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8/9/2019 Radiology of the Acute Abdomen
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8/9/2019 Radiology of the Acute Abdomen
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IntoductionIntoduction
P#ain fi#m ra$i!#!gy
Initia# in%estigati!n t! $etermine seri!uspath!#!gy
&he se'!n$(#ine in%estigati!ns areu#tras!un$ an$ '!mpute$ t!m!graphy
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8/9/2019 Radiology of the Acute Abdomen
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&(s'an
the -est
e+aminati!n t! in%estigate a-$!mina#trauma
its superi!r three $imensi!na#re'!nstru'ti!n 'apa-i#ity
it in%!#%es a signifi'ant ra$iati!n $!se
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!rma# a-$!mina# ra$i!graph ith
an unremarka-#e -!e# gas
pattern. &here is n! e%i$en'e !f
free gas. !rma# s!ft tissue
stru'tures su'h as the ki$neys*arr!hea$s, an$ ps!as sha$!s
*arr!s, are e## $em!nstrate$
an$ there are n! a-n!rma#
'a#'ifi'ati!ns.
&he a-$!mina# ra$i!graph
is taken as a supine
anteri!r(p!steri!r fi#m
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Approach to evaluating
abdominal radiographs
Approach to evaluating
abdominal radiographs
&he a-$!mina#
ra$i!graph is takenas a supine anteri!r(p!steri!r fi#m
the first(#ine
in%estigati!n f!r-!e# !-stru'ti!n
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&! interpret the a-$!mina# ra$i!graph it
is imp!rtant t! systemati'a##y 'he'k the
f!##!ing3
&! interpret the a-$!mina# ra$i!graph it
is imp!rtant t! systemati'a##y 'he'k the
f!##!ing3
4
Assess f!r free intra(perit!nea# gas !r gas in an unusua# p#a'e su'h as an !rgan1
2
3
Assess the -!e# gas pattern #!!king f!r e%i$en'e !f -!e# !-stru'ti!n
Assess the s!ft tissue stru'tures that are %isi-#e.
A#s! assess f!r 'a#'ifi'ati!ns in the s!ft tissue stru'tures
Assess the %isi-#e -!nes
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Radiological assessment
and classical signs
Radiological assessment
and classical signs
&he main in$i'ati!ns f!r imaging in
a'ute a-$!mina# pain3 suspe'te$
perf!rati!n4 !-stru'ti!n !r rena#
'!#i'
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.
Assessing gas
/re't 'hest ra$i!graph $em!nstrating free intraperit!nea# gas
-e#! the $iaphragm *arr!s, in$i'ati%e !f -!e# perf!rati!n.
In the in%estigati!n !f
-!e# perf!rati!n a e##(
penetrate$ ere't 'hest
ra$i!graph is the m!stusefu# in%estigati!n t!
assess f!r free
intraperit!nea# gas -e#!
the $iaphragm
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A-$!mina# ra$i!graph
$em!nstrating. Rig#ers sign that is
'hara'teristi' !f -!e# perf!rati!n.
Arr! $em!nstrates -!e# a## that
is easi#y i$entifie$ -e'ause !f gas
!n -!th si$es !f the -!e#.
Pitfalls
&he a-sen'e !f free gas $!es n!t
e+'#u$e perf!rati!n
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A supineanter!p!steri!r
a-$!mina#
ra$i!graph
t! $etermine thepresen'e !f sma## !r
#arge -!e#!-stru'ti!n
intra%en!us '!ntrast(enhan'e$ '!mpute$t!m!graphy s'an !f
the a-$!men
o!el gas pattern
"suspected obstruction#
t! i$entify the 'ause !f the !-stru'ti!n
t! he#p p#an appr!priate patient management
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Interpretation of bo!el gas patterns in bo!el obstruction
A-$!mina# ra$i!graph sh!ing
$i#ate$ -!e# in the 'entre !f the
a-$!men ith %isi-#e %a#%u#ae
'!nni%entes *arr!, that is'hara'teristi' !f sma## -!e#
!-stru'ti!n.
