Acute abdoment contains all traumatic and non traumatic routine workup done at radiology center along with all the causes regarding abdominal pain refrence takent from manorama berry book of radiology

1. ACUTE ABDOMEN
BY DR AVINASH DAHATRE
RADIOLOGY DEPARTMENT

2. ACUTE ABDOMEN
Acute pain in abdomen which is sudden in onset.
• CAUSES:-
 ACUTE APPENDICITIS
 ACUTE PANCREATITIS
 INTESTINAL OBSTRUCTION
 RENAL COLIC
 MESENTRIC ISCHEMIA
 CHOLECYSTITIS
 ABDOMINAL TRAUMA
 OVARIAN TORSION

3. ACUTE APPEDICITIS
• It is an undeveloped distal end of large cecum
• Normal diameter<6mm
POSITIONS:-

4. PLAIN RADIOGRAPH
• Shows
appendicolith in
RIF
• Localized ileus air-
fluid level in
cecum

5. ON USG
• Screening modality of choice.
• Inflammed appendix is seen
as non-compressible, tubular,
aperistaltic, blind ending
structure noted in RIF.
• Transverse diameter of >6mm

6. CECT
• 4-5mm thin slice taken.
• Abnormal appendix with
distended lumen and
enhancing wall.
• periappendicular fluid and
fat strandring.

7. ACUTE PANCREATITIS:-
• It is the inflammatory process of pancreas.
• Most common cause is alcohol abuse and gall stone.
• Less common causes are hypercalcemia, hypertriglyceridemia, ductal
obstruction.
• Increase in serum amylase and lipase.

8. • colon cut-off sign describes
gaseous distension seen in
the proximal colon
associated with abrupt
termination of gas within the
colon usually at the level of
the splenic flexure and
decompression of distal
part.

10. On usg
• Appear as diffusely
hypoechoic gland.
• Intra or peripancreatic fluid
collection

11. CECT:-
PANCREAS
PYLORUS
ACUTE EDEMATOUS PANCREATITIS

12. THICK
PYLORUS
PSEUDO CYST

13. PERI-PANCREATIC
FLUID COLLECTION PERI-RENAL
FAT
STRANDING
ACUTE EDEMATOUS PANCREATITIS

14. CT shows illdefined hypoattenuating areas in
body of pancreas with peri pancreatic fat
stranding and fluid collection s/o ACUTE
NECTROTISING PANCREATITIS.

15. INTESTINAL OBSTRUCTION
CAUSES:-
• Fibrous adhesions
Almost all are related to post-
operative adhesions
• Abdominal hernia
• external hernia related to
abdominal or pelvic wall defect

16. RADIOGRAPH
SMALL BOWEL OBSTRUCTION
• Multiple air fluid level seen
by arrows.
• With some width of 3cm in
small bowel and large bowel

17. TOO AND FRO MOTION ON USG

18. CT SCAN
• Few mildly dilated small bowel loops with soft tissue
densities and air trapping seen in form of string of
bead appearance.
• Few collapsed edematous loops.

19. PLAIN STRING OF BEADS APPEARENCE CONTRAST

20. • Dilatation of jejunal loops.
• Abrupt transition zone seen at right distal
jejunum and proximal ileal loops.
• Circumferential wall thickening.

21. Dilated jejunal loops
Zone of transition:- Constricted
part between dilated bowel loops
and normal bowel.

22. MESENTRIC ISCHEMIA
• Acute SMA embolus is most
common cause of mesentric
ischemia
• Oclussion due to vasculitis
Atherosclerosis, and
thrombotic microangiopathy.
• Thick walled dilated loop with
thumb print sign

23. Axial contrast CT image showing Thickened Bowel Wall Showing
Halo Or Target Appearence seen in SMA thrombosis.
Axial CT contrast image showing thrombosis of
SMA

24. RENAL COLIC
• Abdominal pain most commonly caused by ureteric calculi.
Composition of urinary tract stones:-
• calcium oxalate +/- calcium phosphate: ~75%
• struvite (triple phosphate): 15%
• pure calcium phosphate: 5-7%
• uric acid: 5-8%
• cystine: 1%

25. PLAIN RADIOGRAPH

26. USG:-

27. CT SCAN

28. ACUTE CHOLECYSTITIS
• acute inflammation of the gallbladder.
• Responsible for approximately 3-10% of all patients with abdominal
pain.
• Pain typically persists for more than six hours.
• CAUSES:-
• gallstone obstruction of the gallbladder neck or cystic duct
• reactive production of mucus, leading to increased intraluminal
pressure and distention
• secondary bacterial infection.

29. USG
• Murphy’s sign:-maximal
abdominal tenderness from
pressure of the ultrasound
probe over the
visualized gallbladder.
• gallbladder wall thickening (>3
mm)
• pericholecystic fluid is
secondary findings.

