Abdominal Radiology in Intensive Care MedicineDr. Andrew Ferguson MEd FRCA DIBICM FCCP : Abdominal Radiology in Intensive Care MedicineDr. Andrew Ferguson MEd FRCA DIBICM FCCP
Plain abdominal film : Plain abdominal film Bones
Solid organs etc.
Psoas shadow
Kidneys
Liver
Spleen
Hollow organs
Stomach
Small bowel
Large bowel
Slide 3 :
Normal Gas Pattern : Normal Gas Pattern Stomach
Always
Small Bowel
Two or three loops of non-distended bowel
Normal diameter < 3 cm = 1 US quarter
Large Bowel
In rectum or sigmoid – almost always
Normal Fluid Levels (Erect) : Normal Fluid Levels (Erect) Stomach
Always (except supine film)
Small Bowel
Two or three levels possible
Large Bowel
None normally
Plain Abdominal Film – Small Bowel : Plain Abdominal Film – Small Bowel Central position
When distended, valvulae conniventes crossing entire lumen seen in jejunum
Diameter should be < 2.5 - 3cm
Often only well visualised when abnormal
Plain Abdominal Film – Large Bowel : Plain Abdominal Film – Large Bowel Large Bowel
Peripheral
Haustra usually don't extend from wall to wall
Caecum normally contains semifluid material with multiple pockets of gas
Transverse colon may dip down deeply into the pelvis
Erect Film : Erect Film Air rises (pneumoperitoneum), fluid sinks
Rugal folds of stomach may be visible
Kidneys & transverse colon drop
Small bowel drops
Breasts drop
Lower abdomen bulges increasing X-ray density
Diaphragm descends, lung bases clearer
Fluid levels visible if present
Calcification : Calcification Linear
Wall of vessel/tube
Rimlike
Wall of viscus
Lamellar
Lumen of viscus
Cloudlike
Solid organ/tumour
Abnormal Gas Patterns : Abnormal Gas Patterns Functional Ileus
Localized (Sentinel Loops)
Generalized adynamic ileus
Mechanical Obstruction
SBO
LBO
Abnormal Gas Patterns : Abnormal Gas Patterns
Sigmoid Volvulus : Sigmoid Volvulus Bowel loop points to RUQ
Inverted-U appearance of distended sigmoid loop
Coffee bean sign - bowel walls oedematous so contiguous walls form dense white line on AXR
Caecal Volvulus : Caecal Volvulus Distended large bowel
Long axis from the RLQ to epigastrium or LUQ
Caecum most commonly displaced to LUQ
Extraluminal Air – Rigler’s sign : Extraluminal Air – Rigler’s sign Both sides of bowel wall visible due to intraperitoneal air
Extraluminal air – under diaphragm : Extraluminal air – under diaphragm Normal up to 5-7 days post-op laparotomy
Extraluminal air – Falciform ligament sign : Extraluminal air – Falciform ligament sign
Extraluminal air – football sign : Extraluminal air – football sign Massive pneumoperitoneum
Only 2% of PP in adults demonstrate sign
Extraluminal air – lesser sac : Extraluminal air – lesser sac
Slide 19 : Small bowel obstruction