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ACUTE ABDOMEN

ACUTE ABDOMEN. ABNORMAL GAS COLLECTIONS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY. OR. GAZ. ACUTE ABDOMEN EXAMINATION. RADIOGRAPHS LEFT LATERAL DECUBITUS ABDOMEN UPRIGHT ABDOMENT UPRIGHT CHEST SUPINE ABDOMEN. PNEUMOPERITONEUM. FREE AIR SENSITIVITY OF IMAGING STUDIES.

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ACUTE ABDOMEN

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  1. ACUTE ABDOMEN ABNORMAL GAS COLLECTIONS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY

  2. OR GAZ

  3. ACUTE ABDOMENEXAMINATION • RADIOGRAPHS • LEFT LATERAL DECUBITUS ABDOMEN • UPRIGHT ABDOMENT • UPRIGHT CHEST • SUPINE ABDOMEN

  4. PNEUMOPERITONEUM

  5. FREE AIR SENSITIVITY OF IMAGING STUDIES • COMPUTED TOMOGRAPHY 99% • LATERAL UPRIGHT CHEST RADIOGRAPH 98% • AP UPRIGHT CHEST RADIOGRAPH 80 - 90% • LEFT DECUBITUS ABDOMEN RADIOGRAPH 80- 90% • SUPINE ABDOMEN RADIOGRAPH ?

  6. PNEUMOPERITONEUM SENSITIVITY OF IMAGING STUDIES • RADIOLOGIC DEMONSTRATION DEPENDS ON: • VOLUME OF FREE AIR • TIME INTERVAL BEFORE IMAGING • TYPE OF IMAGING • CONDUCT OF IMAGING EXAMINATION • AS LITTLE AS ONE CC CAN BE DEMONSTRATED • 10% OF PATIENTS WITH PERFORATED ULCERS DO NOT DEMONSTRATE PNEUMOPERITONEUM

  7. UPRIGHT CHEST

  8. PNEUMOPERITONEUMUPRIGHT RADIOGRAPHS UPRIGHT ABD CENTRAL TENDON AND HEMIDIAPHRAGM UNDER RIGHT HEMIDIAPHRAGM

  9. FREE AIR…….DECUBITUS VIEWGAS BETWEEN LIVER AND BODY WALLBUT MAY ALSO BE IN OR ONLY IN THE PELVIS

  10. ACUTE ABDOMINAL PAINUPRIGHT AP CHEST & LEFT LATERAL DECUB NEGATIVE

  11. PNEUMOPERITONEUM SUPINE RADIOGRAPHS

  12. GAS BUBBLE ON LIVER SURFACE

  13. FREE AIRCENTRAL TENDON

  14. FREE AIRCENTRAL TENDON

  15. RIGLER’S SIGNBOTH SIDES OF BOWEL WALL VISIBLE DOUBLE WALL SIGN

  16. MASSIVE PNEUMOPERITONEUMFOOTBALL SIGN

  17. FALCIFORM LIGAMENTGAS BUBBLE OVER LIVER

  18. FALCIFORM LIGAMENT

  19. PNEUMOPERITONEUMSUBHEPATIC GAS BUBBLE

  20. DIVERTICULITIS PNEUMOPERITONEUM

  21. ANTERIOR ABDOMINAL WALLANATOMIC FOLDS

  22. FREE AIRINFERIOR EPIGASTRIC VESSELS(LATERAL UMBILICAL LIGAMENTS)

  23. FREE AIR 2 DAYS AFTER OHT CT 3 DAYS LATER: DIVERTICULITIS

  24. PNEUMOPERITONEUMWITH PERITONITIS • PERFORATED VISCUS • ULCER • NEOPLASM • BOWEL OBSTRUCTION • ISCHEMIC BOWEL • TRAUMA • TRAUMA • PERITONITIS • GAS FORMING ORGANISM

  25. PSEUDO-PNEUMOPERITONEUM

  26. CENTRAL TENDON GAS YES, BUT JUST THE STOMACH

  27. GAS UNDER THE RIGHT HEMIDIAPHRAGM HEPATIC FLEXURE ANTERIOR-SUPERIOR TO LIVER

  28. SUBDIAPHRAGMATIC FATSIMULATING FREE AIR

  29. FREE AIR OR NOT FREE AIR?THAT IS THE QUESTION PNEUMOTHORAX SIMULATES FREE AIR

  30. GAS IN SUBPHRENIC ABSCESS SIMULATES FREE AIR

  31. RETROPERITONEAL GASSIMULATES FREE AIR

  32. RETROPERITONEAL GAS

  33. RETROPERITONEAL GAS IMAGING • LITTLE CHANGE IN POSITION OR SHAPE WHEN COMPARING SUPINE, UPRIGHT, DECUB RADIOGRAPHS • BUT FREE INTRAPERITONEAL GAS IS FREELY MOBILE • TENDS TO STAY IN ONE RETROPERITONEAL COMPARTMENT • DUODENAL PERFORATION…..RUQ ANTERIOR PARARENAL SPACE • SIGMOID DIVERTICULITIS….. LLQ • PERIRENAL ABSCESS…………. PERINEPHRIC SPACE • OFTEN FORMS LINEAR, CURVILINEAR GAS COLLECTIONS

  34. 49-YEAR-OLD MAN WITH FEVER AND DIARRHEA FOR 2 WEEKS. HE HAS INFECTED URINE

  35. RETROPERITONEAL GAS IMAGING • BENEATH DIAPHRAGM CAN SIMULATE PNEUMOTHORAX • BUT MEDIAL, LATERAL, LOW NOT DIRECTLY UNDER APEX AS FREE AIR • DIFFERENTIATE BY OBTAINING UPRIGHT OR DECUBITUS VIEWS • LARGE VOLUME OF GAS CAN OUTLINE RETROPERITONEAL STRUCTURES • KIDNEY, LIVER MARGIN, PSOAS, FLANK STRIPE • RETROPERITONEAL GAS CAN EXTEND • CEPHALAD TO MEDIASTINUM • FASCIAL PLANES OF BODY WALL AND EXTREMITIES • INTO PERITONEAL CAVITY

  36. RETROPERITONEAL GAS

  37. 13-YEAR-OLD GIRL WITH CROHN’S DISEASE HAS SUBACUTE FEVER AND ABD PAIN

  38. RETROPERITONEAL GASEXTENDS TO POSTERIOR PARARENAL SPACE & THEN PROPERITONEAL FAT

  39. ABDOMINAL PAIN 4 HOURS AFTER COLONOSCOPY AND BIOPSY EXTENSIVE RETROPERITONEAL GAS

  40. BAROTRAUMAMEDIASTINUM – RETROPERITONEUM – FREE AIR

  41. RETROPERITONEAL GASCAUSES • IATROGENIC • SURGERY • DIAGNOSTIC PROCEDURE • TRAUMA • PENETRATING • RUPTURED VISCUS • RETROPERITONEAL DUODENUM, COLON, RECTUM • PERFORATED BOWEL • SECONDARY TO TUMOR, INFECTION, OBSTRUCTION, NECROSIS • CAUDAL EXTENSION OF PNEUMOMEDIASTINUM • GAS WITHIN ABSCESS

  42. BOWEL WALL GAS

  43. PNEUMATOSIS OF COLONINFANTADULT NECROTIZING ENTEROCOLITIS ISCHEMIC COLITIS

  44. WHAT IS THE ABNORMALITY HERE? USE LUNG WINDOWS TO LOOK FOR GAS

  45. 72-YEAR-OLD WOMAN WITH DIARREHA FOR 2 DAYSNORMAL PHYSICAL EXAMINATION

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