Radiology Of GIT and

Musculoskeletal system
By. Dr Abduselam
 Distinguishing small and large bowel
Small bowel
• Valvulae conventes
(compelete, much closer,
thinner & relatively regularly
placed)
• Many loops
• Central distribution
• Small radius of curvature
• Small diameter (3-5cm)
• Absence of solid faeces
Large bowel
• Haustra (incomplete,
further apart, thicker &
relatively irregularly
placed)
• Few loops
• Peripheral distribution
• Large radius of curvature
• Large diameter (5cm+)
• Presence of solid faeces
Erect Plain abdominal film
normal appearance:
 relatively large amount gas in stomach and colon
 small bowel is gasless or small amount of gas may
present
 3 air fluid levels
 some causes of small bowel fluid levels
SBO, paralytic ileus ,
hypokalaemia, cleansing enema
SBO
 Small Bowel obstruction
Radiographic features
 >3 distended loops, >3cm width of air fluid
levels after 3-5 hrs
 reduction in large bowel caliber or collapse
 string of beads sign : gas bubbles trapped b/n
v.connivents in dilated fluid filled bowel
 stepladder appearance , in low level
obstruction.
LBO
Large bowel obstruction
• causes in developed world
• colonic ca : commonest
• diverticulitis second most
• volvulus
• in undeveloped world
• volvulus 85 %
• radiographic features depend on
– 1.site of obstruction
– 2.ileocaecal valve: whether or not valve is competent
• If ileocaecal valve is competent
• small bowel is not distended
• caecum is markedly distended
• More often , ileocaecal valve is closed leads to blind
loop obstruction

• The obstructed colon contains large amount of gas

identified by haustral margins ,around periphery
diameter distended >5cm
Sigmoid volvulus
• most frequent in old age
• plain radiographic diagnosis can be easy
Radiographic features of sigmoid volvulus
 lack of haustra at the margin
 large coffee bean sign
 Omega sign
 Case 1:
This 67 year-old women
presented to the surgical
ward with a distended
abdomen and vomiting.

Present this x-ray

Give a diagnosis and potential

causes
 Case 1: Answer
Radiology Report:
Plain abdominal radiograph.
Multiple dilated loops of small bowel within the
central abdomen. Gas is not seen in the large
bowel. No evidence of hernia or gallstone to
suggest potential cause of the dilated loops.
These findings are in keep with a low small bowel
obstruction.
I would like to know if the patient has a history of
abdominal surgery as the commonest cause is
surgical admissions.

The three commonest causes of small bowel obstruction are:

Surgical adhesions
Herniae
Intraluminal mass eg, small bowel lymphoma or gallstone (in gallstone ileus)
 Case 2:
This 71 year-old gentleman
visits his GP complaining of
blood in his urine. He has had a
number of UTI’s in recent years.

Present this x-ray

Give a diagnosis and potential

causes
 Case 2: Answer

Radiology Report:
Plain abdominal radiograph.
Two rounded radio-opacities measuring 4cm within
the pelvis. Both opacities are smooth in outline,
laminated in nature, have the same density as
bone and project over the bladder. No other renal
tract calcification.
Does the patient have a history of neurogenic
bladder?
Given the size of these stones and history of UTI’s
these are bladder calculi.

Bladder calculi are more common in those with a history of:

•UTI’s
•A neurogenic bladder
•Bladder diverticulum
 Dysphagia
DDX
• Achalasia
– Failure of relaxation of distal esophageal
sphinictor
– smooth tapered lower esophagus , a rat tail or bird
beak sign

• Esophageal cancer
Esophageal Ca
Most advanced lesions On Barium swallow
- Mucosal destruction and growth
may appear as Stricture or, abrupt shouldering
- mucosal ulceration and necrosis produce
irregular rugged channel appearance
- intraluminal mass
Filling defect
- Infiltrative lesion
may present as a smooth stricture
 Radiographic features of gastric ca

features of early gastric ca

-poly poid lesion :>5cm
-superficial lesion: <5cm
-excavated lesion : malignant ulcer
features of advanced gastric ca
-ulcerated luminal mass
-rigidity , diffuse narrowing ,linitis plastica
-thickened wall > 1cm by CT
-LAP at gastrohepatic , gastrocolic ligament
and at perigastric nodes
- hepatic metastases
-bulky mass with ulceration
-rare exophytic tumor resembling
leiomyoma
-extension into perigasric fat
-reginal LAP
-metastasis to liver adrenal and
peritoneum
 Skull fracture
• Classified as linear, depressed or basal.
• Clinically difficult to detect. If detectable there
is likely to be underlying brain injury.
• Increased significance if an open fracture, or
if the fracture communicates with an air sinus,
is depressed or crosses an artery or major
dural sinus.

