Radiology ----Classical Signs in GIT Dr. Muhammad Bin Zulfiqar.
It is very difficult to learn much in the sea of radiology.
This presentation is the way to memorize classical signs in radiology.
Radiology Spotters collection by Dr Pradeep. Nice collection Radiology spotters mixed collection ppt made by or collected by Dr. Pradeep, this is a collection of confusing spotter and very important spotter commonly asked in exams, our references is radiopaedia, learning radiology and Aunt Minnie.. Thanks
various congenital gastrointestinal diseases manifesting in childhood or even in adults, their radiographic findings on various imaging modalities such as radiograph, barium, ultrasound etc.
Radiology Spotters collection by Dr Pradeep. Nice collection Radiology spotters mixed collection ppt made by or collected by Dr. Pradeep, this is a collection of confusing spotter and very important spotter commonly asked in exams, our references is radiopaedia, learning radiology and Aunt Minnie.. Thanks
various congenital gastrointestinal diseases manifesting in childhood or even in adults, their radiographic findings on various imaging modalities such as radiograph, barium, ultrasound etc.
A brief introduction to the IBD and its classification. Mainly dealing here with the Imaging techniques used in the diagnosis of the IBD.
Inflammatory bowel disease (IBD) is an idiopathic disease caused by a dysregulated immune response to host intestinal microflora. The two major types of inflammatory bowel disease are ulcerative colitis (UC), which is limited to the colon, and Crohn disease (CD), which can affect any segment of the gastrointestinal tract from the mouth to the anus, involves "skip lesions," and is transmural. There is a genetic predisposition for IBD, and patients with this condition are more prone to the development of malignancy.
Dislocation of joint is very tricky. In this presentation radiological evaluation of Dislocation of various joints will be discussed.
This is one of the best pictoral review of important joint dislocations
Renal Color Doppler Ultrasound.
After studying this presentation one will be able to perform and interpret ultrasound.
This presntation in my opinion is best short analog to text.
In this presentation we will discuss the bone age assessment mainly focusing wrist radiograph.
we shall also highlights some points in adult bone age
Basically it is an introduction. We shall not discuss its judicial importance
Role of medical imaging in developemental dysplasia of Hip Dr muhammad Bin Zu...Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of medical imaging---plain Radiography, Ultrasound,Arthrography, CT and MRI in the evaluation of Developemental dysplasia of hip. Our main focuss will be on Sonographic evaluation.
In this presentation we will discuss the basic of axial trauma from head to pelvis. We will discuss the important key points that aids in the diagnosis of axial trauma
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 21 with caption in this presentation.
In my opinion it will be very benificial to have this in your android.
This presentation is the first series of the MR imaging of Knee.
In this presentation MRI anatomy has been discussed. As we all know good knowledge of medical imaging three dimensional anatomy is key for good reporting.
Hope we all get benifitted.
Suggestions are most welcome
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 20 with caption in this presentation.
In my opinion it will be very benificial to have this in your android. ,
This presentation is almost a complete Pictoral view of Radiograph chest.
This presentation will help radiologist in daily reporting.
This presentation will help physicians, surgeons, anesthetist and almost all medical professionals in diagnosing commonly presenting cardiac diseases.
This will also help all in preparaing TOACS examination.
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 19 with caption in this presentation.
In my opinion it will be very benificial to have this in your android. ,
In this presentation we will dscuss the imp imaging features of Posterior fossa tumors in pediatric age group.
Medulloblastoma
Pilocytic Astrocytoma
Ependymoma
Brainstem Glioma
Schwanoma
Meningioma
Epidermoid Cyst
Arachnoid Cyst
In this presentation we will discuss about the
Anatomy of Prostate
Technique of Transrectal US
Carcinoma Prostate and
Different modes of prostatic biopsy.
In this presentation we shall discuss all fractures with specific names .
This is a pictoral review.
This presentation will be very helpful for radiologist to have in their androids to help them in rapid reporting
In this presentation all images of Chapter 18 from Grainger and Allison have been discussed.
Our aim is to discuss authentic material .
This is only for educational purposes.
In this chapter air space infilteration have been discussed. Ground glass haze and consolidation are discussed in detail.
This presentation is a selection of images from 17th chapter of grainger and allison.
