X raysX rays

SurgerySurgery

Barium swallow-lateral view-1Barium swallow-lateral view-1

Mass in mid oesophagus-shouldering and Mass in mid oesophagus-shouldering and irregular shadow irregular shadow

Shadow-persistent in various films and Shadow-persistent in various films and fluoroscopic controlfluoroscopic control

D/D-carcinoma; mass out oesophagus D/D-carcinoma; mass out oesophagus e.g.mediastinal masse.g.mediastinal mass

Confirmation-oesophagoscopy and biopsy Confirmation-oesophagoscopy and biopsy and rule out bronchus invasionand rule out bronchus invasion

Barium swallow-2Barium swallow-2

Hugely dilated oesophagus with narrow Hugely dilated oesophagus with narrow lower end rat tail appearance)lower end rat tail appearance)

D/D-Achalasia cardia, carcinoma lower D/D-Achalasia cardia, carcinoma lower end oesophagus , strictureend oesophagus , stricture

Confirmation-oesophagoscopy and Confirmation-oesophagoscopy and manometrymanometry

Biopsy and follow up Biopsy and follow up

Barium meal-stomachBarium meal-stomach

Mucosal irregularity, no mass, no ulcer Mucosal irregularity, no mass, no ulcer cratercrater

Upper GI scopy and biopsy (well targeted Upper GI scopy and biopsy (well targeted at least 10 biopsy to rule out carcinoma)at least 10 biopsy to rule out carcinoma)

H.pylori infection –if present , should be H.pylori infection –if present , should be treatedtreated

Follow up Follow up

EnteroclysisEnteroclysis

Intubation of jejunum and instillation of Intubation of jejunum and instillation of contrast media through the tubecontrast media through the tube

Films- head of the barium column followed Films- head of the barium column followed till ICJ.till ICJ.

Indication-Tumours , Diarrhoea , Indication-Tumours , Diarrhoea , unexplained abdominal painunexplained abdominal pain

Findings-dilatation of jejunum with Findings-dilatation of jejunum with narrowing of a segmentnarrowing of a segment

CI-complete obstructionCI-complete obstruction

PneumoperitoneumPneumoperitoneum

D/D-Peptic ulcer perforationD/D-Peptic ulcer perforation Inflammation and perforation-Inflammation and perforation-

Diverticulitis,appendicitis, toxic mega colonDiverticulitis,appendicitis, toxic mega colon Iatrogenic-surgery or procedures which Iatrogenic-surgery or procedures which

puts air inside peritoneumputs air inside peritoneum Infarction-intestineInfarction-intestinePnuematosis coli-cyst rupturesPnuematosis coli-cyst ruptures

X-ray chest with dome of X-ray chest with dome of diaphragmdiaphragm

D/D-Subphrenic abscess, Hepatic D/D-Subphrenic abscess, Hepatic abscessabscess

Mostly followed by peritonitis,laparotomy.Mostly followed by peritonitis,laparotomy.

Treatment-Aspiration(Pig tail)Treatment-Aspiration(Pig tail)

Barium mealBarium meal

Dialated stomach and duodenumDialated stomach and duodenumDiagnosis- Wilkie’s syndrome (Superior Diagnosis- Wilkie’s syndrome (Superior

Mesenteric Syndrome) Mesenteric Syndrome) D/D—duodenal tumours, mechanical D/D—duodenal tumours, mechanical

obstruction,Extra mural tumour, obstruction,Extra mural tumour, Secondaries, LymphomasSecondaries, Lymphomas

Confirmation-Upper G I Confirmation-Upper G I scopy,Peritonioscopy, CT ,and CT guided scopy,Peritonioscopy, CT ,and CT guided biopsybiopsy

Plain X-ray abdomenPlain X-ray abdomen

Findings-Dialated bowel loops, with Findings-Dialated bowel loops, with multiple gas and fluid levelmultiple gas and fluid level

Diagnosis- Large bowel obstructionDiagnosis- Large bowel obstructionCommon causes-Common causes-

peritonitis,tumour,tortion,volvulus etc.peritonitis,tumour,tortion,volvulus etc.Tt-emergency surgeryTt-emergency surgery

X-ray chest-PA viewX-ray chest-PA view

Multiple round opaque shadow in both Multiple round opaque shadow in both lung fieldlung field

D/D-Breast, D/D-Breast, thyroid,Kidney,testis,GIT,Sarcomathyroid,Kidney,testis,GIT,Sarcoma

Sometimes get confused with Sometimes get confused with tuberculosis(miliary tubeculosis)tuberculosis(miliary tubeculosis)

Revised diagnosis and repeat x-raysRevised diagnosis and repeat x-rays

Plain-xray abdomenPlain-xray abdomen

Radio-opaque shadow in rt upper Radio-opaque shadow in rt upper abdomen abdomen

D/D-renal stone, gall stone, calcified lymph D/D-renal stone, gall stone, calcified lymph nodes,Faecolith, phlebolithnodes,Faecolith, phlebolith

Lateral view-ray abdomen after Lateral view-ray abdomen after preparation)preparation)

USG,IVUUSG,IVU

Intra venous urogramIntra venous urogram

Indications- Hydronephrosis- dilatation of renal Indications- Hydronephrosis- dilatation of renal pelvices and calycespelvices and calyces

