CT EVALUATION OF

ACUTE ABDOMEN

DULEEKA WIJEGUNAWARDHANA

CLINICAL FELLOW IN DIAGNOSTIC RADIOLOGY

SIR CHARLES GAIRDNER HOSPITAL

ACUTE ABDOMEN

Sudden, severe abdominal pain

Unclear aetiology

Less than 24 hours

…ctd

Medical / Surgical emergency

Urgent investigations

Specific diagnosis

Prompt treatment

Causes

GIT- Appendicitis, Diverticulitis, Small bowel obstruction, Ischaemic

colitis, Bowel perforation

GUT- Ureteric calculi, Pyelonephritis

Hepato-biliary- Cholecystitis, Pancreatitis

Vascular- Abdominal aortic aneurysm, Aortic dissection,

Intra abdominal haemorrhage

IMAGING MODALITIES

Radiography

Sonography

Computed Tomography

Magnetic Resonance Imaging

Nuclear Medicine

CT PROTOCOL ???

GIT CAUSES

Acute appendicitis

Perforated appendix

Acute diverticulitis

Diverticular abscess

Small Bowel Obstruction

Adhesions

Hernia

Tumour

Small Bowel Obstruction

Incarcerated right inguinal hernia

Bowel Ischaemia

Bowel Ischaemia- Causes

Arterial or venous occlusion

Hypo-perfusion

Bowel obstruction

SMV THROMBOSIS

INTUSSUSCEPTION

Bowel perforation

Duodenitis & Perforated duodenal ulcer

GUT causes

Ureteric calculus

Pyelonephritis

Ureteric calculus

Multi phasic CT

Cortico-medullary

phase

30 sec delay

Nephrographic

phase

70-90 sec delay

Excretory phase

5 min delay

Acute Pyelonephritis

Hepato-biliary system

Emphysematous

cholecystitis

Liver abscess

Haemorrhagic

pancreatic pseudocyst

Vascular Causes

Ruptured abdominal

aortic aneurysm

Aortic dissection

???

Draped aorta sign

High attenuation crescent sign

Retroperitoneal Haemorrhage

On warfarin Renal tumour-AML

Helical CT

-allows rapid & cost effective evaluation of acute abdomen

PROPER TECHNIQUE & PROTOCOL

THE END