Approach to Abdominal Plain Film Radiology - PowerPoint PPT Presentation

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Approach to Abdominal Plain Film Radiology

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  1. Approach toAbdominal Plain Film Radiology Nalin Amin, MD, CCFP, FRCSC Assistant Professor Dept. Of Surgery, McMaster University

  2. Objectives What is the use of plain xrays anymore? Three views? Radiation concern? Flat Plate? KUB? Decub? Develop approach CASES

  3. What is the use? • Still good screening for: • Bowel obstruction • Ileus • Free air (on upright views) • NGT placement • Stones follow-up • etc

  4. 3 views • Upright/Standing • Supine (upper) • Supine (lower)

  5. Supine (upper) Supine (lower) Upright

  6. Flat plate • b/c used ‘glass plate’ in old days • Now digital technology • KUB • ‘Kidneys/Ureters/Bladder’ • Supine view with field-of-view from kidney to bladder • +/- IV contrast • Assess for radiopaque calculi • Decub • Lying on side • Good for free air if cannot do upright

  7. Radiation • 1 CXR ~ 0.1 mSv ≈ 1 cigarette ( risk of ca) • 1 abdo XR ~ 0.7 mSv ≈ 7 cigs • 1 pelvis XR ~ 0.6 mSv • CT abdo/pelvis ~14 mSv ≈ 140 cigs • CT chest ~7 mSv

  8. APPROACH ABCS! A = air B = bowel C = calcifications S = soft tissues

  9. Air

  10. Stomach LB SB Bowel

  11. L-Spine w/DDD 12th rib anastomotic staple chole clips renal stone phlebolith pelvic clips Calcifications

  12. Soft Tissues spleen margin liver edge properitoneal fat left kidney shadow

  13. male pt XY Soft Tissues bladder

  14. Diff SB vs LB

  15. CASES Case 1

  16. Free air (on upright)

  17. CASES Case 2

  18. Free air (on supine) • harder to see • need significant amount more to see • Football sign • falciform is the laces • Rigler’s sign • bowel wall outlined by free air • normally not mesenteric side aspect seen

  19. CASES Case 3

  20. CASES

  21. left renal calculi • 80% radioopaque • ca2+ oxalate, phosphate • struvite • 20% radiolucent • uric acid (+ve on CT) • cystine (+ve on CT) • HIV indinavir (-ve on CT)

  22. CASES

  23. CASES Case 4

  24. SBO • multiple AF levels • varying heights • “string-of-pearls” • low grade vs high grade • early/partial vs complete • if gas is seen distally (early/partial) • decompressed distally (complete/high grade)

  25. SBO causes • adhesions (50%) • hernias (15%) • ca (1º and mets) (15%)

  26. CASES Case 5

  27. LBO

  28. ‘applecore’ carcinoma proximal LBO

  29. LBO causes • Cancer • Diverticulitis • Volvulus • Hernia • note if IC valve competent or incompetent • this case, competent • ie. no SBD

  30. non-dilated SB loops

  31. CASES Case 6

  32. paralytic ileus • hard to discriminate from BO

  33. CASES Case 7

  34. gallstone ileus

  35. pneumobilia dilated SB loops gallstone

  36. triad • gallstone • SBO or ileus • pneumobilia • central • as opposed to PV gas (peripheral)

  37. CASES Case 8

  38. thumbprinting • bowel wall edema • DDx (4 I’s) • ischemia • infectious colitis • PMC • inflammatory (UC/IBD) • infiltrative • other: edema, Rn, tumor, hemorrhage