Abdominal xray images
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Abdominal xray images Presentation Transcript

  • 1. 17th, August 2012 Dr Huong
  • 2. Abdominal Xray images Digestive bowel obstruction: duodenal Obst., small and large bowel Obst. Necrotizing Enterocolitis( NEC) Intussusception Volvulus and malrotation Peritonitis: due to appendicitis, meconium peritonitis, the others causes…
  • 3. Pediatric abdo xray Gas Distribution: There are pockets of gas scattered in several areas of the abdomen. There is gas in the small bowel, colon, and rectum. Bowel Dilatation: No excessively dilated bowel. Air-Fluid Levels: None. Arrangement of Loops: Large loops are not present. Impression: Within normal limits.
  • 4. Plain adult abdo Xray
  • 5. Duodenal atresia/obstrution Plain radiograph of the abdomen: The arrows point to the dilated stomach and that part of the duodenum which is above the obstruction. Other parts of abdomen do not contain gas.
  • 6. Duodenal atresia/obstruction: double bubble sign
  • 7. Duodenal obstruction
  • 8. Duodenal obstruction:
  • 9. Duodenal obstruction
  • 10. Small bowel obstruction
  • 11. Small bowel obstruction
  • 12. Large bowel obstruction
  • 13. Necrotizing Enterocolitis( NEC) NEC is one of the most common acquired, life-threatening gastrointestinal diseases in the newborn, affecting 1%–5% of neonatal ICU admissions and up to 10% of neonates under 1500 g NEC most commonly manifests within the first or second week of life The symptoms referable to the gastrointestinal tract include feeding intolerance, vomiting, diarrhea, and blood in the stool Physical signs include abdominal distention and, in more advanced cases, palpable, distended bowel loops and abdominal wall erythema and edema. Neonates with severe disease may even present in shock
  • 14. Necrotizing Enterocolitis Plain abdominal radiography is the current modality of choice for the evaluation of neonates suspected of having NEC. The timing of follow-up plain abdominal radiographs depends on the severity of the NEC and may vary from 6 to 24 hourly plain abdominal radiography must include one image obtained with a vertical beam with the patient supine and a second image obtained with a horizontal beam
  • 15. Necrotizing Enterocolitis Radiographic findings: Intramural gas football sign( intra- peritoneal air) Free Intraperitoneal Gas Portal venous gas
  • 16. Necrotizing Enterocolitis: intramural gas Supine (a): The bowel is mildly dilated with gas, mainly on the left side. The bubbly pattern of gas seen mainly in the right lower quadrant represents intramural gas. cross-table lateral (b): Free intraperitoneal gas is present anteriorly (arrows)
  • 17. Intra- mural gas generalized bowel dilatation with gas, intramural gas mainly in the large bowel, and portal venous gas There is a band of radiolucency or black band (black arrow) and a band of soft-tissue opacity or white band (white arrow) along the margin of the involved loop. The black band represents the intramural gas in the serosal layer of the bowel wall, and the white band represents the submucosa and mucosa, which is contrasted on one side by the intramural gas and on the other side by the gas in the lumen
  • 18. Intra- mural gasThe intraluminal gas present is limited almost entirely to the large bowel, and there is no significant dilatation. There is extensive intramural gas involving the entire large bowel despite the benign clinical course. There are well-developed black and white bands There is marked dilatation of bowel with gas and fluid and extensive intramural gas (arrows). The intramural gas is seen as multiple curvilinear black bands, and in some areas white bands are also visible
  • 19. Intra- mural gas Differentiation of intraluminal gas from intramural gas in the nondependent part of a bowel loop: two hyperechoic foci are noted within the wall (arrows), which represent intramural gas. In the other loop, there is intraluminal gas (arrowhead) floating on the intraluminal fluid and causing a posterior artifact. Multiple bowel loops are seen surrounded by some free fluid. There is extensive intramural gas involving all of these loops
  • 20. Necrotizing Enterocolitis: football sign? In radiology, the football sign is a sign indicative of air in the abdominal cavity seen on supine radiographs of the abdomen. It appears as a large oval radiolucency reminiscent of an American football.[1] The football sign is most frequently seen in infants with spontaneous or iatrogenic gastric perforation causing pneumoperitoneum.
  • 21. football sign
  • 22. Necrotizing Enterocolitis: Free Intraperitoneal Gas There is a small amount of free intraperitoneal gas anterior to the liver (arrows). There are even smaller amounts of free intraperitoneal gas anteriorly, which are seen as subtle triangular areas of lucency between the anterior abdominal wall and loops of bowel (arrows) and as a linear area of lucency anterior to the stomach (arrowhead).
  • 23. Necrotizing Enterocolitis: portal venous gas Supine abdominal radiograph shows a small bubble of portal venous gas projected over the liver (arrow) Cross-table lateral radiograph obtained immediately after a shows that portal venous gas (arrow) may be depicted more extensively in the liver on this view
  • 24. Necrotizing Enterocolitis: portal venous gas
  • 25. Intussusception: Target sign: Meniscus sign(crescent sign):
  • 26. Intussusception
  • 27. with air enema therapy
  • 28. with barium enema therapy
  • 29. Volvulus : 1.Gastric volvulus
  • 30. Volvulus : Gastric volvulus
  • 31. Malrotation
  • 32. Caecal vovulus in adult
  • 33. Caecal vovulus in adult
  • 34. Sigmoid vovulus in adult
  • 35. Sigmoid vovulus in adult Bird of Prey Sign-tapered barium column in sigmoid volvulus
  • 36. Peritonitis due to appendicitis  Perforated appendicitis.  A, Soft-tissue mass effect  and presence of a  fecalith (arrow) in the  right lower quadrant  suggest perforated  appendicitis on plain  radiographs
  • 37. appendicitis Abdominal X-ray (AXR) showing Appendicolith
  • 38. Necrotic appendicitis in a 16-year-old boy. A large soft-tissue mass is seen in the right lower quadrant representing fluid- containing bowel loops. The proximal small bowel is slightly dilated with short air-fluid levels (arrows) and the large bowel is dilated with long levels indicating a dynamic (paralytic) ileus.
  • 39. Meconium Peritonitis Meconium peritonitis refers to a sterile chemical  peritonitis due to intra-uterine bowel perforation and  spillage of fetal meconium into the fetal peritoneal  cavity. It is a common cause of peritoneal calcification.  Plain film - abdominal radiograph may show intra-abdominal (peritoneal) calcification (can  be curvilinear, linear or flocculant) may show a mass containing calcification in the context of  a meconium pseudocyst  if the processus vaginalis is patent at the time of  perforation, calcification may also be seen in the scrotum.
  • 40. Meconium Peritonitis
  • 41. Meconium Peritonitis
  • 42. Meconium Peritonitis
  • 43. Meconium Peritonitis
  • 44. Meconium Peritonitis
  • 45. Meconium Peritonitis