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1.2.2. Emergency Abdominal Imaging
1.2.2. Emergency Abdominal Imaging
Dr Graham Lloyd-Jones BA MBBS MRCP FRCR. Abdominal x-ray – System and anatomy. Available in
www.radiologymasterclass.co.uk/tutorials
Dr Jeremy Jones. Normal abdominal X-ray. Available at www.radiopaedia.org/cases/normal-abdominal-x-ray
Dr Graham Lloyd-Jones BA MBBS
MRCP FRCR. Abdominal x-ray –
System and anatomy. Available in
www.radiologymasterclass.co.uk/t
utorials
INTERPRETATION
Jaap Stoker, Adrienne van Randen, Wytze Laméris, and Marja A. Boermeester. Imaging Patients with Acute Abdominal Pain.
Modality
Conventional Abdominal US Examination
Radiography
• Provided useful information
• Used to exclude major illness for 56-65% of patients with
such as bowel obstruction acute abdominal pain.
and perforated viscus.
• Correct diagnosis after clinical
• Some study investigators evaluation increased from
have reported an accuracy of 70% to 83% after evaluation
53%. with US.
• Treatment management • US findings led to an
changes 🡪 only 4% of alteration in treatment
patients. management for 22% of
patients
• In select cases, such as those
of patients suspected of
having bowel obstruction,
perforated viscus, urinary
tract calculi, or foreign bodies
has been reported to have
good accuracy.
Jaap Stoker, Adrienne van Randen, Wytze Laméris, and Marja A. Boermeester. Imaging Patients with Acute Abdominal Pain.
Modality
CT Examination MR Imaging
• CT was significantly • MR imaging is used in
more sensitive than US only select cases at
(89% vs 70%) many institutions,
• Two RCT in which primarily after US yields
standard practice was nondiagnostic findings
compared with early CT) in pregnant women.
🡪 early CT group had
shorter hospital stays
• Overall sensitivity of CT
is reportedly 96%
compared with 30% for
conventional
radiography
Jaap Stoker, Adrienne van Randen, Wytze Laméris, and Marja A. Boermeester. Imaging Patients with Acute Abdominal Pain.
Case 1
Female elderly with
acute abdominal pain
Bowel Gas Pattern
Musson RE, Bickle I, Vijay RKP. Gas patterns on plain abdominal radiographs: a pictorial review. Postgrad Med J 2011;87:274–87.
Pneumoperitoneum
Pneumo-retroperitoneum
Musson RE, Bickle I, Vijay RKP. Gas patterns on plain abdominal radiographs: a pictorial review. Postgrad Med J 2011;87:274–87.
Case 2
Male 54 years old. Vague abdominal pain, not passing or little flatus or
stool for 3 days. Had surgery 4 days prior for ruptured appendix
General adynamic ileus
• Generalized, uniform
dilatation of small and
large intestine with no
transition point
Musson RE, Bickle I, Vijay RKP. Gas patterns on plain abdominal radiographs: a pictorial review. Postgrad Med J 2011;87:274–87.
Case 3
Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of
Feature of Gas Pattern
SBO vs LBO
Role of Cross Sectional Imaging in
SBO and LBO
Musson RE, Bickle I, Vijay RKP. Gas patterns on plain abdominal radiographs: a pictorial review. Postgrad Med J 2011;87:274–87.
Complicated Bowel Obstruction
Schematic Drawing of Large
Bowel Volvulus
Vandendries, C et al. “Diagnosis of colonic volvulus: findings on multidetector CT with three-dimensional reconstructions.” The British journal of radiology vol.
83,995 (2010): 983-90. doi:10.1259/bjr/35714052
Journal of Clinical Imaging
Science
Figure 5 Sigmoid volvulus: (a) Erect plain abdominal radiograph in a 58-year-old man presenting with abdominal distension and severe lower
abdominal pain demonstrates marked distension of the sigmoid colon with a typical coffee-bean sign (arrows) which is highly characteristic of
sigmoid volvulus. A rubber tube has been placed for decompression. Axial contrast-enhanced computed tomography images (b and c) in another
patient with similar presentation demonstrates the whirl pattern (arrow in b) and the characteristic bird beak appearance (arrow in c). The
redundant and dilated sigmoid colon (asterisk) is better depicted on the coronal image (d) with characteristic beak appearance (arrow).
