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AfterNOON DELIGHT

AfterNOON DELIGHT

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AfterNOON DELIGHT

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  1. AfterNOON DELIGHT Abdominal Imaging August 5, 2010

  2. Teaser 71yo woman with a h/o spinal stenosis POD#6 s/p laminectomy with lumbar spinal fusion presenting with abdominal distension.

  3. Abdominal X Rays KUB: KUB is usually done with the patient supine You should look at the : 1. Bones 2. Lung bases 3. Soft tissue 4. Gas patterns Lung Bases Bones Mettler: Essentials of Radiology, 2nd ed.

  4. Gas Pattern Mettler: Essentials of Radiology, 2nd ed.

  5. Feeding tubes

  6. 65 year old female with history of CLL, currently undergoingchemotherapy. Now with nausea/vomiting and diffuse abdominal pain.

  7. Obstruction Bickle IC, Kelly B. Abdominal x rays made easy: abnormal intraluminal gas studentBMJ 2002;10:140-1. (May.)

  8. Air fluid levels • Small-bowel obstruction • Large-bowel obstruction • Paralytic ileus • Gastroenteritis • Hypokalemia • Uremia • Jejunaldiverticulosis • Mesenteric thrombosis • Saline cathartics • Peritoneal metastases • Cleansing enemas • Normal (<25 mm long)

  9. Small Bowel Obstruction • Mural lesions • Tumor • Stricture due to Crohn's disease • Irradiation • Ischemia • Luminal • Bezoar • Gallstone • Ascarislumbricoides bolus • Intussusception • Extrinsic • Adhesions • Hernia • Volvulus • Abdominal malignancy

  10. 96 yo man w/ respiratory failure presenting w/constipation

  11. 41 yo man with sickle cell anemia c/b acute chest presenting with constipation.

  12. After an unpleasant intervention Upright CXR Supine

  13. Paralytic Ileus Paralytic ileus occurs when intestinal peristalsis ceases and there is an accumulation of fluid and gas in the bowel. • Peritonitis • Surgery • Trauma • Inflammation • Appendicitis • Pancreatitis • Cholecystitis •  Salpingitis • Congestive heart failure • Pneumonia • Renal Colic • Renal Failure • Leaking AAA • Hypokalemia • Drugs • Narcotics • Anti-cholinergics • Spinal Lesions • Mesenteric Ischemia

  14. 60-year-old woman with h/o retroperitoneal abscess s/pendoscopic-guided OG tube placement. Now with increased Peak airway pressures.

  15. Subsequent CT

  16. Extravasation of Oral Contrast

  17. 55 yo woman with cerebral palsy and chronic aspiration s/p G-tube placement presenting with leukocytosis

  18. Perforation on Supine film:In 56 % of patients w/ a pneumoperitoneum the gas may be detectable on the supine radiograph Almost half the patients will have gas in the RUQ adjacent to the liver

  19. Name that structure… Splenic Flexure stomach right adrenal Tail of pancreas Mettler: Essentials of Radiology, 2nd ed.

  20. Body of pancreas Head of pancreas Gallbladder SMV/A Portal vein IVC Left Adrenal Splenic Vein IVC Renal Vein L Ureter Mettler: Essentials of Radiology, 2nd ed.

  21. Duodenum L ureter R Ureter IVC Aorta L Psoas Mettler: Essentials of Radiology, 2nd ed.

  22. Iliopsoas muscle Ext Iliac a/v Bladder Male Male R ureter Rectosigmoid Rectum Mettler: Essentials of Radiology, 2nd ed.

  23. Prostate Uterus Male Female Rectum R ureter Rectum L ureter

  24. 47 yo woman presenting with LLQ abdominal pain

  25. Diverticulitis Diverticulitis occurs when the neck of a diverticulum becomes occluded, resulting in inflammation, erosion, and microperforation. • The most common CT finding is paracolic fat stranding. RadioGraphics 2004; 24:703–715

  26. 84 yo woman presenting with epigastric pain and nausea/vomiting

  27. Pancreatitis CT findings include: Enlarged Pancreas Peri-pancreatic fluid possibly a focal ileus RadioGraphics 2004; 24:703–715