Abnormal gas

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The lecture illustrates the different patterns of abnormal gas in abdominal plain X-rays.

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Abnormal gas

  1. 1. Abnormal Gas..Basic concepts Dr/Ahmed Bahnassy Consultant Radiologist MBCHB-MD-FRCR E-mail:aatteya2001@yahoo.com
  2. 2. Where is the gas ? IP RP BW  Intraperitoneal GB  Retroperitoneal AB  Bowel wall  Gall bladder and biliary  Abscess
  3. 3. PNEUMOPERITONEUM
  4. 4. FREE AIR SENSITIVITY OF IMAGING STUDIES COMPUTED TOMOGRAPHY 99% LATERAL UPRIGHT CHEST RADIOGRAPH 98% AP UPRIGHT CHEST RADIOGRAPH 80 - 90% SUPINE ABDOMEN RADIOGRAPH ?
  5. 5. PNEUMOPERITONEUM SENSITIVITY OF IMAGING STUDIES RADIOLOGIC DEMONSTRATION DEPENDS ON: – VOLUME OF FREE AIR – TIME INTERVAL BEFORE IMAGING – TYPE OF IMAGING – CONDUCT OF IMAGING EXAMINATION AS LITTLE AS ONE CC CAN BE DEMONSTRATED 10% OF PATIENTS WITH PERFORATED ULCERS DO NOT DEMONSTRATE PNEUMOPERITONEUM
  6. 6. UPRIGHT CHEST
  7. 7. PNEUMOPERITONEUM UPRIGHT RADIOGRAPHS UPRIGHT ABD CENTRAL TENDONUNDER RIGHT HEMIDIAPHRAGM AND HEMIDIAPHRAGM
  8. 8. FREE AIR…….DECUBITUS VIEW GAS BETWEEN LIVER AND BODY WALLBUT MAY ALSO BE IN OR ONLY IN THE PELVIS
  9. 9. FREE AIRCENTRAL TENDON
  10. 10. FREE AIRCENTRAL TENDON
  11. 11. RIGLER’S SIGNBOTH SIDES OF BOWEL WALL VISIBLEDOUBLE WALL SIGN
  12. 12. MASSIVE PNEUMOPERITONEUM FOOTBALL SIGN
  13. 13. FALCIFORM LIGAMENTGAS BUBBLE OVER LIVER
  14. 14. FALCIFORM LIGAMENT
  15. 15. PNEUMOPERITONEUMSUBHEPATIC GAS BUBBLE
  16. 16. DIVERTICULITISPNEUMOPERITONEUM
  17. 17. ANTERIOR ABDOMINAL WALL ANATOMIC FOLDS
  18. 18. FREE AIR INFERIOR EPIGASTRIC VESSELS(LATERAL UMBILICAL LIGAMENTS)
  19. 19. PSEUDO-PNEUMOPERITONEUM
  20. 20. CENTRAL TENDON GAS YES, BUT JUST THE STOMACH
  21. 21. GAS UNDER THE RIGHT HEMIDIAPHRAGM HEPATIC FLEXURE ANTERIOR-SUPERIOR TO LIVER
  22. 22. SUBDIAPHRAGMATIC FAT SIMULATING FREE AIR
  23. 23. FREE AIR OR NOT FREE AIR? THAT IS THE QUESTIONPNEUMOTHORAX SIMULATES FREE AIR
  24. 24. RETROPERITONEAL GAS SIMULATES FREE AIR
  25. 25. RETROPERITONEAL GAS
  26. 26. RETROPERITONEAL GAS CAUSES IATROGENIC – SURGERY – DIAGNOSTIC PROCEDURE TRAUMA – PENETRATING – RUPTURED VISCUS  RETROPERITONEAL DUODENUM, COLON, RECTUM PERFORATED BOWEL  SECONDARY TO TUMOR, INFECTION, OBSTRUCTION, NECROSIS CAUDAL EXTENSION OF PNEUMOMEDIASTINUM GAS WITHIN ABSCESS
  27. 27. RETROPERITONEAL GAS IMAGING LITTLE CHANGE IN POSITION OR SHAPE WHEN COMPARING SUPINE, UPRIGHT, DECUB RADIOGRAPHS  BUT FREE INTRAPERITONEAL GAS IS FREELY MOBILE TENDS TO STAY IN ONE RETROPERITONEAL COMPARTMENT  DUODENAL PERFORATION…..RUQ ANTERIOR PARARENAL SPACE  SIGMOID DIVERTICULITIS….. LLQ  PERIRENAL ABSCESS…………. PERINEPHRIC SPACE OFTEN FORMS LINEAR, CURVILINEAR GAS COLLECTIONS
  28. 28. Severe dysuria-left flank pain
  29. 29. RETROPERITONEAL GAS IMAGING BENEATH DIAPHRAGM CAN SIMULATE PNEUMOTHORAX LARGE VOLUME OF GAS CAN OUTLINE RETROPERITONEAL STRUCTURES  KIDNEY, LIVER MARGIN, PSOAS, FLANK STRIPE RETROPERITONEAL GAS CAN EXTEND  CEPHALAD TO MEDIASTINUM  FASCIAL PLANES OF BODY WALL AND EXTREMITIES  INTO PERITONEAL CAVITY
  30. 30. RETROPERITONEAL GAS
  31. 31. 13-YEAR-OLD GIRL WITH CROHN’S DISEASE HAS SUBACUTE FEVER AND ABD PAIN