Reproduced with permission from: Ramanathan S, Ojili V, Vassa R, Nagar A. Large Bowel Obstruction in the Emergency Department: Imaging
Spectrum of Common and Uncommon Causes. Available from: https://dx.doi.org/10.4103/jcis.JCIS_6_17
Journal of Clinical Imaging
Science
Figure 6 Cecal volvulus: (a) Erect plain radiograph of the abdomen in a 65-year-old male patient presenting with severe abdominal pain
demonstrates mildly dilated loops of small bowel (short arrows) in the right hemi abdomen and a markedly dilated gas filled structure in the left
upper quadrant (long arrow) which is compressing the stomach which contains nasogastric tube. Axial contrast enhanced computed tomography
images (b and c) demonstrate a large air and fluid filled structure in the left abdomen (asterisk) with absence of cecum in its normal location. A small
amount of fluid (arrow) is noted secondary to early ischemia. The enteric contrast is noted to opacify only the small bowel. Imaging findings are
concerning for cecal volvulus which was subsequently confirmed at surgery.
Reproduced with permission from: Ramanathan S, Ojili V, Vassa R, Nagar A. Large Bowel Obstruction in the Emergency Department: Imaging
Spectrum of Common and Uncommon Causes. Available from: https://dx.doi.org/10.4103/jcis.JCIS_6_17
Role of Cross-Sectional Imaging in
Volvulus
Vandendries, C et al. “Diagnosis of colonic volvulus: findings on multidetector CT with three-dimensional reconstructions.” The British journal of radiology vol.
83,995 (2010): 983-90. doi:10.1259/bjr/35714052
Focal Ileus (Sentinel
Loop)
Case 5
Male 25 years old
complains abdominal
pain with constipation,
suspected bowel
obstruction
• Sign of Perforation
• Appendiceal abscess
• Extraluminal air
• Defect in the enhancing appendiceal wall
Gonzalez et al. Acute pancreatitis structured radiology report: the importance for the patients´s management. DOI:
10.1594/ecr2017/C-1474
Colon Cut off Sign
Gonzalez et al. Acute pancreatitis structured radiology report: the importance for the patients´s management. DOI:
10.1594/ecr2017/C-1474
Pancreatic fluid collections
(Revised Atlanta
Classification)
Trikudanathan G, et al. Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence-Based Approach. DOI:
https://doi.org/10.1053/j.gastro.2019.01.269
Acute Peri-pancreatic
Fluid Collection
Xiao B. Acute pancreatitis: A pictorial review of early pancreatic fluid collections. Artif Intell Med Imaging 2020; 1(1): 40-49
Xiao B. Acute pancreatitis: A pictorial review of early pancreatic fluid collections. Artif Intell Med Imaging 2020; 1(1): 40-49
Xiao B. Acute pancreatitis: A pictorial review of early pancreatic fluid collections. Artif Intell Med Imaging 2020; 1(1): 40-49
Other Focal Acute Abdominal
Pain
Diverticulitis
Jaap Stoker, Adrienne van Randen, Wytze Laméris, and Marja A. Boermeester. Imaging Patients with Acute Abdominal Pain.
Radiology 2009 253:1, 31-46
Other Focal Acute Abdominal
Pain
Cholecystitis
Jaap Stoker, Adrienne van Randen, Wytze Laméris, and Marja A. Boermeester. Imaging Patients with Acute Abdominal Pain.
Radiology 2009 253:1, 31-46
Chawla, Ashish et al. “Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.” Singapore medical
journal vol. 56,8 (2015): 438-43; quiz 444. doi:10.11622/smedj.2015120
Dr Mohammad Taghi Niknejad. Acute calcular cholecystitis. Available at radiopaedia.org
Abdominal Traumatic
Emergencies
Focused Assesment with
Sonography for Trauma (FAST)
• Bed side screening to detect free fluid in abdomen
and thorax
• Sensitivity 80-90% and specificity 95-100% for
detecting free fluid
Holmes EJ, Misra RR. A-z of emergency radiology. Cambridge university press. 2004
Holmes EJ, Misra RR. A-z of emergency radiology. Cambridge university press. 2004
Extended FAST
• Screening for hemothorax and pneumothorax
Holmes EJ, Misra RR. A-z of emergency radiology. Cambridge university press. 2004
Holmes EJ, Misra RR. A-z of emergency radiology. Cambridge university press. 2004
Thank You