If the sma## -!e# is $i#ate$ an$
there is n! '!#!ni' gas4 there is
#ike#y t! -e a '!mp#ete
me'hani'a# sma## -!e#
!-stru'ti!n
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Interpretation of bo!el gas patterns in bo!el obstruction
A-$!mina# ra$i!graph sh!ing $i#ate$sma## *#arge arr!hea$, an$ #arge -!e#
*sma## arr!, 'ause$ -y a sp#eni'
f#e+ure -!e# tum!ur. Sma## -!e#
$i#ati!n is present -e'ause !f an
in'!mpetent i#e!'ae'a# %a#%e.
in'!mp#ete me'hani'a# !-stru'ti!n
!r
a #!'a#ize$ para#yti' i#eus
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Interpretation of bo!el gas patterns in bo!el obstruction
A-$!mina# ra$i!graphs sh!ing
$i#ate$ -!e# in the periphery !fthe a-$!men ith teniae '!#i
'hara'teristi' !f #arge -!e#
!-stru'ti!n
arge -!e# !-stru'ti!n ith a
'!mpetent i#e!'ae'a# %a#%e
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$ther specific causes of obstruction
!#%u#us !fthe -!e#
#arge -!e#!-stru'ti!n
sigm!i$%!#%u#us
the
-!e# gaspattern #!!ks#ike a '!ffee
-ean !r in%erte$7 shape
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A-$!mina# ra$i!graph
$em!nstrating 'ae'a#%!#%u#us that reuire$
surgi'a# $e'!mpressi!n.
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A-$!mina# ra$i!graph sh!ing a 7target sign !r
7'!i#e$ spring type appearan'e in the #eft f#ank
*hite arr!, ith pr!+ima# sma## -!e# $i#ati!n
*-#a'k arr!, 'hara'teristi' !f intussus'epti!n.
an!ther 'ause !f sma##-!e# !-stru'ti!n
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&he ga## -#a$$er is fi##e$
ith gas *arr!, inemphysemat!us
'h!#e'ystitis.
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Assessing the soft tissues and calcifications
Ruptured abdominal aortic aneurysm
!ss !f the right ps!as sha$! an$
$isp#a'ement !f a## 'a#'ifi'ati!n*arr!, in a rupture$ a-$!mina# a!rti'
aneurysm.
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&uspected renal colic
i$ney ureter -#a$$er ra$i!graph sh!ing right ureteri'
'a#'u#us *arr!, at the #e%e# !f : %erte-ra an$ se%era# sma##'a#'u#i ithin the #eft ki$ney.
!n('!ntrast '!mpute$ t!m!graphy !f
the ki$neys4 ureter an$ -#a$$er
first(#ine in%estigati!n
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Assessing the visible bones
;(Ray)ra'ture !f the
#!er ri-s
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Trauma' penetrating or blunt in(ury
P#ain a-$!mina# ra$i!graphy is
n!t in$i'ate$
#tras!un$ !r '!mpute$
t!m!graphy
l
e
s
s
a retaine$ f!reign -!$y is suspe'te$ as rapi$ assessment !f thein=ury is 'riti'a# an$ a $e#ay in'reases m!r-i$ity an$ m!rta#ity
>aem!$ynami'a##y sta-#e patients t! assess
the $egree !f in=uries
In an unsta-#e patient
urgent surgery
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)onclusions)onclusions
P#ain ra$i!graph is sti## the first #ine !f in%estigati!n in the %astma=!rity !f patients presenting ith a'ute a-$!men
Systemati' assessment !f the a-$!mina# ;(ray i## he#p$ete't the un$er#ying s!ur'e !f the a'ute a-$!men in many
'ases -ef!re pr!'ee$ing ith 'r!ss(se'ti!na# imaging su'has '!mpute$ t!m!graphy
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Than* you+Than* you+