For technical assistance:

email [email protected]
call 1-800-401-9962 (inside the US)
call +1-314-447-8300 (outside the US)
Use of the current edition of the electronic version of this book (eBook) is subject to the terms of the nontransferable, limited license granted on
expertconsult.inkling.com. Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book,
at expertconsult.inkling.com and may not be transferred to another party by resale, lending, or other means.
2020_PC
Abdominal
Imaging
The Core Requisites

Joseph R. Grajo, MD
Chief of Abdominal Imaging
Vice Chair for Research
Associate Residency Program Director
Abdominal Imaging Fellowship Director
Department of Radiology
University of Florida College of Medicine
Gainesville, Florida
United States

Dushyant V. Sahani, MD
Associate Professor of Radiology
Department of Radiology
Massachusetts General Hospital
Boston, Massachusetts
United States

Anthony E. Samir, MD, MPH

Associate Director, Ultrasound
Radiology
Massachusetts General Hospital
Boston, Massachusetts
United States
Elsevier
1600 John F. Kennedy Blvd.
Ste 1600
Philadelphia, PA 19103-2899

ABDOMINAL IMAGING: THE CORE REQUISITES  ISBN: 978-0-323-68061-5

Copyright © 2022 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notice

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid ad-
vances in the medical sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors
or contributors for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

Library of Congress Control Number: 2021932208

Content Strategist: Kayla Wolfe

Content Development Specialist: Erika Ninsin
Publishing Services Manager: Deepthi Unni
Project Manager: Srividhya Vidhyashankar
Design Direction: Patrick C. Ferguson

Printed in India

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 To my wife and best friend, Nicolette, who inspires me and loves me
unconditionally, and our daughter Brooklyn, who amazes me each day.

To my parents, Joseph and Ruth, who raised me to set no limits to my potential

and my sister, Jennifer, who has always supported and appreciated me.
Joseph R. Grajo, MD

To my mentors, colleagues, and trainees, who challenge me and encourage my

academic aspirations.
Contributors

Neha Agrawal, MD Richard G. Kavanagh, MB, BCh, BAO, BSc, MCh, FFRRCSI
Abdominal Imaging Fellow Abdominal Imaging Fellow
Department of Radiology Massachusetts General Hospital
Massachusetts General Hospital Boston, Massachusetts
Boston, Massachusetts United States
United States
David Knipp, MD
Ahmad Al-Samaraee, MD, MPH Fellow
Department of Radiology Department of Radiology
Massachusetts General Hospital Massachusetts General Hospital
Boston, Massachusetts Boston, Massachusetts
United States
Department of Radiology
University of Minnesota Hamed Kordbacheh, MD
Minneapolis, Minnesota Abdominal Imaging Research Fellow
United States Department of Radiology
Massachusetts General Hospital
Mark Anderson, MD Boston, Massachusetts
Abdominal Radiologist United States
Massachusetts General Hospital
Instructor Qian Li, MD
Harvard Medical School Instructor of Radiology
Boston, Massachusetts Department of Radiology
United States Massachusetts General Hospital
Boston, Massachusetts
Masoud Baikpour, MD United States
Diagnostic Radiology Resident
Department of Radiology Weier Li, MD
Massachusetts General Hospital Fellow
Boston, Massachusetts Department of Radiology
United States Massachusetts General Hospital
Boston, Massachusetts
Miguel Gosalbez, BS, MD United States
Resident, Radiology
Department of Radiology Babak Maghdoori, MD, FRCPC
University of Florida Abdominal imaging specialist
Gainesville, Florida Cardiothoracic imaging specialist
United States Department of Medical Imaging
Georgian Radiology Consultant
Carolyn Hanna, BS, MD University of Toronto
Resident, Radiology Toronto, Ontario
University of Florida Canada
Gainesville, Florida
United States Laura L. Magnelli, MD
Abdominal Imaging Fellow, PGY-6
Simon Ho, MD Department of Radiology
Resident, Radiology Division of Abdominal Imaging
University of Florida University of Florida College of Medicine
Gainesville, Florida Gainesville, Florida
United States United States

iv
 Contributors v

Craig Meiers, MD Jesse Rayan, MD

Interventional Radiology Fellow Abdominal Imaging Fellow
Department of Radiology Division of Abdominal Imaging
University of Florida Massachusetts General Hospital
Gainesville, Florida Boston, Massachusetts
United States United States

Aileen O’Shea, MB, BAO, BCh, FFRRCSI Justin Ruoss, MD

Abdominal Imaging Fellow Physician
Division of Abdominal Imaging Department of Radiology
Massachusetts General Hospital University of Florida
Boston, Massachusetts Gainesville, Florida
United States United States

Arinc Ozturk, MD Jehan L. Shah, MD

Clinical Research Fellow Diagnostic Radiology Resident
Department of Radiology Department of Radiology
Massachusetts General Hospital University of Florida
Boston, Massachusetts Gainesville, Florida
United States
Interventional Radiology Fellow
Eric W. Pepin, MD, PhD Radiology
Resident Mayo Clinic
Department of Radiology Jacksonville, Florida
University of Florida United States
Gainesville, Florida
United States Boris Sinayuk, MD
Assistant Professor
John Pham, MD Department of Diagnostic Imaging
Radiology, Resident Warren Alpert Medical School
Department of Radiology Rhode Island Hospital
University of Florida Providence, Rhode Island
Gainesville, Florida United States
United States
Joe Uricchio, MD
Theodore T. Pierce, MD Resident
Instructor Department of Radiology
Department of Radiology University of Florida
Massachusetts General Hospital Gainesville, Florida
Boston, Massachusetts United States
United States

Vinay Prabhu, MD, MS

Clinical Assistant Professor
Department of Radiology
NYU Langone Health
New York, New York
United States
Series Foreword

Congratulations to Dr Grajo, lead editor and co-editors, across the spectrum of what radiologists need to know
Drs Sahani and Samir for producing Abdominal Imaging: from their first encounters with subject material in differ-
The Core Requisites, the first book in the newly reimagined ent subspecialty areas, to studying for board exams and
The Core Requisites series. Dr Grajo and colleagues assem- later for reference during clinical practice. The books in
bled a stellar team of contributors and successfully piv- the The Core Requisites series will continue to be richly il-
oted from a traditional narrative or prose-based approach lustrated; Abdominal Imaging: The Core Requisites has over
for knowledge sharing to an outline format that immedi- 500 illustrations. The books are intended to be practical,
ately brings forward and highlights the most important not encyclopedic.
facts and concepts for each topic. The outline format Print and electronic formats will be produced simulta-
makes the material covered readily accessible to readers, neously and included with each purchase. The electronic
a key goal for anyone developing a textbook. Abdominal version will provide mobile access via multiple kinds of
Imaging: The Core Requisites is outstanding and will serve devices and is searchable, adding additional value. This
as a model for subsequent books in the series as they are approach is in keeping with our expectations in the inter-
updated and revised. net age of access to knowledge at the time-of-need and
Dr. Grajo and colleagues used the transition to the new point-of-care.
“The Core Requisites” format to emphasize problem-based Congratulations again to Drs. Grajo, Sahani and Samir
diagnostic scenarios to complement enduringly important for launching this new The Core Requisites series on a ter-
material on anatomy, physiology, physics and imaging rific start. I hope that this and the following books in the
methods. Using a problem-based approach in Abdominal series will become regarded with the same fondness as ear-
Imaging: The Core Requisites allows presentation of material lier books in the Radiology Requisites family that have been
in the way radiologists encounter diagnostic challenges in used by radiologists at all career stages now for over thirty
actual practice including their relative importance and years.
challenges in differential diagnosis versus a traditional tax-
onomic approach that most often treats each disease or James H Thrall, MD
condition one at a time and at the same level of emphasis Chairman Emeritus
regardless of clinical prevalence. Department of Radiology,
While the format of The Core Requisites series differs Massachusetts General Hospital
substantially from the traditional Radiology Requisites Distinguished Taveras Professor of Radiology
series, the philosophy remains the same—the production Harvard Medical School
of a series of books covering the core material required Boston, Massachusetts

