plain film abdomen
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Kobkun Muangsomboon MD. Diagnostic Radiology
Department of Radiology Faculty of Medicine, Siriraj Hospital
Interpretation of plain film abdomen
Objective
• techniques : what and when • interpretation : how • limitation of plain film abdomen
Strategies
• detection • description • differential diagnosis • decision
Radiologic abdominal Survey.
- PA or AP erect chest radiograpy - Supine radiograph of the abdomen
including the pelvic floor - Upright radiograph of the abdomen - Lateral decubitus radiograph - Prone radiograph - Lateral radiograph of the abdomen (cross
table )
- organ identification : tissue fat interface, organ enlargement
- abdominal calcifications - bowel gas pattern : dilatation, distribution ,
air - fluid level - extraluminal air : free air / abnormal gas
collection - soft tissue mass
Interpretation
Organ Identification
Organ identification
Abnormal Calcifications
chronic pancreatitis
staghorn stone
stippled calcifications
calcified myoma uteri
tooth-like calcification
dermoid tumor
retroperitoneal teratoma
retroperitoneal teratoma
Limitation
• non-opaque stone • obscured small stone
What is it?
Bowel Gas Pattern
Bowel characteristic Small bowel
• circumferential fold • diameter 3-5 cm • many number of loops • central distribution of
loops • no feces content
Large bowel • haustra • diameter > 5 cm • few number of loops • Peripheral distribution
of loops • feces content
Intestinal obstruction
• distended bowel loops - disproportion of bowel loops diameter gas -
fluid levels at different height in the same loop
- string of pearl appearance
SBO small bowel obstruction: stepladder pattern
SBO small bowel obstruction
closed loops obstruction mid gut volvulus
coffee bean sign: sigmoid volvulus
Ileus
• temporary arrest of intestinal peristalsis • symptoms: nausea, vomiting
abdominal discomfort • causes:
intra-abdominal infection metabolic disturbance drugs
Ileus
Localized ileus
• acute pancreatitis • acute appendicitis single loop dilatation sentinel loop dilatation
Goal of imagings
• to differentiate obstruction or ileus • to determined level of obstruction • to determine cause of obstruction • to look for complication • to plan management
Limitation
acute colonic pseudo-obstruction
fluid filled bowel loops
Extraluminal air
- Pneumoperitoneum : ulcer perforation neoplasm perforation iatrogenic perforation diverticulitis
Extraluminal air
- radiolucency at right upper abdomen - air beneath dome of diaphragm (upright
position) / subdiaphragmatic free air - cupola sign - double wall sign (Rigler sign) - triangular sign - falciform ligament sign
Pneumoperitoneum
Pneumoperitoneum
Pneumoperitoneum
Pneumoperitoneum
- intestinal wall gas: pneumatosis intestinalis ischemic bowel disease obstruction collagen vascular disease
- gas in portal vein: ischemic bowel disease - aerobilia : post sphincterotomy, infection, fistula - intraabdominal abscess with gas formation
Extraluminal air
Pneumatosis intestinalis
small bowel obstruction: dilated small bowel loops, string of pearls and aerobilia
Gallstone Ileus
• plain film : Rigler triad 1. partial / complete small bowel obstruction 86% 2. aerobilia 69% 3. ectopic calcified gallstone (common >2.5 cm
in diameter) 25%
aerobilia
Air in Portal Vein air in portal vein
CXR-upright Lt.lateral decubitus
subdiaphragmatic abscess
Limitation
Limitation
• sensitivity / specificity • timing / late manifestation • difficult to determine cause of abnormality
Pseudopneumo peritoneum
- Interposition of bowel - Distended bowel loops of stomach - Subphrenic abscess - Subpulmonic pneumothorax - Intramural gas
Abnormal soft tissue mass
Limitation • mass characterization • extension
Abnormal density foreign body
coin
lipiodol staining from TACE
TEST
small bowel obstruction
colonic obstruction
Conclusion
• advantage • limitation • clinical information • further investigation / follow up film
Reference
1. Baker SR. The abdominal plain what will be its role in the future? Radiol clin North Am 1993; 31: 1335-44
2. Eisenberg RL. Gastrointestinal Radiology. 3rd ed. Philadelphia: Lippicott-Raven, 1996
3. Maniatis V, Chryssikopoulos H, Roussakis A, Kalamara C, Kavadias S, Papadopoulos A, et al. Perforation of the alimentary tract: evaluation with computed tomography, Abdom Imaging. 2000;25: 373 – 79
4. Marincek B. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies. Eur Radiol. 2002;12 : 2136-50
5. Taourel P, Kessler N, Lesnik A, Blayac PM, Morcos L, Bruel LM. Nontraumatic abdominal emergencies: imaging of acute intestinal obstruction. Eur Radiol. 2002; 12 : 2151-60
Thank you for attention
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