Abnormal gas
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Abnormal gas

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

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

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Abnormal gas Presentation Transcript

  • 1. Abnormal Gas..Basic concepts Dr/Ahmed Bahnassy Consultant Radiologist MBCHB-MD-FRCR E-mail:aatteya2001@yahoo.com
  • 2. Where is the gas ? IP RP BW  Intraperitoneal GB  Retroperitoneal AB  Bowel wall  Gall bladder and biliary  Abscess
  • 3. PNEUMOPERITONEUM
  • 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. 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. UPRIGHT CHEST
  • 7. PNEUMOPERITONEUM UPRIGHT RADIOGRAPHS UPRIGHT ABD CENTRAL TENDONUNDER RIGHT HEMIDIAPHRAGM AND HEMIDIAPHRAGM
  • 8. FREE AIR…….DECUBITUS VIEW GAS BETWEEN LIVER AND BODY WALLBUT MAY ALSO BE IN OR ONLY IN THE PELVIS
  • 9. FREE AIRCENTRAL TENDON
  • 10. FREE AIRCENTRAL TENDON
  • 11. RIGLER’S SIGNBOTH SIDES OF BOWEL WALL VISIBLEDOUBLE WALL SIGN
  • 12. MASSIVE PNEUMOPERITONEUM FOOTBALL SIGN
  • 13. FALCIFORM LIGAMENTGAS BUBBLE OVER LIVER
  • 14. FALCIFORM LIGAMENT
  • 15. PNEUMOPERITONEUMSUBHEPATIC GAS BUBBLE
  • 16. DIVERTICULITISPNEUMOPERITONEUM
  • 17. ANTERIOR ABDOMINAL WALL ANATOMIC FOLDS
  • 18. FREE AIR INFERIOR EPIGASTRIC VESSELS(LATERAL UMBILICAL LIGAMENTS)
  • 19. PSEUDO-PNEUMOPERITONEUM
  • 20. CENTRAL TENDON GAS YES, BUT JUST THE STOMACH
  • 21. GAS UNDER THE RIGHT HEMIDIAPHRAGM HEPATIC FLEXURE ANTERIOR-SUPERIOR TO LIVER
  • 22. SUBDIAPHRAGMATIC FAT SIMULATING FREE AIR
  • 23. FREE AIR OR NOT FREE AIR? THAT IS THE QUESTIONPNEUMOTHORAX SIMULATES FREE AIR
  • 24. RETROPERITONEAL GAS SIMULATES FREE AIR
  • 25. RETROPERITONEAL GAS
  • 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. 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. Severe dysuria-left flank pain
  • 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. RETROPERITONEAL GAS
  • 31. 13-YEAR-OLD GIRL WITH CROHN’S DISEASE HAS SUBACUTE FEVER AND ABD PAIN
  • 32. RETROPERITONEAL GASEXTENDS TO POSTERIOR PARARENAL SPACE & THEN PROPERITONEAL FAT
  • 33. AFTER COLONOSCOPY AND BIOPSYEXTENSIVE RETROPERITONEAL GAS
  • 34. BAROTRAUMAMEDIASTINUM – RETROPERITONEUM – FREE AIR
  • 35. BOWEL WALL GAS
  • 36. PNEUMATOSIS OF COLON INFANT ADULTNECROTIZING ENTEROCOLITIS ISCHEMIC COLITIS
  • 37. WHAT IS THE ABNORMALITY HERE?USE LUNG WINDOWS TO LOOK FOR GAS
  • 38. 72-YEAR-OLD WOMAN WITH DIARREHA
  • 39. 58-YEAR-OLD WOMANMILD ABDOMINAL PAIN FOR 2 DAYS SCLERODERMA, GAS IN COLON WALL
  • 40. PNEUMATOSIS 2 DAYS AFTER SEGMENTAL SB RESECTIONRESOLVED SPONTANEOUSLY
  • 41. ASYMPTOMATIC 40-YEAR-OLD MANBENIGN STEADY STATE PNEUMATOSIS
  • 42. ISCHEMIC BOWEL
  • 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. ACUTE ONSET OF ABDOMINAL PAIN SMA EMBOLIS
  • 45. Thumprinting
  • 46. SBO ISCHEMIC BOWELAT SURGERY: SB TWISTED UNDERADHESION
  • 47. ISCHEMIC SMALL BOWEL ETIOLOGY ? SMV CLOT
  • 48. Gall bladder and Biliary GAS
  • 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. BILE DUCT GAS BILE DUCT GASCHUNKY AND CENTRAL
  • 51. BILE DUCT GAS AND SBO
  • 52. SBO GALLSTONE ILEUS
  • 53. GALLSTONE ILEUS
  • 54. GALLSTONE ILEUSBILE DUCT GAS, SBO, STONE
  • 55. GALLBLADDER GAS GALLBLADDER LUMEN – GALLBLADDER-BOWEL FISTULA – GALLSTONE ILEUS – EMPHYSEMATOUS CHOLECYSTITIS GALLBLADDER WALL GAS – EMPHYSEMATOUS CHOLECYSTITIS
  • 56. EMPHYSEMATOUS CHOLECYSTITIS
  • 57. PORTAL VEIN GAS
  • 58. SMALL BOWEL ISCHEMIAGAS IN MESENTERIC AND PORTAL VEINS 48 SubPhrenic Abs CT
  • 59. 65-YEAR-OLD MAN ABDOMINAL PAIN PORTAL VEIN GASDELICATE AND PERIPHERAL
  • 60. 36-YEAR-OLD MAN MULTIPLE CONGENITAL ANOMALIES FEVER , WBC 17.8, 15 BANDSISCHEMIA OF SB AND STOMACH
  • 61. ABSCESS
  • 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. APPENDICEAL ABSCESS RETROCECAL APPENDIXABNORMAL GAS… UNCHANGED ON MULTIPLE VIEWS
  • 64. SIGMOID DIVERTICULITISGAS FILLED “DIVERTICULUM!!
  • 65. Huge Abscess !
  • 66. FEVER 10 DAYS AFTERABDOMINAL SURGERY
  • 67. CROHN’S DISEASE WITH ABSCESS
  • 68. PANCREATIC ABSCESS
  • 69. PANCREATIC GAS -only 3 causes GAS IN PANCREATIC BED – ABSCESS – POST PANCREATIC DRAINAGE PROCEDURE  PERCUTANEOUS OR SURGICAL – PUESTOW PROCEDURE – PSEUDOCYST – PANCREATIC FISTULA
  • 70. PANCREATITIS WITH ABSCESS LESSER SAC ABSCESS GAS IN PANCREATIC ABSCESS
  • 71. PANCREAS-GAS BUT NO ABSCESSPANCREAS-COLON FISTULA
  • 72. LESSER SAC
  • 73. GAS IN LESSER SACPERFORATED GASTRIC ULCER
  • 74. GASTRIC ULCERPERFORATION INTO LESSER SAC
  • 75. Pancreatic Abscess.
  • 76. Summary IP RP BW GB AB