vi
 Preface

When Elsevier approached me about helping to relaunch but focused on the radiology trainee in preparation for
the Requisites series, I was excited about the opportunity clinical rotations and board examinations.
to contribute to the rebirth of a classic and fundamental Our approach to Abdominal Imaging: The Core Requisites
radiology textbook. I was honored to be asked to spear- was to present focused “need to know” material in a format
head a new abdominal imaging title, combining the con- that addresses commonly encountered clinical scenarios,
tents of gastrointestinal and genitourinary radiology as such as right upper quadrant pain, chronic liver disease,
seen in prior iterations. Furthermore, I was thrilled for and postoperative imaging. In each chapter, we review im-
another chance to work with two of my most influential portant anatomy, discuss imaging techniques and protocol
mentors and prestigious colleagues, Dr. Anthony Samir considerations, describe specific disease processes associ-
and Dr. Dushyant Sahani. ated with the clinical scenario, summarize relevant tumor
This textbook serves as a launch point for a rebranding of staging, and highlight key elements of a structured report.
the Requisites series as “The Core Requisites.” In this series, We hope that you will enjoy this new venture in your
we aim to present high-yield information in a concise for- journey of continuous learning.
mat with easy-to-read chapters, targeting a wide audience Joseph R. Grajo, MD

vii
Contents

SECTION I 17 Benign Focal Liver Lesions 135

Gastrointestinal Tract, 1 CRAIG MEIERS

1 Abdominal Radiography, 2 18 Cholecystitis, 146

WEIER LI BABAK MAGHDOORI AND HAMED KORDBACHEH

2 Gastrointestinal Fluoroscopy, 7 19 Jaundice, 156

WEIER LI BABAK MAGHDOORI AND HAMED KORDBACHEH

3 Gastric Wall Thickening/Masses, 12 SECTION III

DAVID KNIPP Lymphatic System, 165
4 Hollow Viscus Perforation, 17 20 Splenomegaly/Splenic Lesions, 166
DAVID KNIPP ERIC W. PEPIN

5 Small Bowel Obstruction, 23 21 Lymphadenopathy, 173

JOHN PHAM AND SIMON HO JUSTIN RUOSS

6 Bowel Wall Thickening, 30 SECTION IV

AHMAD AL-SAMARAEE
Genitourinary, 182
7 Imaging of the Postoperative Bowel, 37 22 Urolithiasis, 183
JEHAN L. SHAH AND MIGUEL GOSALBEZ
MARK A. ANDERSON

8 Mesenteric Ischemia, 47 23 Cystic Renal Masses, 188

RICHARD G. KAVANAGH
LAURA MAGNELLI

9 Colorectal Cancer and Screening, 54 24 Solid Renal Lesions, 195

RICHARD G. KAVANAGH
LAURA MAGNELLI AND CAROLYN HANNA

10 Right Upper Quadrant Pain, 62 25 Diffuse Renal Parenchymal Disorders, 204

NEHA AGRAWAL
JESSE RAYAN

11 Right Lower Quadrant Pain, 72 26 Urinary Tract Obstruction, 215

NEHA AGRAWAL
BORIS SINAYUK

12 Pancreatitis, 85 27 Urothelial Lesions, 221

JOHN PHAM AND SIMON HO
BORIS SINAYUK

13 Solid Pancreatic Masses, 92 28 Adrenal Gland Enlargement and Nodules, 229

JEHAN L. SHAH AND MIGUEL GOSALBEZ
ERIC W. PEPIN AND JOE URICCHIO

14 Cystic Pancreatic Lesions, 103

JEHAN L. SHAH
SECTION V
Reproductive System, 243
SECTION II
29 Prostate Imaging, 244
Hepatobiliary, 114 QIAN LI AND JOSEPH R. GRAJO

15 Chronic Liver Disease, 115 30 Testicular Lesions, 251

ARINC OZTURK
QIAN LI

16 Imaging of the Cirrhotic Liver, 124 31 Endometrial/Junctional Zone Thickening, 259

ARINC OZTURK
MASOUD BAIKPOUR

viii
 Contents ix

32 Focal Uterine Lesions, 268 SECTION VI

MASOUD BAIKPOUR Miscellaneous, 318
33 Cystic Adnexal Lesions, 281 37 Postoperative Imaging, 319
AILEEN O’SHEA JESSE RAYAN

34 Solid Adnexal Lesions, 299 38 Abdominal/Pelvic Trauma, 327

AILEEN O’SHEA THEODORE T. PIERCE

35 Müllerian Abnormalities, 306 39 Pitfalls, 337

VINAY PRABHU THEODORE T. PIERCE

36 Pelvic Floor Disease, 314 Index, 345

VINAY PRABHU
This page intentionally left blank

http://afkebooks.com
SECTION I
Gastrointestinal Tract

1
 1 Abdominal Radiography
WEIER LI

CHAPTER OUTLINE Anatomy, Embryology, Pathophysiology Soft Tissues and Bone

Techniques Foreign Bodies
Specific Disease Processes High Yield Topics
Intraluminal Gas KUB Emergencies
Extraluminal Gas Physics Pearls
Calcifications

