Imaging in acute nontrumatic solid organs injuries. A . Norouzi MD. The 'acute abdomen' is a clinical condition characterized by severe abdominal pain, requiring the clinician to make an urgent therapeutic decision.
A. Norouzi MD
LEFT: Plain abdominal film in a patient with an acute abdomen, showing no abnormalities.
RIGHT: Subsequent CT shows distended small bowel loops (arrowheads) that are not seen on plain abdominal film because they are filled with fluid only and do not contain intraluminal air.
Always remember :
Commonest are the commonest
Inflamed fat at sonography. Extended-view of the ventral abdomen depicting an area of hyperechoicnoncompressible inflamed fat in the omentum (red arrows). Compare this to the echogenicity of normal abdominal or subcutaneous fat (green arrows). This patient had an omental infarction.
Same patient as above. Unenhanced CT depicts an area of fatty tissue with slightly increased density (arrowheads), in the right-upper quadrant. Compare this to normal low-density subcutaneous fat. Diagnosis: omental infarction.
Diffuse thickening of bowel wall in a patient with colitis. fatty tissue with slightly increased density (arrowheads), in the right-upper quadrant. Compare this to normal low-density subcutaneous fat. Diagnosis:
Obstructive ileus. CT depicts distended small bowel loops, but part of the small bowel and the whole colon is nondistended. Therefore this must be an obstructive small bowel ileus, and in this case its cause can easily be identified: intussusception (arrowhead).
Clinically appendicitis. US only showed a little bit of ascites. A diagnostic puncture (arrow marks needletip) revealed blood. In a woman this finding is very suspicious of an EP.
Intraperitoneal ascites. A diagnostic puncture (arrow marks air in a patient suspected of having appendicitis. Air better seen on images with lung setting on the right.
Longitudinal and transverse US show thickened gallbladder wall. The gallbladder is noncompressible ('hydropic') and causes an impression in the anterior abdominal wall (arrowheads).
LEFT: US of a normal gallbladder after an overnight fast shows the wall as a pencil-thin echogenic line.RIGHT: US in the postprandial state shows pseudothickening of the gallbladder
LEFT: US in a 59-year-old woman with acute thin rim of enhancing soft-tissuecholecystitis shows the layered appearance of a thickened gallbladder wall, with a hypoechoic region between echogenic linesRIGHT: At contrast-enhanced CT the thick-walled gallbladder contains a hypodense outer layer (arrow) due to subserosaloedema
43-year-old woman with acute calculouscholecystitis.
LEFT: US shows marked wall thickening with intramural hypoechoic nodules (arrowheads), and an intraluminal stone (arrow).
RIGHT: Contrast-enhanced CT shows a deformed and thickened gallbladder wall containing hypoattenuating nodules
LEFT: Gallbladder carcinoma. US shows marked generalized wall thickening (arrowheads), replacing the gallbladder lumen. Multiple gallbladder stones (arrow) indicate the probable location of the filled lumen.
RIGHT: Contrast-enhanced CT depicts a thick-walled gallbladder (arrowhead), with local infiltration of the mass in the adjacent liver (arrow).
Adenomyomatosis in a 39-year-old woman. US shows mural thickening with calcifications with the characteristic 'comet-tail' reverberation artifact (arrow) due to small cholesterol crystals within Rokitansky-Aschoff sinuses.
56-year-old man with liver cirrhosisLEFT: US depicts wall thickening (arrow), surrounded by ascites. Note the irregular cirrhotic liver parenchyma. RIGHT: At contrast-enhanced CT the wall of the gallbladder (arrow) appears nearly normal, because subserosaloedema can not be well differentiated from surrounding ascites at CT.
Diffuse gallbladder wall thickening in congestive right heart failure
Pancreatitis in a 56-year-old manContrast-enhanced CT shows peripancreatic inflammatory changes (arrowheads), and thickening of the wall of the gallbladder (arrow) which is secondarily involved in the pancreatic inflammation.
Necrotizing pancreatitis: only enhancement of a part of the pancreatic headThere are 2 or more fluid collections and more than 50% of the gland does not enhance (Balthazar grade E, CTSI :10).
On day 3 there is no enhancement of the pancreas, consistent with necrosis (compare to enhancing spleen).
On follow up the peripancreatic collections increase in size and finally there are air bubbles in the heterogeneous collection, consistent with infected pancreatic necrosis.
There is a large, homogeneous, well-demarcated with necrosis (compare to enhancing spleen).peripancreatic collection which abuts the stomach and the pancreas.
LEFT: Subtle want to be able to exclude in patients with acute abdominal pain especially when they present with back or flank pain. periaortic stranding, MIDDLE: Hemorrhage into posterior pararenal and perirenal compartment, RIGHT: Extravasation of iv. contrast
High-attenuating crescent sign in a patient with subtle evidence of leak adjacent to the right psoas muscle (broad arrow).
LEFT: draped aorta sign. evidence of leak adjacent to the right psoas muscle (broad arrow).
RIGHT: two weeks later there is a rupture