abdominal imaging

GASTROINTESTINAL IMAGING MII - Lecture Dr Jeanette Fulton 2/2009 GASTROINTESTINAL IMAGING • Anatomy – – – – Esophagus Stomach Small Intestine Colon • Imaging Studies – Xray with Barium or water soluable contrast – CT – Nuclear Medicine NORMAL SWALLOW ASPIRATION Contrast tracks anteriorly into trachea with aspiration GI IMAGING Single AP radiograph Showing filling of the stomach and proximal small bowel without mass, obstruction or filling defect AP SUPINE ABDOMEN XRAY GAS PATTERN STOMACH COLON SM BOWEL Normal abdominal gas pattern with air in the stomach and scattered non-distended loops of large and small bowel ESOPHAGEAL DISEASE • • • • • • • ESOPHAGEAL CANCER HIATAL HERNIA VARICES CANDIDA MALLORY-WEISS TEAR BOERHAAVE’S SYNDROME ACHALASIA SIGNS / SYMPTOMS • CHEST PAIN • DIFFICULTY SWALLOWING • HOARSENESS NORMAL ESOPHAGUS Normal double contrast esophagram (barium coating and air distention) Effervescent granules release air with ingestion PATHOLOGY/RADIOLOGY CORRELATION Pathology image X ray image ESOPHAGEAL CANCER Typical squamous cell carcinoma Poor prognosis from local extension into critical mediastinal structures (esophagus lacks a serosa) DIVERTICULITIS Black arrow thickened bowel wall, white arrow air in tic NORMAL SMA ARTERIOGRAM Catheter is placed in superior mesenteric artery showing normal filling of small and large intestinal branches ABNORMAL SMA ARTERIOGRAM GI BLEED Subtracted SMA arteriogram shows contrast collecting at site of active bleeding in Rt lower quadrant NUCLEAR MEDICINE Technetium-labeled RBC’S Labeled red blood cells are imaged over hour showing extravasation in Rt colon steadily increasing indicating active bleeding ABDOMINAL XRAY PNEUMOPERITONEUM • Signs on Plain Film – Air under the diaphragm – Rigler’s Sign – Triangle Sign – Cupula Sign – Continuous Diaphragm Sign – Falciform Ligament Sign – Football Sign NORMAL GAS PATTERN AIR UNDER THE DIAPHRAGM Perforation of GI tract leads to pneumoperitoneum collecting subdiaphragmaticly on upright x-ray UPRIGHT ERECT AND DECUBITUS ABDOMEN FILMS SHOW FREE AIR UNDER THE DIAPHRAGM DECUBITUS LEFT LATERAL DECUBITUS (left side dependent) shows air along liver margin This is the preferred xray if the patient cannot stand Rigler’s Sign – See both sides of the bowel wall Triangle Sign – Small triangles of air Rigler’s Sign – Double Wall Sign Cupula – Continuous Diaphragm Sign CT – FREE AIR CT – FREE AIR SUMMARY • PLAIN X-RAY -BOWEL GAS PATTERN –BARIUM -OUTLINES LUMEN • CT -PROBLEM SOLVING • NM • US SPECIAL SITUATIONS • ANGIOGRAPHY • MR -LITTLE USE REVIEW • • • • • • • • • • • Aspiration / Esophageal cancer / Hiatal hernia Varices / Candida / Mallory-Weiss / Boerhaave’s Gastric cancer / Ulcer / Pyloric stenosis Duodenal ulcer Small bowel obstruction Crohn’s disease Appendicitis Colon cancer Diverticulitis GI hemorrhage Necrotizing enterocolitis ...GASTROINTESTINAL IMAGING • Anatomy – – – – Esophagus Stomach Small Intestine Colon • Imaging Studies – Xray with Barium or water soluable contrast... Medicine NORMAL SWALLOW ASPIRATION Contrast tracks anteriorly into trachea with aspiration GI IMAGING Single AP radiograph Showing filling of the stomach and proximal small bowel without mass,... obstruction or filling defect AP SUPINE ABDOMEN XRAY GAS PATTERN STOMACH COLON SM BOWEL Normal abdominal gas pattern with air in the stomach and scattered non-distended loops of large and small