Polycystic kidney disease- Spider-leg Polycystic kidney disease- Spider-leg appearanceappearance

Limitations-Diabetes, renal failure, Dye Limitations-Diabetes, renal failure, Dye reactions, Multiple Myelomareactions, Multiple Myeloma

Near normal-present filmNear normal-present film

T-tube cholangiogramT-tube cholangiogram

Findings-dialated CBD, radiolucent Findings-dialated CBD, radiolucent shadow at the lower end of CBD, Rt and lt shadow at the lower end of CBD, Rt and lt hepatic duct near normalhepatic duct near normal

T-tube cholangiogram-done after 2 wks to T-tube cholangiogram-done after 2 wks to report about residual stonereport about residual stone

Tract forms-extraction can be done Tract forms-extraction can be done through tract or Endoscopical extractionthrough tract or Endoscopical extraction

Barium enema-Air double contrastBarium enema-Air double contrast

Mucosal irregularities and polyps can be Mucosal irregularities and polyps can be identifiedidentified

D/D-carcinoma, ulcerative colitisD/D-carcinoma, ulcerative colitisConfirmation-colonoscopy and biopsyConfirmation-colonoscopy and biopsyPresentation.??Presentation.??

Barium enema-air double contrastBarium enema-air double contrast

Filling defect at recto-sigmoid junctionFilling defect at recto-sigmoid junction

Confirmation-colonoscopy and biopsyConfirmation-colonoscopy and biopsy

Tt????Tt????

Barium enema-double contrastBarium enema-double contrast

Changes pertaining to Ulcerative colitisChanges pertaining to Ulcerative colitisLoss of haustrations(more so on left side Loss of haustrations(more so on left side

of the colon)of the colon)Granulations,Psuedopolyps(not clear hereGranulations,Psuedopolyps(not clear herePresentation????Presentation????D/D-Tuberculosis,carcinomaD/D-Tuberculosis,carcinoma

Barium enema-Air double contrastBarium enema-Air double contrast

Showing entire colonShowing entire colon

Saw-tooth appearanceSaw-tooth appearance

Diverticulosis-Sigmoid and left colonDiverticulosis-Sigmoid and left colon

Complications ?????Complications ?????

Symptoms-????Symptoms-????

Barium enemaBarium enema

““Claw” like endingClaw” like endingTypical findings of intussusceptionTypical findings of intussusceptionMost likely –ileo colic Most likely –ileo colic Causes-Polyp, over growth of lymphatic Causes-Polyp, over growth of lymphatic

tissue esp in child, malignant growth in old tissue esp in child, malignant growth in old ageage

Presentation???? Presentation????

LoopogramLoopogram

Indication-To rule out any distal Indication-To rule out any distal obstructions, to look for healing of the obstructions, to look for healing of the anastomosisanastomosis

Seems no obstructionSeems no obstruction

Apart from imaging , colonoscopy can also Apart from imaging , colonoscopy can also be donebe done

Endoscopic retrograde Endoscopic retrograde cholangiopancreatography(ERCP) cholangiopancreatography(ERCP)

Findings-pancreatic calcifications and non Findings-pancreatic calcifications and non dialated pancreatic duct can be seen dialated pancreatic duct can be seen

CBD not seenCBD not seen

ERCP can also be used to get tissue ERCP can also be used to get tissue diagnosisdiagnosis

Oral CholecystogramOral Cholecystogram

Normal contracting Gall bladderNormal contracting Gall bladder

To evaluate gall bladder function and to To evaluate gall bladder function and to rule out stones.rule out stones.

OBSOLETEOBSOLETE

MammogramMammogram

Cranio-caudal- does not show axillary tail and Cranio-caudal- does not show axillary tail and axillary lymphnodesaxillary lymphnodes

Medio-lateral oblique- Inner quadrants are not Medio-lateral oblique- Inner quadrants are not seen wellseen well

Findings-Irregular mass in medial upper Findings-Irregular mass in medial upper quadrant (Rt breast), no calcification seenquadrant (Rt breast), no calcification seen

Left breast-near normalLeft breast-near normal Indications-Screening, Doubtful mass, for contra Indications-Screening, Doubtful mass, for contra

lateral breast in pt with breast cancer, follow up lateral breast in pt with breast cancer, follow up (after breast conservative Tt of ca breast)(after breast conservative Tt of ca breast)

Lower limb angiogramLower limb angiogram

Findings-occlusion of popliteal artery (around Findings-occlusion of popliteal artery (around knee) , segmental blockknee) , segmental block

Collaterals forming anterior and posterior tibialCollaterals forming anterior and posterior tibial

Causes- Atherosclerosis,InflammationCauses- Atherosclerosis,Inflammation

Tt-???Tt-???

SplenoportovenographySplenoportovenography

Findings-hugely dialated portal and spleen Findings-hugely dialated portal and spleen vein, with collateralsvein, with collaterals

Obsolete-portal hypertension, to study Obsolete-portal hypertension, to study portal venous anatomyportal venous anatomy

USG with Doppler to assess the PV , USG with Doppler to assess the PV , splenic vein, collateralssplenic vein, collaterals

UGI scopyUGI scopyCT scanCT scan

Thank youThank you