30. CT SCAN
• cholelithiasis: gallstones
isodense to bile will be
missed on CT.
• tensile gallbladder
fundus sign is positive
when the gallbladder
fundus is seen to bulge
into the anterior
abdominal wall.

31. MERCEDES BENZ SIGN:- Air within
gall stone

32. PERICHOLIC FAT
STRANDING
PERINEPHRIC FAT
STRANDING

33. MRCP
• MR
cholangiopancreatography
(MRCP) may show an
impacted stone in the
gallbladder neck or cystic duct
as a rounded filling defect.

34. ABDOMINAL TRAUMA
• Blunt abdominal trauma represent 5% mortality and 15% for
polytrauma.

35. CATEGORY A CATEGORY B CATEGORY C
Hemodynamically unstable
patient, clinically major
abdominal trauma,
Unresponsive hypotension,
Need immediate resuscitation
Hemodynamically stable,
Least moderate clinical
suspicion of trauma,
Mild to Moderate hypotension,
Patient who is stabilized after
initial resuscitation
Patient Macroscopic hematuria
>35Rbc’s,
With fracture or diastasis of
pubic symphysis needs imaging
of urinary ytract
•If they have clear clinical
evidence of abdominal trauma
then go for OT without imaging.
•Conventional chest and
abdominal radiographs can be
obtain as per trauma protocols.
•USG performed to see
intraperitoneal free fluid
•Patient should be evaluated
for imaging,
•Chest and abdominal
radiographs obtain
•If test are unremarkable and
clinically evaluated for organ
injury then CT scan is more
sensitive than USG for liver and
spleen injury etc.
•Retrograde urethrogram
should be performed to rule
out urethral injury.
•If urethrogram indicate no
injury the CT cystogram is
added to CT ABDOMEN
As per ACR guidelines patients are divided into following categories:-

36. RADIOGRAPHS
large volume pneumoperitoneum is
present, it may be superimposed over a
normally aerated lung with normal lung
markings.
Free air under diaphragm

37. Erect chest radiograph demonstrating
subdiaphragmatic free gas bilaterally and
evidence of the cupola sign.

38. FOCUSED ASSESMENT WITH SONOGRAPHY AND TRAUMA (FAST)
• It provide fast examination of abdomen to detect free fluid which indicate free fluid and
organ injury.
• FAST should be completed within few minutes with an aim to search for intraperitoneal free
fluid.
• SITES TO BE SEEN:-
Right kidney, liver,morrisons pouch, perihepatic collection, left kidney, spleen, perisplenic
collection, bilateral flank for paracolic gutter.
Free fluid in pelvis and pouch of douglas.
Thoracic view for pleural effusion.

40. CT SCAN
PLAIN ARTERIAL
Spleen shows major devascularisation and no enhancement on arterial phase
contrast.

41. VENOUS
Mild intraperitoneal Free fluid collection noted of 7HU

42. AAST SPLEENIC INJURY GRADING
GRADE I HEMATOMA:- Subcapsular <10% surface area
Laceration:- Capsular tear <1% intraparenchymal depth
GRADE II HEMATOMA:- Subcapsular 10-50% area
LACERATION:- 1-3 cm intraparenchymal depth
GRADE III HEMATOMA:- Subcapsular >50% area
LACERATION:- >3 cm intraparenchymal depth
GRADE IV LACERATION:- Major Devascularisation
GRADE V LACERATION :- Completely shattered spleen

43. CECT:-Large laceration in the right lobe of the liver with a perihepatic hematoma.
Active contrast extravastation from the liver parenchyma into the perihepatic space
AAST GRADING

44. CECT shows:- Extravasation of
intra-venous administered
contrast into the peritoneal cavity
through a rupture of the urinary
bladder dome.
USG :- Discontinuity in wall of
urinary bladder at its dome with
gross ascites. Foley catheter is in
situ.
FLUOROSCOPY:- flame-shaped
density adjacent to lateral walls of
bladder representing extra-
peritoneal contrast from a bladder
rupture.
BLADDER TRAUMA

45. OVARIAN TORSION
• It is the partial or complete rotation of
ovarian pedicle along its long axis.
• Most commonly associated with adnexal
mass, dermoid cyst.

46. USG:- Unilateral ovarian
enlargement and which is
edematous with multiple small
cystic structure at periphery
which is due to transudation of
fluid in follicle.
COLOR DOPPLER SHOW:
•lack of arterial flow.
•Arterial waveform show lack of
diastolic flow with spike
configuration.

47. MRI
• Most common finding is adnexal mass with deviation of uterus to
the side of torsion
• Engorged vessel and vascular pedicles are identified between mass
and uterus.
• Hemorrhage can be seen as high signal intensity ring in periphery
shows low signal intensity on T1WI - T2WI.
• Lack of enhancement of infraction on T1+ contrast image.

48. Hemorrhage can be seen as high signal intensity ring in periphery shows low signal
intensity on T1WI - T2WI.