resides in the left upper quadrant. The increased folds of the

Anatomy, Embryology, jejunum give it a feathery pattern. In contrast, the ileum is
Pathophysiology usually larger in caliber and contains fewer folds, producing
a more featureless mucosal pattern. In general, the small
n There are five distinct densities in plain radiography, four bowel should be less than 3 cm in diameter.
of which are natural: gas (black), fat (dark gray), soft n The large bowel (or colon) extends from the ileocecal
tissue (medium gray), calcifications (white), and metal valve to the anus, and comprises the cecum, ascending
(intense white). colon, transverse colon, descending colon, sigmoid colon
n Dedicated assessment of each density is essential in any and rectum. The large bowel is distinguished by haustra,
search pattern. which are large folds that only cross portions of the
bowel wall. Large bowel contains feculent material that
often gives a mottled appearance, representing a mixture
Techniques of gas/liquid/solid material. The cecum can be normal at
up to 9 cm in diameter, whereas the remainder of the
n The standard abdominal radiograph is obtained in a su- large bowel can distend normally up to 6 cm.
pine projection, with x-rays passing from anteroposte-
rior (AP). Field of view should span the inferior ribs to
the inferior pubic rami, and include both lateral abdomi- EXTRALUMINAL GAS
nal walls.
Extraluminal gas outside of the bowel lumen can range
n Additional projections can be obtained to assess for free
from atypical to grossly pathological (Fig. 1.1).
air or air-fluid levels. These include upright positioning
(erect) or with the patient lying on his or her side (lateral n Gas within the peritoneal cavity is called pneumoperito-
decubitus). The erect view is typically preferred for ease of neum. This is best identified on erect imaging, which will
use and must include the diaphragm even at the expense show free air under the diaphragm, particularly on the
of the pelvis. A lateral decubitus view can be alternatively right (Fig. 1.2). Caution must be exercised to identify the
performed in patients unable to tolerate upright imaging. normal left upper quadrant stomach bubble when evaluat-
ing for free air on the left. On decubitus imaging, free air will
appear clearly outside the contours of the bowel lumen,
Specific Disease Processes rising to the antidependent portion of the radiograph.
n Small volumes of postoperative pneumoperitoneum can
INTRALUMINAL GAS be an expected finding within 7 to 10 days after surgery.
If there has been no history of recent intervention, or
There is wide variation in the appearance of a normal if the volume of pneumoperitoneum is larger than
bowel gas pattern. expected, there should be a concern for pathological
n Gas in the left upper quadrant (stomach) can produce a hollow viscus perforation.
gastric bubble on erect imaging. If distended with air or n In the absence of upright or decubitus projections, large
ingested contrast, the normal gastric rugae can be a dis- volume pneumoperitoneum can be identified by a vari-
tinguishing feature. ety of signs, including Rigler’s sign, football sign and so
n The small bowel is comprised of the duodenum, jejunum, on. (Fig. 1.3).
and ileum. It is identified on radiography by the presence of n Gas in the bowel wall (pneumatosis) can occur in a vari-
circumferential folds called valvulae conniventes (or plicae ety of benign or pathological processes. Correlation with
circulares) that traverse the entire width of the small bowel. history is essential as pneumatosis can be iatrogenic
The jejunum begins at the ligament of Treitz and primarily (e.g., related to recent G-tube placement), pathological
2
 1 • Abdominal Radiography 3

L
AR
SUPINE
R
CH

Fig. 1.1 ​Portable anteroposterior KUB demonstrates marked conspicu- Fig. 1.3 ​Portable anteroposterior KUB demonstrates pneumoperito-
ity of the bilateral kidneys because of pneumoretroperitoneum. A na- neum with Rigler’s sign. Note the conspicuity of the bowel walls be-
sogastric tube is also noted, as well as a Foley catheter with excreted cause of air outlining both sides.
contrast in the bladder.

CALCIFICATIONS
Calcium deposits in a wide variety of normal and abnormal
UPRIGHT
structures.
n Benign aortic calcifications are common and can help
visualize the borders of the aorta and major branches.
Large aortic and branch vessel aneurysms can be
identified by the demarcation of their associated wall
calcifications.
n Pancreatic calcifications overlying the mid-abdomen can
be seen in chronic pancreatitis.
n Calcified renal or bladder calculi can be seen overlying
the expected renal fossa and bladder. These should be
distinguished from pelvic phleboliths, which are ex-
tremely common, especially in elderly adults. Phlebo-
liths tend to be rounder and have a radiolucent center, as
well as a more lateral position in the pelvis compared
with urolithiasis.
n Densely calcified gallstones or a calcified (porcelain)
gallbladder can often be seen in the right upper
quadrant.
Fig. 1.2 ​Upright KUB demonstrates free air under the diaphragm, the so n Uterine fibroids can often become calcified. Ovarian
called “continuous diaphragm sign.” dermoid cysts are also an uncommon cause of pelvic
calcifications.
n Other unusual causes of calcifications include calcified
(related to bowel ischemia), medication-related (i.e., che- lymphadenopathy, remote fat necrosis and “dropped
motherapy) or idiopathic. gallstones.”
n Air can also be seen overlying the liver. Gas within the
bile ducts (pneumobilia) can be seen in the presence of a
SOFT TISSUES AND BONE
sphincterotomy, biliary stent, biliary bypass, or biliary
fistula. Pneumobilia should overlie the central liver. Air The outlines of the major abdominal organs can often
that extends to the periphery of the liver may reflect por- be distinguished by their surrounding fat planes. Pa-
tal venous gas, which is always pathological. Gas in the tients with cachexia or extreme weight loss may lose
portal vein is typically a result of bowel ischemia and these fat planes, making the identification of normal
may be an ominous sign. abdominal organs difficult. Similarly, disruption of the
4 SECTION I • Gastrointestinal Tract

normal fat planes can be a secondary clue for ascites or NG TUBE

hemoperitoneum.
R
KMR
n The liver and gallbladder are located in the right upper
quadrant. A Riedel lobe is a normal anatomic variant where
the right liver projects inferiorly to the level of the pelvis.
n Splenomegaly can be noted with mass effect upon the
normal bowel gas in the left hemiabdomen.
n Both kidneys can often be visualized around the T12-L2
vertebral body levels. The psoas muscle shadows are just
medial to each kidney and mark the course of both ureters.
n Large abdominal soft tissue masses can produce mass ef-
fect on the adjacent structures, particularly the bowel gas.
n The imaged osseous structures include the lower spine,
pelvis, and proximal hips and femurs. A wide variety of
pathology includes fractures, sclerotic and lytic metasta-
ses; inflammatory disease and degenerative changes can
be seen.
Fig. 1.5 ​Portable anteroposterior KUB demonstrates a normally posi-
FOREIGN BODIES tioned nasogastric tube in the stomach. However, there is a radiodense
surgical pad marker in the right lower quadrant from a retained lapa-
Foreign bodies should be evaluated for appropriateness and rotomy pad.
positioning whenever possible.
n Iatrogenic lines and tubes, such as nasogastric or percu-
taneous gastrostomy tubes, biliary tubes, nephrostomy
tubes, ureteral stents, peritoneal drainage catheters and
peritoneal dialysis catheters (Fig. 1.4).
n Surgical material, which can suggest prior procedures,
such as cholecystectomy clips, gastric bypass clips, bowel
sutures and nephrectomy clips.
n Implanted devices, such as an intrauterine contraceptive
device, renal or biliary stents, inferior vena cava filter,
endovascular aortic stent and hip prosthesis.
n Other foreign bodies, such as bullet fragments, ingested
foreign body, retained surgical needle or sponge and rectal
foreign body (Figs. 1.5 and 1.6).

Fig. 1.6 ​Portable anteroposterior KUB demonstrates a metallic foreign

body overlying the cecum, consistent with dislodged dental implant
during traumatic intubation.