Our aim is to provide standard and proved cases of the disease process.
This all is for educational purpose
Objectives of this presentation are
Introduction to ct
Cross sectional anatomy
Common important pathologies
This presentation is aimed to educate beginers to help in ct interpretetion.
16 High Resolution Computed Tomography of Interstitial and Occupational Lung ...Dr. Muhammad Bin Zulfiqar
This presentation is collection of images from chapter 16 of Grainger and Allison.
Inthis we will discuss the ILD.
This is only for educational purposes.
This Presentation is a collection of chapter 5 images from Grainger and Allison.
Our aim is to study authentic data.
This is only for educational purposes
In this presentation we will discuss role of high resolution in characterizing normal variant and pathologies of spinal pathologies.
This is a pictoral review.
This presentation provides sufficient material for anyone who wants is interested in interventional radiology. Here we will discuss the available facilities, mechanisms and equipments.
In my opinion this presentation will prove a footstep in interventional radiology
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Radiology ----Classical Signs in GIT Dr. Muhammad Bin Zulfiqar
1. CLASSICAL SIGNS IN GASTROINTESTINAL
RADIOLOGY(PART 1 & 2)
Dr. Muhammad Bin Zulfiqar
PGR IV FCPS SHL/SIMS
Alnoor Diagnostic Centre
2. INTRODUCTION
Radiologists have established many classic imaging signs for
visual manifestations of pathophysiologic processes.
The use of familiar objects to describe visual findings enables
radiologists both to arrive at a correct diagnosis and to
effectively convey such diagnostic findings to clinicians
The goal of this article is to review an array of classic signs
associated with gastrointestinal tract pathologies whose
imaging manifestations resemble everyday objects e.g. The
“football” and “cobblestone” signs.
3. INTRODUCTION
This article organizes the gastrointestinal signs from proximal
to distal within the gastrointestinal tract.
4. BIRD’S BEAK SIGN
The “bird’s beak” sign is a classic finding on esophagrams; it
describes a dilated proximal esophagus with a smooth-
tapered, distal esophagus at the level of the esophageal
hiatus in the setting of achalasia.
Achalasia is further characterized by esophageal aperistalsis
and failure of the lower esophageal sphincter to relax
5. Radiograph of the distal esophagus after oral contrast
administration obtained in a patient with achalasia
demonstrates marked proximal esophageal dilatation with
tapering of the distal esophagus resembling a bird’s
beak. Note the debris in the dilated proximal esophagus.
6. ACHALASIA
There are both primary and secondary forms of
achalasia.
Primary achalasia, the more common etiology, is
idiopathic
The lack of lower esophageal sphincter
relaxation is likely due to a loss of inhibitory
neurons in the esophageal myenteric plexus
9. CORKSCREW SIGN
The “corkscrew” sign is the visual manifestation of lumen-
obliterating, simultaneous, nonperistaltic contractions within
the esophagus
These abnormal contractions of varying amplitude occur in
diffuse esophageal spasm, a rare esophageal motility disorder
10. Esophagram in a patient with diffuse esophageal spasm demonstrates non-
peristaltic contractions within the esophagus resulting in a corkscrew
appearance
11. DIFFUSE ESOPHAGEAL SPASM
Characterized on manometry by periods of normal peristalsis
followed by simultaneous, repetitive, ineffective contractions.
These abnormal contractions segment the normal esophageal
lumen, mimicking a corkscrew on barium studies of the
esophagus
12. DOUBLE-BARREL ESOPHAGUS
The term “double-barrel esophagus” classically refers to the
radiographic appearance of a dissection between the
esophageal mucosa and submucosa without perforation.
The double-barrel radiographic appearance of the esophagus
is due to the visualization of a barium-filled, intramural
dissecting channel separated from the true esophageal lumen
by a lucent line known as the mucosal stripe.
