Radiology of the Acute Abdomen

8/9/2019 Radiology of the Acute Abdomen

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IntoductionIntoduction

P#ain fi#m ra$i!#!gy

Initia# in%estigati!n t! $etermine seri!uspath!#!gy

&he se'!n$(#ine in%estigati!ns areu#tras!un$ an$ '!mpute$ t!m!graphy


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&(s'an

the -est

e+aminati!n t! in%estigate a-$!mina#trauma

its superi!r three $imensi!na#re'!nstru'ti!n 'apa-i#ity

it in%!#%es a signifi'ant ra$iati!n $!se


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!rma# a-$!mina# ra$i!graph ith

an unremarka-#e -!e# gas

pattern. &here is n! e%i$en'e !f

free gas. !rma# s!ft tissue

stru'tures su'h as the ki$neys*arr!hea$s, an$ ps!as sha$!s

*arr!s, are e## $em!nstrate$

an$ there are n! a-n!rma#

'a#'ifi'ati!ns.

&he a-$!mina# ra$i!graph

is taken as a supine

anteri!r(p!steri!r fi#m


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Approach to evaluating

abdominal radiographs

Approach to evaluating

abdominal radiographs

&he a-$!mina#

ra$i!graph is takenas a supine anteri!r(p!steri!r fi#m

the first(#ine

in%estigati!n f!r-!e# !-stru'ti!n


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&! interpret the a-$!mina# ra$i!graph it

is imp!rtant t! systemati'a##y 'he'k the

f!##!ing3

&! interpret the a-$!mina# ra$i!graph it

is imp!rtant t! systemati'a##y 'he'k the

f!##!ing3

4

Assess f!r free intra(perit!nea# gas !r gas in an unusua# p#a'e su'h as an !rgan1

2

3

Assess the -!e# gas pattern #!!king f!r e%i$en'e !f -!e# !-stru'ti!n

Assess the s!ft tissue stru'tures that are %isi-#e.

A#s! assess f!r 'a#'ifi'ati!ns in the s!ft tissue stru'tures

Assess the %isi-#e -!nes


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Radiological assessment

and classical signs

Radiological assessment

and classical signs

&he main in$i'ati!ns f!r imaging in

a'ute a-$!mina# pain3 suspe'te$

perf!rati!n4 !-stru'ti!n !r rena#

'!#i'


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.

Assessing gas

/re't 'hest ra$i!graph $em!nstrating free intraperit!nea# gas

-e#! the $iaphragm *arr!s, in$i'ati%e !f -!e# perf!rati!n.

In the in%estigati!n !f

-!e# perf!rati!n a e##(

penetrate$ ere't 'hest

ra$i!graph is the m!stusefu# in%estigati!n t!

assess f!r free

intraperit!nea# gas -e#!

the $iaphragm


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A-$!mina# ra$i!graph

$em!nstrating. Rig#ers sign that is

'hara'teristi' !f -!e# perf!rati!n.

Arr! $em!nstrates -!e# a## that

is easi#y i$entifie$ -e'ause !f gas

!n -!th si$es !f the -!e#.

Pitfalls

&he a-sen'e !f free gas $!es n!t

e+'#u$e perf!rati!n


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A supineanter!p!steri!r

a-$!mina#

ra$i!graph

t! $etermine thepresen'e !f sma## !r

#arge -!e#!-stru'ti!n

intra%en!us '!ntrast(enhan'e$ '!mpute$t!m!graphy s'an !f

the a-$!men

o!el gas pattern

"suspected obstruction#

t! i$entify the 'ause !f the !-stru'ti!n

t! he#p p#an appr!priate patient management


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Interpretation of bo!el gas patterns in bo!el obstruction

A-$!mina# ra$i!graph sh!ing

$i#ate$ -!e# in the 'entre !f the

a-$!men ith %isi-#e %a#%u#ae

'!nni%entes *arr!, that is'hara'teristi' !f sma## -!e#

!-stru'ti!n.

If the sma## -!e# is $i#ate$ an$

there is n! '!#!ni' gas4 there is

#ike#y t! -e a '!mp#ete

me'hani'a# sma## -!e#

!-stru'ti!n


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A-$!mina# ra$i!graph sh!ing $i#ate$sma## *#arge arr!hea$, an$ #arge -!e#

*sma## arr!, 'ause$ -y a sp#eni'

f#e+ure -!e# tum!ur. Sma## -!e#

$i#ati!n is present -e'ause !f an

in'!mpetent i#e!'ae'a# %a#%e.

in'!mp#ete me'hani'a# !-stru'ti!n

!r

a #!'a#ize$ para#yti' i#eus


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A-$!mina# ra$i!graphs sh!ing

$i#ate$ -!e# in the periphery !fthe a-$!men ith teniae '!#i

'hara'teristi' !f #arge -!e#

!-stru'ti!n

arge -!e# !-stru'ti!n ith a

'!mpetent i#e!'ae'a# %a#%e


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$ther specific causes of obstruction

!#%u#us !fthe -!e#

#arge -!e#!-stru'ti!n

sigm!i$%!#%u#us

the

-!e# gaspattern #!!ks#ike a '!ffee

-ean !r in%erte$7 shape


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A-$!mina# ra$i!graph

$em!nstrating 'ae'a#%!#%u#us that reuire$

surgi'a# $e'!mpressi!n.


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A-$!mina# ra$i!graph sh!ing a 7target sign !r

7'!i#e$ spring type appearan'e in the #eft f#ank

*hite arr!, ith pr!+ima# sma## -!e# $i#ati!n

*-#a'k arr!, 'hara'teristi' !f intussus'epti!n.

an!ther 'ause !f sma##-!e# !-stru'ti!n


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&he ga## -#a$$er is fi##e$

ith gas *arr!, inemphysemat!us

'h!#e'ystitis.


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Assessing the soft tissues and calcifications

Ruptured abdominal aortic aneurysm

!ss !f the right ps!as sha$! an$

$isp#a'ement !f a## 'a#'ifi'ati!n*arr!, in a rupture$ a-$!mina# a!rti'

aneurysm.


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&uspected renal colic

i$ney ureter -#a$$er ra$i!graph sh!ing right ureteri'

'a#'u#us *arr!, at the #e%e# !f : %erte-ra an$ se%era# sma##'a#'u#i ithin the #eft ki$ney.

!n('!ntrast '!mpute$ t!m!graphy !f

the ki$neys4 ureter an$ -#a$$er

first(#ine in%estigati!n


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Assessing the visible bones

;(Ray)ra'ture !f the

#!er ri-s


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Trauma' penetrating or blunt in(ury

P#ain a-$!mina# ra$i!graphy is

n!t in$i'ate$

#tras!un$ !r '!mpute$

t!m!graphy

l

e

s

s

a retaine$ f!reign -!$y is suspe'te$ as rapi$ assessment !f thein=ury is 'riti'a# an$ a $e#ay in'reases m!r-i$ity an$ m!rta#ity

>aem!$ynami'a##y sta-#e patients t! assess

the $egree !f in=uries

In an unsta-#e patient

urgent surgery


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)onclusions)onclusions

P#ain ra$i!graph is sti## the first #ine !f in%estigati!n in the %astma=!rity !f patients presenting ith a'ute a-$!men

Systemati' assessment !f the a-$!mina# ;(ray i## he#p$ete't the un$er#ying s!ur'e !f the a'ute a-$!men in many

'ases -ef!re pr!'ee$ing ith 'r!ss(se'ti!na# imaging su'has '!mpute$ t!m!graphy


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Than* you+Than* you+

Radiology of the Acute Abdomen

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Transcript of Radiology of the Acute Abdomen