High Yield Topics

KUB EMERGENCIES
Obstruction

Small Bowel Large Bowel

Obstruction Ileus Obstruction
Disproportionate small Diffuse small and large Massively dilated
bowel dilation over bowel dilation cecum
large bowel dilation
(Fig. 1.7)
NG TUBE Air-fluid levels on Concordant history Collapsed distal
Fig. 1.4 ​Portable anteroposterior KUB demonstrates a weighted feeding upright radiograph (surgery, drugs, etc.) colon
tube tip above the diaphragm over the right hemithorax, within the
‘String of pearls sign’
right lower lobe bronchus.
 1 • Abdominal Radiography 5

Fig. 1.7 ​Upright KUB demonstrates multiple dilated loops of small

bowel with prominent air fluid levels, consistent with small bowel
obstruction.
jmf supine 1 of 2

Pneumoperitoneum (free air): suggestive of hollow viscus R

perforation. Signs include:
Fig. 1.8 ​Portable anteroposterior KUB demonstrates marked distention
n Free air under the diaphragm on upright imaging. of a loop of large bowel extending to the left upper quadrant, consistent
n Rigler’s sign (gas outlining both walls of bowel). with cecal volvulus.
n Outlining of liver edge, falciform ligament, urachus.
n Football sign: massive pneumoperitoneum.
Pneumatosis: can be a sign of ischemia, although some-
times benign.
n Associated with portal venous gas (air in the portal
veins).
n Gas tracking as bubbly collections along the wall of small
bowel (pneumatosis intestinalis), colon (pneumatosis
coli), gallbladder (emphysematous cholecystitis), bladder
(emphysematous cystitis), kidney (emphysematous py-
elonephritis), or stomach (emphysematous gastritis).
n Associated dilation can be ominous.
Volvulus: twisting of bowel upon itself resulting in obstruc-
tion and impending ischemia.
L
n Sigmoid (more common): coffee bean sign, extremely
dilated, extending from left lower quadrant to right up- PJL
per quadrant (\).
n Cecal (less common): extends from right lower quadrant
to left upper quadrant (/) (Fig. 1.8).
n Gastric volvulus and midgut volvulus are difficult to di-
agnose by plain radiograph and usually identified on
fluoroscopy or computed tomography.
Megacolon: complication of inflammatory bowel disease
and infectious colitis (Clostridium difficile) (Fig. 1.9).
n Marked colonic dilation (typically transverse colon):
greater than 6 cm.
n Ahaustral markings: featureless bowel morphology. Fig. 1.9 ​Portable anteroposterior KUB demonstrates severe dilatation
n Pseudopolyps: related to bowel ulceration. of the transverse colon with diffuse pseudopolyps along the colonic
walls, consistent with ulcerative colitis and toxic megacolon.
n Thumbprinting: mucosal edema.
6 SECTION I • Gastrointestinal Tract

Physics Pearls Suggested Reading

1. Levine MS. Plain film diagnosis of the acute abdomen. Emerg Med
n There is much more soft tissue to penetrate in abdominal North Am. 1985;3:541-562.
radiography compared with the chest, resulting in 503 2. Kellow ZS, MacInnes M, Kurzencwyg D, et al. The role of abdominal
radiography in the evaluation of the non-trauma emergency patient.
more radiation dose per examination. Radiology. 2008;248:887-893.
n Kilovolt (kV) level is kept as low as possible to maintain 3. Ros PR, Huprich JE. ACR appropriateness criteria on suspected small
tissue contrast, while still high enough to penetrate the bowel obstruction. J Am Coll Radiol. 2006;3:838-841.
soft tissues. 4. Maglinte D, Balthazar E, Kelvin F, et al. The role of radiology in the diagnosis
n Milliampere (mA) level is therefore maximized in ab- of small-bowel obstruction. AJR Am J Roentgenol. 1997;168:1171-1180.
5. Ahn S, Mayo-Smith W, Murphy B, et al. Acute nontraumatic abdomi-
dominal radiography. Portable radiography machines nal pain in adult patients: abdominal radiography compared with CT
often have a fixed mA; kV is often increased in portable evaluation. Radiology. 2002;225:159-164.
exams, leading to degraded imaging.
n Minimizing patient motion also plays a key role.
n Scatter is reduced with collimation and a Bucky grid.
n Consider gonadal shielding in young males.
 2 Gastrointestinal Fluoroscopy
WEIER LI

CHAPTER OUTLINE Techniques Protocols

Fluoroscopic Contrast Agents Barium Swallow (Esophagram)
Equipment Factors Abnormalities on Esophagram
Pearls for Maximizing Image Quality and Physics Pearls
Minimizing Radiation Exposure

Techniques n Imaging with fluoroscopy is heavily operator controlled,

allowing for wide customization and personalization of
n Fluoroscopy is an imaging modality where continuous each study.
x-ray images are obtained to evaluate the body in real
time, often with the aid of administered radiopaque con- Types and indications of fluoroscopic procedures in the
trast material (Fig. 2.1). abdomen and pelvis include:
n Fluoroscopic examinations attempt to answer specific
questions, and therefore understanding the indications
and limitations of each examination is crucial.

Gastrointestinal Fluoroscopic Procedures Indications

Modified Barium Swallow Esophageal symptoms, e.g., dysphagia, hiatal hernia, reflux
Upper GI study Stomach evaluation, e.g., gastritis, mass, ulcers
Postoperative upper GI leak study Leak or obstruction following gastric bypass (Fig. 2.2)
Small bowel follow through Small bowel transit time, obstruction, inflammatory bowel
disease (Fig. 2.3)
Stoma examinations Presurgical planning
Fistulogram Presurgical planning
Enema Rectal obstruction, presurgical planning, anastomotic integrity
Enteroclysis Direct contrast administration through NG tube to
evaluate small bowel
Genitourinary Fluoroscopic Procedures
Cystogram Bladder perforation, bladder capacity prerenal transplant
Voiding cystourethrography Vesicoureteral reflux
Retrograde urethrography Anterior urethral injury, stricture
Hysterosalpingogram Patency of fallopian tubes, uterine abnormalities
(Fig. 2.4)
Interventional Procedures
Placement of vascular catheters and stents
Placement of drainage catheters
Urological procedures, e.g., retrograde pyelography, percu-
taneous nephrostomies, and suprapubic cystotomies
Hydrostatic reduction of intussusceptions and sigmoid
volvulus
GI, Gastrointestinal; NG, nasogastric.
7
8 SECTION I • Gastrointestinal Tract

Monitor

Video camera

Optical coupling

Image intensifier

Grid

Patient
Table

Filtration
Fig. 2.3 ​Small bowel follow through demonstrates narrowing and
structuring of the terminal ileum consistent with Crohn disease.
Collimator

X-ray tube

X-ray generator

Fig. 2.1 ​Schematic diagram of a fluoroscopic imaging system.

Fig. 2.4 ​Hysterosalpingogram with two separate cervical catheters

demonstrates uterine didelphys.

