Acute abdomen

Acute Abdomen Radiological Approach Prof Dr. Haney A Sami

Acute Abdomen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Definition ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Causes

Imaging techniques ,[object Object],[object Object],[object Object],[object Object],[object Object]

Imaging techniques ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Value of CT

Common causes of acute pain in an abdominal quadrant ,[object Object],[object Object],[object Object],[object Object],[object Object]

Common causes of acute pain in an abdominal quadrant ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Common causes of acute pain in an abdominal quadrant ,[object Object],[object Object],[object Object]

Pancreatitis Ulcer Diverticulitis Cholecystitis Appendicitis

What to Examine by Plain X-ray ,[object Object],[object Object],[object Object],[object Object],[object Object]

Key to densities in AXRs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Normal Gas Pattern ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Gas in stomach Gas in a few loops of small bowel Gas in rectum or sigmoid Normal Gas Pattern

Normal Fluid Levels ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Erect Abdomen Always air/fluid level in stomach A few air/fluid levels in small bowel

Large vs. Small Bowel ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complete Abdomen Obstruction Series ,[object Object],[object Object],[object Object],[object Object]

Complete Abdomen Supine ,[object Object],[object Object],[object Object],[object Object],[object Object]

Complete Abdomen Erect ,[object Object],[object Object],[object Object],[object Object]

Complete Abdomen Erect Chest ,[object Object],[object Object],[object Object],[object Object],[object Object]

Complete Abdomen Prone ,[object Object],[object Object],[object Object],[object Object]

Abnormal Gas Patterns ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],Localized Ileus Key Features Sentinel Loops Supine Prone

Localized Ileus Pancreatitis Ulcer Diverticulitis Cholecystitis Appendicitis Sentinel Loops

Localized Ileus Pitfalls ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Generalized Ileus Key Features

Generalized Adynamic Ileus Supine Erect

Is It An Ileus? ,[object Object],[object Object]

Mechanical SBO Key Features ,[object Object],[object Object],[object Object],[object Object],SBO

Mechanical SBO Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],*Cause may be visible on plain film

Mechanical SBO Pitfalls ,[object Object]

Differentiation between SBO & ILEUS ,[object Object],[object Object],[object Object]

Mechanical LBO Key Features ,[object Object],[object Object],[object Object],[object Object]

Mechanical LBO Causes ,[object Object],[object Object],[object Object],[object Object],[object Object]

Mechanical LBO Pitfalls ,[object Object],[object Object],[object Object],[object Object]

Carcinoma of Sigmoid – LBO – Decompressed into SB Prone Supine

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Air in biliary tree Gallstone Gallstone Ileus

Post-op C-section Adynamic Ileus

Abnormal Gas Patterns Ileus and Obstruction ,[object Object],[object Object],[object Object],[object Object]

Conditions causing extraluminal air ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Chilaiditi’s syndrome ,[object Object],[object Object]

Extraluminal Air Free Intraperitoneal Air

Signs of Free Air ,[object Object],[object Object],[object Object],[object Object],Crescent sign Free Intraperitoneal Air

Free Air Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Soft Tissue Masses ,[object Object],[object Object],[object Object],[object Object]

Bladder Outlet Obstruction – pre- and post- cath Hours later

Normal structures that calcify ,[object Object],[object Object],[object Object],[object Object]

Abnormal structures that contain calcium ,[object Object],[object Object],[object Object],[object Object],[object Object]

Abnormal structures that contain calcium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Abdominal Calcifications Patterns ,[object Object],[object Object],[object Object],[object Object]

Rimlike Calcification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Renal Cyst Gallbladder Wall

Linear or Track-like ,[object Object],[object Object],[object Object],Atherosclerosis Calcification Vas Deferens

Lamellar or Laminar ,[object Object],[object Object],[object Object],[object Object],Stone in Ureterocoele Staghorn Calculi

Cloudlike, Amorphous, Popcorn ,[object Object],[object Object],[object Object],Nephrocalcinosis Myomatous Uterus

Visceral Inflammation Colitis Appendicitis Diverticulitis Bowel Inflammation Cholecystitis Pancreatitis

Inflammation - Cholecystitis ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object]

Thickening of gallbladder wall Cholelithiasis .

Pancreatitis ,[object Object],[object Object],[object Object]

Notice the peripancreatic stranding ( bars ) as well as the fluid thickening of the interfascial space

[object Object],[object Object]

Appendicitis ,[object Object],[object Object],[object Object]

This image of an acute abdomen ( arrow ) displays periappendicial stranding and dilattion of its terminal portion .

For comparison, this image of a normal appendix can be visualized at the ileocecal junction . Also notethe fat ventralcontaining heria

Inflammation - Colitis ,[object Object],[object Object],[object Object]

This example of colitis shows thickening of the colon and pericolonic stranding typical of inflammation .

Thickening of sigmoid colon due to pseudomembranous colitis

A case of diverticulitis showing a thickened sigmoid colon and a diverticulum

Distal ureteral stone lead ing to right hyrdronephrosis in above image Ureteral junctional stone Renal Colic

Renal stone right sided hydronephrosis Renal Colic

Acute abdomen

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Acute abdomen