  32. 32. RETROPERITONEAL GASEXTENDS TO POSTERIOR PARARENAL SPACE & THEN PROPERITONEAL FAT
  33. 33. AFTER COLONOSCOPY AND BIOPSYEXTENSIVE RETROPERITONEAL GAS
  34. 34. BAROTRAUMAMEDIASTINUM – RETROPERITONEUM – FREE AIR
  35. 35. BOWEL WALL GAS
  36. 36. PNEUMATOSIS OF COLON INFANT ADULTNECROTIZING ENTEROCOLITIS ISCHEMIC COLITIS
  37. 37. WHAT IS THE ABNORMALITY HERE?USE LUNG WINDOWS TO LOOK FOR GAS
  38. 38. 72-YEAR-OLD WOMAN WITH DIARREHA
  39. 39. 58-YEAR-OLD WOMANMILD ABDOMINAL PAIN FOR 2 DAYS SCLERODERMA, GAS IN COLON WALL
  40. 40. PNEUMATOSIS 2 DAYS AFTER SEGMENTAL SB RESECTIONRESOLVED SPONTANEOUSLY
  41. 41. ASYMPTOMATIC 40-YEAR-OLD MANBENIGN STEADY STATE PNEUMATOSIS
  42. 42. ISCHEMIC BOWEL
  43. 43. ISCHEMIC BOWEL IMAGING SIGNS– DILATION  PSEUDOOBSTRUCTION– BOWEL WALL  THICKENED  PNEUMATOSIS  UNENHANCING– GAS IN VESSELS  MESENTERIC, SMV, PORTAL VEINS– OBSTRUCTED VESSELS  SMA, SMV – HIGH DENSITY CLOT ON UNENHANCED CT – FILLING DEFECTS ON CT WITH IV CONTRAST– ASCITES, FREE AIR AFTER PERFORATION
  44. 44. ACUTE ONSET OF ABDOMINAL PAIN SMA EMBOLIS
  45. 45. Thumprinting
  46. 46. SBO ISCHEMIC BOWELAT SURGERY: SB TWISTED UNDERADHESION
  47. 47. ISCHEMIC SMALL BOWEL ETIOLOGY ? SMV CLOT
  48. 48. Gall bladder and Biliary GAS
  49. 49. BILE DUCT GAS IATROGENIC – BILE DUCT SURGERY – SPHINCTEROTOMY BILIARY FISTULA – GALLSTONE ERODING INTO BOWEL – DUODENAL ULCER – UPPER ABDOMINAL MALIGNANCY – TRAUMA CHOLANGITIS – GAS FORMING ORGANISM
  50. 50. BILE DUCT GAS BILE DUCT GASCHUNKY AND CENTRAL
  51. 51. BILE DUCT GAS AND SBO
  52. 52. SBO GALLSTONE ILEUS
  53. 53. GALLSTONE ILEUS
  54. 54. GALLSTONE ILEUSBILE DUCT GAS, SBO, STONE
  55. 55. GALLBLADDER GAS GALLBLADDER LUMEN – GALLBLADDER-BOWEL FISTULA – GALLSTONE ILEUS – EMPHYSEMATOUS CHOLECYSTITIS GALLBLADDER WALL GAS – EMPHYSEMATOUS CHOLECYSTITIS
  56. 56. EMPHYSEMATOUS CHOLECYSTITIS
  57. 57. PORTAL VEIN GAS
  58. 58. SMALL BOWEL ISCHEMIAGAS IN MESENTERIC AND PORTAL VEINS 48 SubPhrenic Abs CT
  59. 59. 65-YEAR-OLD MAN ABDOMINAL PAIN PORTAL VEIN GASDELICATE AND PERIPHERAL
  60. 60. 36-YEAR-OLD MAN MULTIPLE CONGENITAL ANOMALIES FEVER , WBC 17.8, 15 BANDSISCHEMIA OF SB AND STOMACH
  61. 61. ABSCESS
  62. 62. ABSCESS SUSPECT AN ABSCESS WHEN RADIOGRAPHS SHOW A GAS COLLECTION THAT IS ABNORMAL BECAUSE OF PERSISTENCE ON MULTIPLE VIEWS GET HISTORY, PX, LAB DATA BY CONSULTATION WITH ORDERING MD. CONFIRM WITH CROSS-SECTIONAL IMAGING
  63. 63. APPENDICEAL ABSCESS RETROCECAL APPENDIXABNORMAL GAS… UNCHANGED ON MULTIPLE VIEWS
  64. 64. SIGMOID DIVERTICULITISGAS FILLED “DIVERTICULUM!!
  65. 65. Huge Abscess !
  66. 66. FEVER 10 DAYS AFTERABDOMINAL SURGERY
  67. 67. CROHN’S DISEASE WITH ABSCESS
  68. 68. PANCREATIC ABSCESS
  69. 69. PANCREATIC GAS -only 3 causes GAS IN PANCREATIC BED – ABSCESS – POST PANCREATIC DRAINAGE PROCEDURE  PERCUTANEOUS OR SURGICAL – PUESTOW PROCEDURE – PSEUDOCYST – PANCREATIC FISTULA
  70. 70. PANCREATITIS WITH ABSCESS LESSER SAC ABSCESS GAS IN PANCREATIC ABSCESS
  71. 71. PANCREAS-GAS BUT NO ABSCESSPANCREAS-COLON FISTULA
  72. 72. LESSER SAC
  73. 73. GAS IN LESSER SACPERFORATED GASTRIC ULCER
  74. 74. GASTRIC ULCERPERFORATION INTO LESSER SAC
  75. 75. Pancreatic Abscess.
  76. 76. Summary IP RP BW GB AB
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