Coming into radiology as someone who was mainly concerned with what was going on above the diaphragm I found the world of abdominal CT fairly daunting. But by getting to grips with the anatomy of the abdomen things became a whole lot clearer
At this level of the abdomen we get a nice demonstration of the superior mesenteric artery – we can’t see the superior mesenteric vein here but normally the vein should lie to the right of the artery at the level of the pancreas, if this is reversed then consider intestinal malrotation which can predispose to midgut volvulus
I always check to see there is a clean layer of fat surrounding the SMA – if this is infiltrated consider a malignant pathology such as a pancreatic tumour
Always follow the vessels no matter which CT it is you’re looking at, be it head, neck, chest or abdomen. I always follow the portal veins within the liver formed at the confluence by the splenic vein (which runs posterior to the pancreas) and the superior mesenteric vein which runs vertically. In patients with liver cirrhosis and pancreatitis in particular you are looking for a filling defect or occluded vessel representing thrombosis
There aren’t many retroperitoneal structures that cross the midline but the left renal vein is one of them – characteristically this passes anterior to the aorta from the left kidney to the IVC but in some people this can have a retroaortic course where it passes behind the aorta. I have seen the occasional incidental left renal vein thrombosis so it is worth checking for filling defects! This is a must in cases of renal cell carcinoma which likes to spread into the IVC via the renal veins