FLUOROSCOPIC CONTRAST AGENTS

n Contrast agents are compounds that enable improved
visualization of internal luminal structures, spaces, and
tracts, and allow for controlled real time evaluation of
targeted organs.
n Fluoroscopic contrast agents are divided into two types:
Fig. 2.2 ​Postoperative swallow study with water-soluble contrast positive and negative contrast. Positive contrast materials,
demonstrates a posterior leak, which communicates with the aortic such as barium and iodine compounds, absorb x-rays more
graft, consistent with aortoesophageal fistula. strongly than surrounding tissues and appear radiopaque.
Another random document with
no related content on Scribd:
 4. Agriornis maritimus. G. R. Gray.
Plate XIII.
Pepoaza maritima, D’Orb. & Lafr., Mag. de Zool. 1837, p. 65.
Agriornis leucurus. Gould’s MSS., and on Pl. xiii.

Inhabits the coast of Patagonia. It is a scarce, shy, solitary bird,

frequenting the valleys in which thickets grow, but often feeding on
the ground. In the interior plains of Patagonia, on the banks of the
Santa Cruz, I several times saw it chasing beetles on the wing, in a
peculiar manner, half hopping and half flying; when thus employed,
it spreads its tail, and the white feathers in it are displayed in a very
conspicuous manner. I also met with this species in the lofty and arid
valleys on the eastern side of the Cordillera of Central Chile, and
likewise at Copiapó.
Family.—LANIADÆ.
Sub-Fam.—LANIANÆ, Swains.
 Cyclarhis Guianensis, Swains.
C. Guianensis, Swains., Ornith. Draw. Pl. 58. ♀
Tanagra Guianensis, Gmel.
Laniagra Guyanensis, D’Orb. & Lafr.
Falcunculus Guianensis, Swains., (1837.)
Le Sourciroux, Levaill. Ois. D’Afr. Pl. 76. f. 2.

My specimen was obtained at Maldonado, in the latter end of May.

I did not see another during my residence there. In its stomach were
Coleoptera.
Sub-Fam.—THAMNOPHILINÆ.
 Thamnophilus doliatus, Vieill.
Lanius doliatus, Linné.

My specimen was obtained at Maldonado, where it is not very

common. It generally frequents hedge-rows. Cry rather loud, but
plaintive and agreeable. Iris, reddish orange; bill, blue, especially
base of lower mandible. I observed individuals (females?) in which
the black and white bands on the breast were scarcely visible, and
even those on the under tail-coverts but obscurely marked.
Family.—TURDIDÆ.
 1. Turdus rufiventer. Licht.
T. rufiventer, Licht. Cat. p. 38.
—— Vieill. Ency. Meth. p. 639?
—— Spix, Av. Sp. Nov. tom. 1. p. 70. t. lxviii.
—— D’Orb. & Lafr. Voy. de l’Amer. Mer. Av. p. 203.
Grive rousse et noirâtre, Azara, No. 79.
Turdus Chochi, Vieill. Ency. Meth. p. 639.
—— D’Orb. & Lafr. Mag. de Zool. 1835. p. 17.
T. leucomelas, Vieill. Ency. Meth. 644.
T. albiventer, Spix, Av. Sp. Nov. tom. 1. p. 70. t. lxix. f. 1. m. 2 fem.
La grive blanche et noirâtre, Azara, No. 80.

The white-bellied thrush, described under the three latter

synonyms, according to M. D’Orbigny, (p. 203 of the ornithological
part of his work), is the female of the T. rufiventer. My specimens
were obtained at Maldonado and the Rio Negro, which latter place,
in 41°, is its most southern limit: Spix found it near Rio de Janeiro in
Brazil. It utters a note of alarm very like that of the common English
thrush, (Turdus musicus).
 2. Turdus Falklandicus. Quoy et Gaim.
T. Falklandicus, Quoy et Gaim. Zool. de l’Uranie, p. 104.
—— Pernetty, Hist. d’un Voy. aux Iles Malouines, II. p. 20.
—— D’Orb. & Lafr., Voy. de l’Amer. Mer. Av. p. 202.
T. Magellanicus, King, Proc. Zool. Soc. (1830) p. 14.
—— D’Orb. & Lafr. Mag. de Zool. 1835. p. 16.

M. D’Orbigny has pointed out that the Turdus Magellanicus of

King is only the male bird of Turdus Falklandicus. I obtained
specimens from the Rio Negro, Falkland Islands, Tierra del Fuego
and Chiloe: I believe I saw the same species in the valleys of
Northern Chile; I was informed that the thrush there lines its nest
with mud, in which respect it follows the habits of species of the
northern hemisphere. In the Falkland Islands it chiefly inhabits the
more rocky and dryer hills. It haunts also the neighbourhood of the
settlement, and very frequently may be seen within old sheds. In this
respect, and generally in its habits, it resembles the English thrush
(Turdus musicus): its cry, however, is different. It is tame, silent, and
inquisitive.
 1. Mimus Orpheus. G. R. Gray.
Orpheus Calandria, D’Orb. & Lafr. Mag. de Zool. (1835) p. 17.—Voy. de l’Amer.
Mer. Av. 206. pl. x. f. 2.
Turdus Orpheus, Spix. Av. t. 1. pl. 71.
Mimus saturninus, P. Max. Beitr. p. 658?
Orpheus modulator, Gould, in Proc. of Zool. Soc. Part IV. (1836) p. 6.

This bird is described in the Proceedings of the Zoological Society

(Part IV. 1836, p. 6.) as having come from the Straits of Magellan,
which undoubtedly is a mistake. It is extremely common on the
banks of the Plata; but a few degrees south of it, is replaced by the O.
Patagonica of D’Orbigny. In Banda Oriental these birds are tame
and bold; they constantly frequent the neighbourhood of the country
houses to pick the meat, which is generally suspended to the posts
and walls. If any other small bird joins in the feast, the Calandria (as
this species is usually called in La Plata) immediately chases him
away. In these respects, and in its manner of sometimes catching
insects, the Mimus is related in its habits with that division of the
Muscicapidæ, which includes the genus Xolmis: indeed, the general
colour of the plumage of X. Nengeta is so like that of Mimus, that it
might readily be mistaken for a bird of that genus. The Calandria
haunts thickets and hedge-rows, where it actively hops about, and in
doing so often elevates and slightly expands its tail.
 2. Mimus Patagonicus. G. R. Gray.
Orpheus Patagonicus, D’Orb. & Lafr. Mag. de Zool. 1836, p. 19.—Voy. de
l’Amer. Mer. Av. p. 210, pl. xi. f. 2.

