AfterNOON DELIGHT Abdominal Imaging August 5, 2010
Teaser 71yo woman with a h/o spinal stenosis POD#6 s/p laminectomy with lumbar spinal fusion presenting with abdominal distension.
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.
Gas Pattern Mettler: Essentials of Radiology, 2nd ed.
65 year old female with history of CLL, currently undergoingchemotherapy. Now with nausea/vomiting and diffuse abdominal pain.
Obstruction Bickle IC, Kelly B. Abdominal x rays made easy: abnormal intraluminal gas studentBMJ 2002;10:140-1. (May.)
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)
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
41 yo man with sickle cell anemia c/b acute chest presenting with constipation.
After an unpleasant intervention Upright CXR Supine
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
60-year-old woman with h/o retroperitoneal abscess s/pendoscopic-guided OG tube placement. Now with increased Peak airway pressures.
55 yo woman with cerebral palsy and chronic aspiration s/p G-tube placement presenting with leukocytosis
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
Name that structure… Splenic Flexure stomach right adrenal Tail of pancreas Mettler: Essentials of Radiology, 2nd ed.
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.
Duodenum L ureter R Ureter IVC Aorta L Psoas Mettler: Essentials of Radiology, 2nd ed.
Iliopsoas muscle Ext Iliac a/v Bladder Male Male R ureter Rectosigmoid Rectum Mettler: Essentials of Radiology, 2nd ed.
Prostate Uterus Male Female Rectum R ureter Rectum L ureter
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
84 yo woman presenting with epigastric pain and nausea/vomiting
Pancreatitis CT findings include: Enlarged Pancreas Peri-pancreatic fluid possibly a focal ileus RadioGraphics 2004; 24:703–715