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 Radiological features

• Plain skull radiographs are the initial

investigation with some progressing to CT.
• Linear fractures will appear as a deeply black
sharply defined line.
• May be mistaken for a suture line or vascular
groove.
• A vascular groove often branches, has a
sclerotic margin and a typical site.

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Depressed skull fracture

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Simple vault fracture

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 Flail chest
Characteristics
• Usually traumatic with two or more ribs fractured in two or
more places.
• Results in disruption of normal chest wall movements, and
paradoxical movement may be seen.
• Always consider underlying lung injury (pulmonary contusion).
• The combination of pain, decreased or paradoxical chest wall
movements and underlying lung contusion are likely to
contribute to the patient’s hypoxia
• Chest wall bruising palpable abnormal movement or rib
crepitus

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 Cont…
Radiological features
• Multiple rib fractures.
• Costochondral separation may not be evident.
• Air space shadowing may be seen with
pulmonary contusions (often absent on initial
films).

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Flail chest
Fracture of the left first rib

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Sternal fracture

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GALEAZZI FRACTURE
a fracture of the radius with associated dislocation of the
distal radio-ulnar joint

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 Montagia Fracture
• a fracture of the ulna with dislocation of the
radial head
 Distal Radial bone fracture
• Very common
1. Colles fracture
- fall on dorsiflexed (extended)wrist
- distal fragment is displaced posteriorly
“dinner- fork deformity”
*
Comminuted mid-femoral shaft fracture

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Spiral fracture of the distal third of the left
tibia

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Spiral fracture of the distal third of the left
tibia

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 Radiological Classification
• Based on configuration of fracture (pattern)
Transverse
Oblique
Spiral
Comminuted
Segmental
Depressed
Avulsion
Impacted
Greenstick

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 According to the Pattern
Transverse Fracture
A fracture in which the line is perpendicular to the long axis of the bone.
Oblique Fracture
A fracture in which the line is at oblique angle to the long axis of the bone.
Longitudinal Fracture
A fracture in which the line runs nearly parallel to the long axis of the bone.
Comminuted
The bone is broken into more than two fragments
A compression fracture,
as occurs in the vertebral body, involves two bones that are crushed or squeezed
together.
Impaction fracture = collapse of one fragment into/onto another
fracture caused when bone fragment are driven in to each other
Avulsion fracture
fracture where a fragment of bone is separated from the main mass.
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fragment pulled away by muscle or ligament
 Transverse Fracture
A fracture in which the line is perpendicular
to the long axis of the bone.

Oblique Fracture
A fracture in which the line is at oblique angle
to the long axis of the bone.

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Severe oblique fracture in which fracture plane
rotates along the long axis of bone; caused by a
twisting injury

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 Comminuted
The bone is broken into more than two
fragments

Incomplete fracture in which cortex on only one

side is disrupted; seen in children

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comminuted oblique
oblique segmental
segmental
comminuted

Results in more than two Fracture line creates an Two complete fractures with a
bone fragments; oblique angle with long “segment” in between
a.k.a. fragmentation axis of bone

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 spiral
spiral transverse
transverse avulsion
avulsion

Severe oblique fracture in Fracture line perpendicular to

Fracture in which tendon is
which fracture plane rotates long axis of bone
along the long axis of bone; pulled from bone, carrying
caused by a twisting injury with it a bone chip.
Fracture where a fragment
of bone is separated from
the main mass. 56
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 Fracture Classifications

Longitudinal Transverse Oblique Spiral Incomplete “T” fracture

Impacted, Comminuted Pathological Closed Open Avulsion

compressed fracture fracture fracture

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Fracture Description
• The essential first step of fracture treatment is to precisely
identify the type of fracture present.
• At a minimum, a fracture should be identified using the
following:
– Name of the injured bone
– Location of the injury (eg, dorsal or volar; metaphysis,
diaphysis, or epiphysis)
– Orientation of the fracture (eg, transverse, oblique,
spiral)
– Condition of the overlying tissues (eg, open or closed
fracture).

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