I obtained specimens of this bird at the Rio Negro and at Santa

Cruz in Southern Patagonia, at both of which places it is common. It
is not found in Tierra del Fuego, for neither it nor the other species of
the genus inhabit forests. This species has slightly different habits
from the M. Orpheus. It is a shyer bird, and frequents the plains and
valleys thinly scattered with stunted and thorn-bearing trees. It does
not appear to move its tail so much. Its cry, like that of the rest of the
genus, is harsh, but its song is sweet. The M. Patagonicus, whilst
seated on the highest twig of some low bush, often enlivens the
dreariness of the surrounding deserts by its varying song. Molina,
however, describing the song of an allied species, has greatly
exaggerated its charms. It may be compared to that of the sedge-bird
(Motacilla salicaria, Linn.), but is much more powerful, some harsh
notes and some very high ones being mingled with a pleasant
warbling. The song of the different mocking thrushes certainly is
superior to that of any other bird which I heard in South America;
and they are almost the only ones which formally perch themselves
on an elevated twig for the purpose of singing. They sing only during
the spring of the year. I may here mention, as a curious instance of
the fine shades of difference in habits between very closely allied
species, that when I first saw the M. Patagonicus, I concluded from
habits alone that it was different from M. Orpheus. But having
afterwards procured a specimen of the former, and comparing the
two without particular care, they appeared so very similar that I
changed my opinion. Mr. Gould, however, immediately upon seeing
them (and he did not then know that M. D’Orbigny had described
them as different) pronounced that they were distinct species; a
conclusion in conformity with the trifling difference of habit and
geographical range, of which he was not at the time aware.
 3. Mimus Thenca. G. R. Gray.
Turdus Thenca. Mol.
Orpheus Thenca. D’Orb. Voy. de l’Amer. Mer. Orn. p. 209, pl. f. 3.

This species seems to be confined to the coast of the Pacific, west

of the Cordillera, where it replaces the M. Orpheus, and M.
Patagonicus of the Atlantic side of the continent. Its southern limit is
the neighbourhood of Concepcion, (lat. 37° S.) where the country
changes from thick forests to an open land. The Thenca, (which is the
name of this species, in the language of the Aboriginal Indians,) is
common in central and northern Chile, and is likewise found (I
believe the same species) near Lima, (lat. 12°) on the coast of Peru.
The habits of the Thenca are similar, as far as I could perceive, to
those of the M. Patagonicus. I observed many individuals, which had
their heads stained yellow from the pollen of some flower, into which
they bury their heads, probably for the sake of the small beetles
concealed there. Molina describes the nest of the Thenca, as having a
long passage, but I was assured by the country people, that this nest
belonged to the Synallaxis ægithaloides, and that the Thenca makes
a simple nest, built externally of small prickly branches of the
mimosa.
 4. Mimus trifasciatus. G. R. Gray.
Plate XVI.
Orpheus trifasciatus. Gould, in Proc. of Zool. Soc. Part v. 1837, p. 27.

M. vertice, nuchâ, et dorso nigrescentibus; uropygio rufo pallidè

lavato; alis nigrescentibus, tectricibus notâ albescente terminali
fascias tres transversas facientibus; rectricibus caudæ duabus
intermediis nigrescentibus, reliquis ad apicem pallidioribus;
plumis auricularibus, strigâ superciliari, gulâ, et corpore subtùs
albis, lateribus notis guttisque fuscis ornatis; rostro pedibusque
nigris.
Long. tot. 10⅝ unc.; rost. 1⅜; alæ, 5; caudæ, 5½; tarsi, 1¾.
The vertex, nape of the neck and the back, blackish; with the lower
part of the back tinged with pale rufous; the wings blackish, with
the tips of the wing coverts white, forming three transverse
bands; the tail with the two intermediate feathers black, with the
tips of the others much paler; the auricular feathers with a streak
above the eyes, throat, and beneath the abdomen white; the
flanks ornamented with fuscous marks and spots.
Habitat, Charles Island, Galapagos Archipelago. (October).
 5. Mimus melanotis. G. R. Gray.
Plate XVII.
Orpheus melanotis, Gould, in Proc. of Zool. Soc. Part v. 1837, p. 27.

M. vertice, nuchâ, dorsoque pallidè fuscis; plumis capitis et dorsi

ad medium colore saturatiore; alis intensè fuscis, singulis
plumis ad marginem pallidioribus, secundariis, tectricibusque
majoribus notâ albâ terminali, fascias duas transversas
facientibus; caudæ rectricibus nigrescenti-fuscis ad apicem
albis, loro, plumisque auricularibus nigrescenti-fuscis; laterum
plumis notâ fuscâ centrali, abdomine albo; rostro pedibusque
nigris.
Long tot. 9½ unc.; rost. 1¼; alæ, 4½; caudæ, 4½; tarsi, 1⅜.
The vertex, nape of the neck and the back, pale brown; the feathers
of the head and the back, as far as the middle, of a darker colour;
the wings intensely brown, with the margins of each of the
feathers paler; the secondaries and the greater wing-coverts
terminated with white marks, giving the appearance of two
transverse bands; the feathers of the tail blackish brown, with the
tips white; the lores and the feathers of the ears blackish brown,
the feathers of the sides with a central brown mark, the abdomen
white; the bill and feet black.
Habitat, Chatham and James’s Islands, Galapagos Archipelago.
(October.)
 Birds. Pl. 16.

Mimus trifasciatus.
 Birds. Pl. 17.

Mimus melanotis.
 Birds. Pl. 18.

Mimus parvulus.
 6. Mimus parvulus. G. R. Gray.
Plate XVIII.
Orpheus parvulus. Gould, in Proc. of Zool. Soc. Part v. 1837, p. 27.

M. vertice, nuchâ caudâque intensè fuscis, hujus rectricibus ad

apicem albo notatis; alis fuscis secundariis tectricibusque notâ
albâ apicali fascias duas transversas facientibus; loro
plumisque auricularibus nigrescentibus; gulâ, colli lateribus,
pectore, et abdomine albescentibus; plumis laterum notis fuscis
per medium longitudinaliter excurrentibus.
Long. tot. 8⅛ unc.; rost. 1; alæ, 3⅝; caudæ, 3¾; tarsi, 1¼.
The vertex, the nape of the neck, and the tail intensely black; with
the tips of the tail feathers marked with white; the wings brown
with the secondaries and coverts tipped with white marks, giving
the appearance of two transverse hands; the lores and the
feathers of the ears black; the throat, the sides of the neck,
breast, and the abdomen white; the flanks marked longitudinally
with brown.
Habitat, Albemarle Island, Galapagos Archipelago. (October.)
It will be seen, that the three last species of the genus Mimus, were
procured from the Galapagos Archipelago; and as there is a fact,
connected with their geographical distribution, which appears to me
of the highest interest, I have had these three figured. There are five
large islands in this Archipelago, and several smaller ones. I
fortunately happened to observe, that the specimens which I
collected in the two first islands we visited, differed from each other,
and this made me pay particular attention to their collection. I found
that all in Charles Island belonged to M. trifasciatus; all in
Albemarle Island to M. parvulus, and all in Chatham and James’s
Islands to M. melanotus. I do not rest this fact solely on my own
observation, but several specimens were brought home in the Beagle,
and they were found, according to their species, to have come from
the islands as above named. Charles Island is distant fifty miles from
Chatham Island, and thirty-two from Albemarle Island. This latter is
only ten miles from James Island, yet the many specimens procured
from both belonged respectively to different species. James and
Chatham, which possess the same species, are seventy miles apart,
but Indefatigable Island is situated between them, which perhaps,
has afforded a means of communication. The fact, that islands in
sight of each other, should thus possess peculiar species, would be
scarcely credible, if it were not supported by some others of an
analogous nature, which I have mentioned in my Journal of the
Voyage of the Beagle. I may observe, that as some naturalists may be
inclined to attribute these differences to local varieties; that if birds
so different as O. trifasciatus, and O. parvulus, can be considered as
varieties of one species, then the experience of all the best
ornithologists must be given up, and whole genera must be blended
into one species. I cannot myself doubt that M. trifasciatus, and M.
parvulus are as distinct species as any that can be named in one
restricted genus.
The habits of these three species are similar, and they evidently
replace each other in the natural economy of the different islands;
nor can I point out any difference between their habits and those of
M. Thenca of Chile; I imagined, however, that the tone of their voice
was slightly different. They are lively, inquisitive, active birds, and
run fast; (I cannot assert, positively, that M. Thenca runs). They are
so extremely tame, a character in common with the other birds of
this Archipelago, that one alighted on a cup of water which I held in
my hand, and drank out of it. They sing pleasantly; their nest is said
to be simple and open. They seem to prefer the dry sterile regions
nearer the coast, but they are likewise found in the higher, damper
and more fertile parts of the islands. To these latter situations,
however, they seem chiefly attracted by the houses and cleared
ground of the colonists. I repeatedly saw the M. melanotis at James
Island, tearing bits of meat from the flesh of the tortoise, which was
cut into strips and suspended to dry, precisely in the same manner as
I have so often observed the M. Orpheus, in La Plata, attacking the
meat hung up near the Estancias.
 1. Furnarius rufus. Vieill.
Furnarius rufus, Vieill., Ency. Meth. 513.
Merops rufus, Gmel. Pl. enl. 739.
Opetiorhynchus rufus, Tem. Man.
Turdus vadius, Licht. Cat.
Figulus albogularis, Spix, Av. pl. lxxviii. f. 1 & 2.
Fournier, Buff., Azara, No. 221.

