Surgery X-rays

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Surgery X-rays

  1. 1. X rays Surgery
  2. 3. Barium swallow-lateral view-1 <ul><li>Mass in mid oesophagus-shouldering and irregular shadow </li></ul><ul><li>Shadow-persistent in various films and fluoroscopic control </li></ul><ul><li>D/D-carcinoma; mass out oesophagus e.g.mediastinal mass </li></ul><ul><li>Confirmation-oesophagoscopy and biopsy and rule out bronchus invasion </li></ul>
  3. 5. Barium swallow-2 <ul><li>Hugely dilated oesophagus with narrow lower end rat tail appearance) </li></ul><ul><li>D/D-Achalasia cardia, carcinoma lower end oesophagus , stricture </li></ul><ul><li>Confirmation-oesophagoscopy and manometry </li></ul><ul><li>Biopsy and follow up </li></ul>
  4. 7. Barium meal-stomach <ul><li>Mucosal irregularity, no mass, no ulcer crater </li></ul><ul><li>Upper GI scopy and biopsy (well targeted at least 10 biopsy to rule out carcinoma) </li></ul><ul><li>H.pylori infection –if present , should be treated </li></ul><ul><li>Follow up </li></ul>
  5. 10. Enteroclysis <ul><li>Intubation of jejunum and instillation of contrast media through the tube </li></ul><ul><li>Films- head of the barium column followed till ICJ. </li></ul><ul><li>Indication-Tumours , Diarrhoea , unexplained abdominal pain </li></ul><ul><li>Findings-dilatation of jejunum with narrowing of a segment </li></ul><ul><li>CI-complete obstruction </li></ul>
  6. 13. Pneumoperitoneum <ul><li>D/D-Peptic ulcer perforation </li></ul><ul><li>Inflammation and perforation-Diverticulitis,appendicitis, toxic mega colon </li></ul><ul><li>Iatrogenic-surgery or procedures which puts air inside peritoneum </li></ul><ul><li>Infarction-intestine </li></ul><ul><li>Pnuematosis coli-cyst ruptures </li></ul>
  7. 16. X-ray chest with dome of diaphragm <ul><li>D/D-Subphrenic abscess, Hepatic abscess </li></ul><ul><li>Mostly followed by peritonitis,laparotomy. </li></ul><ul><li>Treatment-Aspiration(Pig tail) </li></ul>
  8. 18. Barium meal <ul><li>Dialated stomach and duodenum </li></ul><ul><li>Diagnosis- Wilkie’s syndrome (Superior Mesenteric Syndrome) </li></ul><ul><li>D/D—duodenal tumours, mechanical obstruction,Extra mural tumour, Secondaries, Lymphomas </li></ul><ul><li>Confirmation-Upper G I scopy,Peritonioscopy, CT ,and CT guided biopsy </li></ul>
  9. 20. Plain X-ray abdomen <ul><li>Findings-Dialated bowel loops, with multiple gas and fluid level </li></ul><ul><li>Diagnosis- Large bowel obstruction </li></ul><ul><li>Common causes-peritonitis,tumour,tortion,volvulus etc. </li></ul><ul><li>Tt-emergency surgery </li></ul>
  10. 22. X-ray chest-PA view <ul><li>Multiple round opaque shadow in both lung field </li></ul><ul><li>D/D-Breast, thyroid,Kidney,testis,GIT,Sarcoma </li></ul><ul><li>Sometimes get confused with tuberculosis(miliary tubeculosis) </li></ul><ul><li>Revised diagnosis and repeat x-rays </li></ul>
  11. 24. Plain-xray abdomen <ul><li>Radio-opaque shadow in rt upper abdomen </li></ul><ul><li>D/D-renal stone, gall stone, calcified lymph nodes,Faecolith, phlebolith </li></ul><ul><li>Lateral view-ray abdomen after preparation) </li></ul><ul><li>USG,IVU </li></ul>
  12. 26. Intra venous urogram <ul><li>Indications- Hydronephrosis- dilatation of renal pelvices and calyces </li></ul><ul><li>Polycystic kidney disease- Spider-leg appearance </li></ul><ul><li>Limitations-Diabetes, renal failure, Dye reactions, Multiple Myeloma </li></ul><ul><li>Near normal-present film </li></ul>
