CT ta trang

Figure   Normal duodenum in a 63-year-old man CT scan obtained with oral administration of whole milk, the patient in the right posterior oblique position, and 5-mm helical acquisition with intravenous contrast material shows the lumen, mural enhancement, and the gastroduodenal artery (arrow) Figure   Large duodenal diverticulum in a 77-year-old man CT scan obtained with oral and intravenous contrast material shows two "duodenal lumina." The true lumen is lateral to the diverticulum (straight arrow) The diverticulum contains an airfluid level and causes medial displacement of the pancreatic head (curved arrow) Duodenal diverticula are common findings on abdominal CT scans Figure 3a   Duodenal duplication in a 16-yearold boy (a) CT scan obtained without oral contrast material shows two fluidattenuation structures in the second portion of the duodenum The duplicated segment (curved arrow) is medial to the true lumen and contains debris The true lumen is narrowed and more lateral (straight arrow) (b) Transverse abdominal ultrasound image obtained through the duodenum correlates with the CT finding of debris within the cystic medial duplicated segment (curved arrow) and the lateral true lumen (straight arrow) (c) Image from a single-contrastmaterial upper gastrointestinal study in the anteroposterior projection shows narrowing of the true lumen (straight arrow) by the duplicated duodenal segment (curved arrow), which causes a smooth mass effect (suggestive of an intramural or extrinsic process) and does not communicate with the gastrointestinal tract Figure   Gastrointestinal malrotation in a 51-year-old woman CT scan shows the small bowel in the right side of the abdomen and the colon in the left side The duodenum does not cross the midline between the superior mesenteric artery and the aorta The superior mesenteric artery is to the right of the superior mesenteric vein (arrow) rather than in its typical location to the left Figure 5a   Annular pancreas in a 48year-old man (a) Image from a single-contrast-material upper gastrointestinal examination shows narrowing of the proximal second portion of the duodenum (arrow) (b) CT scan obtained with only oral contrast material helps confirm obstruction of the gastric outlet and a dilated proximal duodenum (c) CT scan obtained caudad to b during the same examination shows a band of ectopic pancreatic tissue posterior to the second portion of the duodenum (arrow) Figure   Ruptured duodenum in a 27-year-old female victim of a motor vehicle accident CT scan shows fluid in the duodenum and leakage of fluid into the right anterior pararenal space (arrow) Figure   Duodenal perforation after endoscopy in a 51-yearold man CT scan shows a thick-walled, contracted duodenum with air in the adjacent retroperitoneum (arrow) Figure   Acute pancreatitis and duodenal edema in a 50-yearold woman CT scan shows an enlarged head of the pancreas with stranding of the peripancreatic fat The wall of the duodenum is thickened, and limited mural enhancement is seen secondary to edema (arrow) Figure   Acute pancreatitis and hemorrhage into the lateral duodenal wall, which caused mass effect and narrowing of the duodenal lumen, in a 46-year-old man CT scan shows extensive stranding of the peripancreatic fat secondary to pancreatitis Massive enlargement of the lateral wall of the duodenum is accompanied by a focal area of increased attenuation at the site of the bleeding (black arrow) The duodenal lumen, which contains low-attenuation fluid, is narrowed and displaced medially (white arrow) Figure 10   Abdominal pain and a perforated duodenal ulcer in a 79-year-old man CT scan obtained with oral contrast material shows intraperitoneal extravasation of contrast material from the lateral portion of the duodenum (white arrow) and leakage of contrast material around the liver (black arrow) Tắc ruột non dãn (> cm), differential (stair step pattern) air-fluid levels on upright films, and a paucity of distal bowel air mesenteric whorl sign Đau bụng cấp nữ 45tuổi Radiological Presentations KUB with colonic contrast Radiological Presentations CT of pelvis with IV & rectal contrast Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page • Intussusception • Closed loop small bowel obstruction • Crohns Disease • Intramural Hemorrhage Findings and Differentials Findings: KUB- Contrast in colon demonstrates no large bowel obstruction or dilatation Ultrasound- Dilated loop of bowel in RLQ with thickened wall and decreased perfusion with surrounding free fluid CT- Distended small bowel loops in mid pelvis with characteristic ‘U-shaped’ configuration and “whirl sign” of twisted mesentery Contrast filled large bowel is uninvolved Differentials: • Intussusception • Closed loop small bowel obstruction • Crohns Disease • Intramural Hemorrhage Discussion Intussusception is another form of bowel obstruction that can result in bowel infarction The invagination of proximal small bowel and mesentery into distal small bowel has an appearance on CT of a “target sign” of telescoped bowel and mesenteric fat Twisting of the mesentery is not characteristic Crohns disease can result is multiple episodes of partial small bowel obstruction, but high grade obstruction is not common Most common location is at the terminal ilium Nonspecific findings of bowel wall thickening and mucosal or serosal edema can also be seen with this process Intramural hemorrhage usually occurs in the setting of anticoagulation therapy, coagulopathy, or trauma It can occur anywhere along the enteric tract, but is most common in the duodenum or jejunum CT findings are nonspecific and depend on the age of the hematoma A “ring sign” with a crescent of high attenuation within a thickened bowel wall is sometimes seen The clinical history would be crucial in making this diagnosis Diagnosis Closed loop small bowel obstruction Figure 1a (a) CT image shows free air bubbles (solid arrows) and fat stranding posterior to the duodenum (D) and free fluid (open arrow) in the anterior pararenal space, with normal pancreas (curved arrow) (b) CT image shows a dilated duodenum (D) with an intraluminal appearance similar to that of stool in the colon Incidentally noted is a probable right renal cyst (arrow) (c) CT image shows the upper aspect of a duodenal diverticulum (arrow) arising from the junction of the second and third portions of the duodenum (D) (d) CT image shows the separation (arrows) between the duodenal lumen (D) and the diverticular lumen (T) Đau bụng tuần CT performed on this third visit to the ER demonstrate findings consistent with a closed loop obstruction There is some ascites, a "whirled" appearance to the mesentery and a prominent loop Surgical exploration found a closed loop obstruction of the distal ileum secondary to a large band like adhesion presumably from the previous csection Mức dịch bên (T) bên (P) không thấy Không thấy vùng chuyển tiếp CT cho thông tin rõ ... the duodenum (arrow) (b) CT scan obtained with only oral contrast material helps confirm obstruction of the gastric outlet and a dilated proximal duodenum (c) CT scan obtained caudad to b during... man (a) CT scan obtained with oral and intravenous contrast material shows a contracted, thickwalled gallbladder (straight arrow) and a fistula to the duodenum (curved arrow) (b) CT scan obtained... examination in the anteroposterior projection reveals a filling defect in the duodenum (arrow), at the junction of the second and third portions (b) CT scan obtained with oral and intravenous contrast