This bird is common in Banda Oriental, on the banks of the Plata;

but I did not see it further southward. It is called by the Spaniards
Casaro, or housebuilder, from the very singular nest which it
constructs. The most exposed situation, as on the top of a post, the
stem of an opuntia, or bare rock, is chosen. The nest consists of mud
and bits of straw; it is very strong, and the sides are thick; in shape it
resembles a depressed beehive or oven, and hence the name of the
genus. Directly in front of the mouth of the nest, which is large and
arched, there is a partition, which reaches nearly to the roof, thus
forming a passage or ante-chamber to the true nest. At Maldonado,
in the end of May, the bird was busy in building. The Furnarius is
very common in Banda Oriental; it often haunts the bushes in the
neighbourhood of houses; it is an active bird, and both walks and
runs quickly, and generally by starts; it feeds chiefly on Coleoptera; it
often utters a peculiar, loud, shrill, and quickly reiterated cry.
 2. Furnarius cunicularius. G. R. Gray.
Alauda cunicularia, Vieill.
Alauda fissirostra, Kittl. Mem. l’Acad. St. Peters, ii. pl. 3.
Certhilauda cunicularia, D’Orb. & Lafr. Mag. de Zool.

This bird has a considerable geographical range. On the eastern

side of the continent it is found from about 40° (for I never saw one
in the southern districts of Patagonia) northward to at least 30°, and
perhaps much further. On the western side its southern limit is the
neighbourhood of Concepcion, where the country becomes dry and
open, and it ranges throughout Chile (specimens were procured from
Valparaiso) to at least as far north as Lima, in lat. 12°, on the coast of
Peru. I may here observe, that the northern limit of all birds, which
are lovers of dry countries, such as this Furnarius and some of the
species of Mimus, is not probably at Lima but near Cape Blanco, 10°
south of the Equator, where the open and parched land of Peru
blends (as it was described to me) rather suddenly into the
magnificent forests of Guayaquil. This Furnarius constantly haunts
the driest and most open districts; and hence sand-dunes near the
coast afford it a favourite resort. In La Plata, in Northern Patagonia,
and in Central Chile, it is abundant: in the former country it is called
Casarita, a name which has evidently been given from its relationship
with the Casaro, or Furnarius rufus, for, as we shall see, its
nidification is very different. It is a very tame, most quiet, solitary
little bird, and like the English robin (Sylvia rubecula) it is usually
most active early in the morning and late in the evening. When
disturbed it flies only to a short distance; it is fond of dusting itself
on the roads; it walks and runs (but not very quickly), and generally
by starts. I opened the stomachs of some, and found in them remains
of Coleoptera, and chiefly Carabidæ. At certain seasons it frequently
utters a peculiar, shrill but gentle, reiterated cry, which is so quickly
repeated as to produce one running sound. In this respect, and in its
manner of walking on the ground, and in its food, this species closely
resembles the Casaro, but in its quiet manners it differs widely from
that active bird. Its nidification is likewise different, for it builds its
nest at the bottom of a narrow cylindrical hole, which is said to
extend horizontally to nearly six feet under ground. Several of the
country people told me, that when boys, they had attempted to dig
out the nest, but had scarcely ever succeeded in getting to the end.
The bird chooses any low bank of firm sandy soil by the side of a road
or stream. At the settlement of Bahia Blanca the walls are built of
hardened mud; and I noticed one, enclosing a courtyard, where I
lodged, which was penetrated by round holes in a score of places. On
asking the owner the cause of this, he bitterly complained of the little
Casarita, several of which I afterwards observed at work. It is rather
curious, that as these birds were constantly flitting backwards and
forwards over the low wall, they must be quite incapable of judging
of distance or thickness even after the shortest circuitous route, for
otherwise they would not have made so many vain attempts.
Uppucerthia dumetoria. J. Geoffr. & D’Orb.
Plate XIX.
Uppucerthia dumetoria, J. Geoffr. & D’Orb. Ann. du Mus. i. 393 and 394.
Furnarius dumetorum, D’Orb. MS.
Uppucerthia dumetorum, D’Orb. & Lafr. Mag. de Zool. 1838, p. 20.

This bird is an inhabitant of extremely sterile regions. I saw several

at the Rio Negro, but at Port Desire they were, perhaps, more
numerous. I did not observe it near Valparaiso, in Central Chile, but
I procured specimens of it from Coquimbo, where the country is
more desert. It frequents open places, in which a few bushes grow. It
hops very quickly, and often flies quietly from one place to another.
It may often be seen turning over and picking dry pieces of dung. It is
a remarkable circumstance, that in the three specimens which I
brought home, from different localities, namely the Rio Negro, Port
Desire, and Coquimbo, the beak varies considerably in length: in that
from Port Desire in Patagonia it is three-eighths of an inch shorter
than in that from Coquimbo in Chile; whilst the Rio Negro specimen
is intermediate between them. Mr. G. R. Gray has pointed out to me
that Latham long since observed a great variation in the beak of the
Patagonian warbler, Opetiorhynchus Patagonicus.
 1. Opetiorhynchus vulgaris. G. R. Gray.
Uppucerthia vulgaris, D’Orb. & Lafr. Mag. de Zool. 1838, p. 23.