  13. 28. T-tube cholangiogram <ul><li>Findings-dialated CBD, radiolucent shadow at the lower end of CBD, Rt and lt hepatic duct near normal </li></ul><ul><li>T-tube cholangiogram-done after 2 wks to report about residual stone </li></ul><ul><li>Tract forms-extraction can be done through tract or Endoscopical extraction </li></ul>
  14. 30. Barium enema-Air double contrast <ul><li>Mucosal irregularities and polyps can be identified </li></ul><ul><li>D/D-carcinoma, ulcerative colitis </li></ul><ul><li>Confirmation-colonoscopy and biopsy </li></ul><ul><li>Presentation.?? </li></ul>
  15. 32. Barium enema-air double contrast <ul><li>Filling defect at recto-sigmoid junction </li></ul><ul><li>Confirmation-colonoscopy and biopsy </li></ul><ul><li>Tt???? </li></ul>
  16. 34. Barium enema-double contrast <ul><li>Changes pertaining to Ulcerative colitis </li></ul><ul><li>Loss of haustrations(more so on left side of the colon) </li></ul><ul><li>Granulations,Psuedopolyps(not clear here </li></ul><ul><li>Presentation???? </li></ul><ul><li>D/D-Tuberculosis,carcinoma </li></ul>
  17. 36. Barium enema-Air double contrast <ul><li>Showing entire colon </li></ul><ul><li>Saw-tooth appearance </li></ul><ul><li>Diverticulosis-Sigmoid and left colon </li></ul><ul><li>Complications ????? </li></ul><ul><li>Symptoms-???? </li></ul>
  18. 38. Barium enema <ul><li>“Claw” like ending </li></ul><ul><li>Typical findings of intussusception </li></ul><ul><li>Most likely –ileo colic </li></ul><ul><li>Causes-Polyp, over growth of lymphatic tissue esp in child, malignant growth in old age </li></ul><ul><li>Presentation???? </li></ul>
  19. 40. Loopogram <ul><li>Indication-To rule out any distal obstructions, to look for healing of the anastomosis </li></ul><ul><li>Seems no obstruction </li></ul><ul><li>Apart from imaging , colonoscopy can also be done </li></ul>
  20. 42. Endoscopic retrograde cholangiopancreatography(ERCP) <ul><li>Findings-pancreatic calcifications and non dialated pancreatic duct can be seen </li></ul><ul><li>CBD not seen </li></ul><ul><li>ERCP can also be used to get tissue diagnosis </li></ul>
  21. 44. Oral Cholecystogram <ul><li>Normal contracting Gall bladder </li></ul><ul><li>To evaluate gall bladder function and to rule out stones. </li></ul><ul><li>OBSOLETE </li></ul>
  22. 46. Mammogram <ul><li>Cranio-caudal- does not show axillary tail and axillary lymphnodes </li></ul><ul><li>Medio-lateral oblique- Inner quadrants are not seen well </li></ul><ul><li>Findings-Irregular mass in medial upper quadrant (Rt breast), no calcification seen </li></ul><ul><li>Left breast-near normal </li></ul><ul><li>Indications-Screening, Doubtful mass, for contra lateral breast in pt with breast cancer, follow up (after breast conservative Tt of ca breast) </li></ul>
  23. 49. Lower limb angiogram <ul><li>Findings-occlusion of popliteal artery (around knee) , segmental block </li></ul><ul><li>Collaterals forming anterior and posterior tibial </li></ul><ul><li>Causes- Atherosclerosis,Inflammation </li></ul><ul><li>Tt-??? </li></ul>
  24. 52. Splenoportovenography <ul><li>Findings-hugely dialated portal and spleen vein, with collaterals </li></ul><ul><li>Obsolete-portal hypertension, to study portal venous anatomy </li></ul><ul><li>USG with Doppler to assess the PV , splenic vein, collaterals </li></ul><ul><li>UGI scopy </li></ul><ul><li>CT scan </li></ul>
  25. 53. Thank you

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