Kobkun Muangsomboon MD. Diagnostic Radiology Department of Radiology Faculty of Medicine, Siriraj Hospital Interpretation of plain film abdomen
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