This bird in general habits has several points of resemblance with

the Furnarius cunicularius, but differs in some other respects. Its
flight is somewhat similar, but it shows two red bands on its wings,
instead of one, by which it can be distinguished at a distance: instead
of walking it only hops; it feeds entirely on the ground, and in its
stomach I found scarcely anything but Coleopterous insects, and of
these many were fungi feeders. It often frequents the borders of
lakes, where the water has thrown up leaves and other refuse. It
likewise may be met with in all parts of the open grassy plains of
Banda Oriental, where (like the Uppucerthia at the Rio Negro) it
often turns over dry dung. Its note is very like that of the F.
cunicularius, but more acute, and consists of a shrill cry, quickly
reiterated so as to make a running sound. I was informed that, like
that bird, it builds its nest at the bottom of a deep burrow. This
species is common in La Plata, the Falkland Islands, and Tierra del
Fuego; in the latter it frequents the higher parts of the mountains, or
those exposed to the western gales, which are free from forests, for it
is a bird that exclusively lives in open countries and on the ground. I
believe it is not found in Chile; nor is it common on the coast of
Patagonia. This species in its habits is very different from the three
following closely allied ones, since the latter never, or most rarely,
leave the sea beach, whilst this bird, excepting by chance, is never
seen there, but always in the interior country. Nevertheless with this
marked difference in habits, (there are several other points beside
that of the station frequented), if the preserved skins of O. parvulus
and O. vulgaris were placed in the hands of any one, even perhaps of
a practised ornithologist, he would at first hesitate to consider them
distinct, although upon closer examination he would find many
points of difference,—of which the much greater strength of the feet
and the greater length of the tarsus are conspicuous in those species,
which live amongst the stones on the sea beach.
 Birds. Pl. 19.

Upercerthia dumetaria.
2. Opetiorhynchus Patagonicus. G. R. Gray.
Patagonian Warbler, Lath. Syn. iv. p. 434.
Motacilla Patagonica, Gmel.
Motacilla Gracula, Forst. Draw. No. 160.
Sylvia Patagonica, Lath. Index, ii. 517.
Furnarius Lessonii, Dumont.
—— Chilensis, Less. Voy. de la Coqu. i. p. 671, n. Tr. d’Ornith. p. 307, pl. 75, f. 1.
Opetiorhynchus rupestris, Kittl. Mem. de l’Acad. St. Petersb. i. p. 188, pl. viii.
Uppucerthia rupestris, D’Orb. & Lafr. Mag. de Zool. 1838, p. 21.

This bird is extremely common on the sea shore of all the bays and
channels of Tierra del Fuego; on the western coast it is replaced in
Northern Chile by the O. nigrofumosus, and in the Falkland Islands
by the O. antarcticus. As the habits of this species and those just
named are quite similar, I shall describe them all together under the
head of O. nigrofumosus. A specimen of O. Patagonicus from Chiloe
has a bill rather more than two-tenths of an inch longer than in those
from Tierra del Fuego; but as no other difference can be perceived, I
cannot allow that this is a specific character any more than in the
case of the Uppucerthia.
3. Opetiorhynchus antarcticus. G. R. Gray.
Certhia antarctica, Garn. Ann. des Sc. Nat. 1826.
Furnarius fuliginosus, Less. Voy. de la Coqu. Zool. i. p. 670.
Patagonian Warbler, Lath. ♀ in Dixons Voy. App. No. 1, 359 and pl.

This species inhabits the Falkland Islands. My specimens were

procured at the east island, from which, also, those described by the
French naturalists came, and likewise that given in the Appendix to
Dixon’s Voyage. I have no doubt that it is peculiar to this group, for
the foregoing species, which in the neighbouring mainland of Tierra
del Fuego supplies its place and has precisely the same habits, has
been examined by Mr. Gould and is considered distinct. The O.
antarcticus has long been noticed by voyagers to the Falkland
Islands from its extreme tameness: in the year 1763 Pernety states it
was so tame that it would almost perch on his finger, and that in half
an hour he killed ten with a wand.
 4. Opetiorhynchus nigrofumosus. G. R.
Gray.
Plate XX.
Uppucerthia nigro-fumosa, D’Orb. & Lafr. Mag. de Zool. 1838, p. 23.
Opetiorhynchus lanceolatus, Gould, MS. and on plate XX.

My specimen was killed at Coquimbo, on the coast of Chile. It

differs from O. Patagonicus in its larger size, much stronger feet and
bill, and more dusky plumage, and in the white streak over the eye
being less plainly marked. In this species the red band, which
extends from the body obliquely across the wings in all the species,
reaches to the third primary, whereas in O. Patagonicus, O. vulgaris,
and O. antarcticus, that feather is not marked, or so faintly, as
scarcely to be distinguishable. In the genus Furnarius, the wing
feathers are marked in an analogous manner. I saw this species (as I
believe) on the coast near the mouth of the valley of Copiapó.
I will now make a few remarks on the habits of these three coast
species. The first, O. antarcticus, is confined, as I have every reason
to believe, to the Falkland Islands. The second inhabits Tierra del
Fuego, and in Chiloe and Central Chile is replaced by the local variety
with a long beak, and this still further northward by the O.
nigrofumosus. On the east side of the continent I do not believe
these marine species extend so far northward. I never saw one on the
shores of the Plata, but they occur in Central Patagonia. These birds
live almost exclusively on the sea beach, whether formed of shingle
or rock, and feed just above the surf on the matter thrown up by the
waves. The pebbly beds of large rivers sometimes tempt a solitary
pair to wander far from the coast. Thus at Santa Cruz I saw one at
least one hundred miles inland, and I several times observed the
same thing in Chile, which has likewise been remarked by Kittlitz,
who has given a very faithful account of the habits of O. Patagonicus.
I must add that I also saw this bird in the stony and arid valleys in
the Cordillera, at a height of at least 8000 feet. In Tierra del Fuego I
scarcely ever saw one twenty yards from the beach, and both there
and at the Falkland Islands they may frequently be seen walking on
the buoyant leaves of the Fucus giganteus, at some little distance
from the shore. In these respects, the birds of this genus entirely
replace in habits many species of Tringa. In the stomachs of those I
opened I found small crabs and little shells, and one Buccinum even
a quarter of an inch long: Kittlitz says, he found in one, besides such
objects, some small seeds. They are very quiet, tame and solitary, but
they may not unfrequently be seen in pairs. They hop and likewise
run quickly; in which latter respect, and likewise in their greater
tameness, they differ from the O. vulgaris. Their cry is seldom
uttered, but is a quick repetition of a shrill note, like that of the last
named bird, and of several species of Furnarius.

Birds. Pl. 20.

Opetiorhynchus lanceolatus.
 Birds. Pl. 21.

Eremobius phœnicurus.

On the 20th of September, I found, near Valparaiso, the nest of O.

Patagonicus, with young birds in it: it was placed in a small hole in
the roof of a deep cavern, not far from the bank of a pebbly stream.
Three months later in the summer I found, in the Chonos
Archipelago (Lat. 45°), a nest of this species, placed in a small hole
beneath an old tree, close to the sea beach. The nest was composed of
coarse grass and was untidily built. The egg rather elongated; length
1·11 of an inch, width in broadest part ·8 of an inch; perfectly white.