plain film abdomen
TRANSCRIPT
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Kobkun Muangsomboon MD. Diagnostic Radiology
Department of Radiology Faculty of Medicine, Siriraj Hospital
Interpretation of plain film abdomen
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Objective
• techniques : what and when • interpretation : how • limitation of plain film abdomen
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Strategies
• detection • description • differential diagnosis • decision
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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 )
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- 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
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Organ Identification
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Organ identification
Abnormal Calcifications
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chronic pancreatitis
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staghorn stone
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stippled calcifications
calcified myoma uteri
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tooth-like calcification
dermoid tumor
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retroperitoneal teratoma
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retroperitoneal teratoma
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Limitation
• non-opaque stone • obscured small stone
What is it?
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Bowel Gas Pattern
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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
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Intestinal obstruction
• distended bowel loops - disproportion of bowel loops diameter gas -
fluid levels at different height in the same loop
- string of pearl appearance
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SBO small bowel obstruction: stepladder pattern
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SBO small bowel obstruction
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closed loops obstruction mid gut volvulus
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coffee bean sign: sigmoid volvulus
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Ileus
• temporary arrest of intestinal peristalsis • symptoms: nausea, vomiting
abdominal discomfort • causes:
intra-abdominal infection metabolic disturbance drugs
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Ileus
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Localized ileus
• acute pancreatitis • acute appendicitis single loop dilatation sentinel loop dilatation
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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
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Limitation
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acute colonic pseudo-obstruction
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fluid filled bowel loops
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Extraluminal air
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- Pneumoperitoneum : ulcer perforation neoplasm perforation iatrogenic perforation diverticulitis
Extraluminal air
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- 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
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Pneumoperitoneum
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Pneumoperitoneum
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Pneumoperitoneum
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- 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
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Pneumatosis intestinalis
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small bowel obstruction: dilated small bowel loops, string of pearls and aerobilia
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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%
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aerobilia
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Air in Portal Vein air in portal vein
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CXR-upright Lt.lateral decubitus
subdiaphragmatic abscess
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Limitation
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Limitation
• sensitivity / specificity • timing / late manifestation • difficult to determine cause of abnormality
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Pseudopneumo peritoneum
- Interposition of bowel - Distended bowel loops of stomach - Subphrenic abscess - Subpulmonic pneumothorax - Intramural gas
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Abnormal soft tissue mass
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Limitation • mass characterization • extension
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Abnormal density foreign body
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coin
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lipiodol staining from TACE
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TEST
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small bowel obstruction
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colonic obstruction
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Conclusion
• advantage • limitation • clinical information • further investigation / follow up film
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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
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Thank you for attention