13. DOUBLE-BARREL ESOPHAGUS
Intramural esophageal dissection is most commonly seen in
middle-aged or elderly women
This entity can occur in the setting of a
1. Coagulopathy,
2. Emetogenic injury,
3. Trauma,
4. Instrumentation,
5. Ingestion of foreign bodies
6. Intramural esophageal abscess,
7. Intraluminal diverticulum
8. Esophageal duplication
15. BULL’S EYE LESIONS
Lesions within the stomach forming central collections of oral
contrast within ulcerated intramural masses can produce a
target or bull’s eye appearance on upper gastrointestinal
barium examinations
Differential diagnosis is broad and includes
1. Gastric metastatic lesions from melanoma and lymphoma
2. Kaposi’s sarcoma
3. Carcinoid tumors
4. Gastric lipomas may also ulcerate and produce a bull’s eye
appearance
16. Radiograph from an upper gastrointestinal series of a patient with
metastatic melanoma demonstrates a bull’s eye lesion in the body of the
stomach
17. RAM’S HORN
The unusual shape of the stomach resembling the horn of the
ram is due to combination of gastric deformity causing a
tubular shape, conical narrowing, and limited distensibility of
the stomach.
Crohn’s disease is notable for this appearance
Crohn’s disease affects the stomach and duodenum in 0.5%
to 4.0% of patients
The antrum is the gastric region most frequently involved
18. Radiograph of the stomach following the oral administration of contrast in a
patient with HIV/AIDS demonstrates somewhat tubular, conical shape of the
distal stomach resembling a ram’s horn
19. LEATHER BOTTLE STOMACH
The stiff, nondistensible wall gives the stomach a leather
bottle appearance, also known as linitis plastica
Differential diagnoses for the appearance of a leather bottle
stomach include
1. Primary scirrhous adenocarcinoma of the stomach
2. Scirrhous metastases from lung, breast, colon
3. Pancreatic carcinomas
4. Lymphoma
5. Crohn’s disease
6. Sarcoidosis
7. Syphilis.
20. LEATHER BOTTLE STOMACH
Primary scirrhous adenocarcinoma of the stomach spreads
predominantly in the submucosa and muscularis propria
Scirrhous tumors constitute 5% to 15% of all gastric
carcinomas
Scirrhous adenocarcinoma is thought to arise near the pylorus
and spread proximally diffusely involving the entire stomach
21. Radiograph of the stomach following oral barium administration
demonstrates a thickened, stiff wall of the stomach secondary to syphilis
creating a leather water bottle-like appearance
22. WINDSOCK SIGN
The windsock appearance is formed by passive elongation of
the intraluminal diverticulum due to continual peristalsis of the
duodenum.
The windsock appearance is most commonly located in the
second portion of the duodenum and consists of the barium-
filled diverticulum that lies entirely within the duodenum
Appearance most commonly caused by Intraluminal Duodenal
Diverticulum
23. WINDSOCK SIGN
Intraluminal duodenal diverticulum is a rare congenital cause
of duodenal obstruction
These intraluminal diverticula are believed to arise from an
improper luminal recanalization of the foregut in the 7th week
of embryogenesis.
A residual tissue diaphragm may span the entire
circumference of the duodenum and only allow passage of
enteric contents through fenestrations
24. Duodenal wind sock sign in a patient with duodenal diverticulum. Image
from an upper gastrointestinal series clearly demonstrates an
intraluminal duodenal diverticulum (arrows) surrounded by a narrow
radiolucent line (arrowheads). The diverticulum, arising in the second
portion of the duodenum and extending to the third portion, was
confirmed at surgery.
25. DOUBLE BUBBLE SIGN
The “double bubble” sign represents the appearance of 2 gas-
filled structures in the upper abdomen of newborns and infants
on plain films of the abdomen
The left-sided, proximal bubble is the distended gas and fluid-
filled stomach.
The second, right-sided, more distal bubble is the distended
duodenum.
The double bubble sign indicates the presence of duodenal
obstruction that can be caused by a number of intrinsic or
extrinsic etiologies
26. DOUBLE BUBBLE SIGN
The intrinsic causes include
1. Duodenal webs
2. Duodenal atresia
3. Duodenal stenosis
The extrinsic etiologies include
1. Preduodenal portal vein
2. Malrotation of the gut with a midgut volvulus
3. Ladd bands
4. Annular pancreas
27. DOUBLE BUBBLE SIGN
Duodenal atresia is the causative entity most commonly linked
with a double bubble sign.
Duodenal atresia is found in 1 in 10,000 newborns and is
typically associated with other congenital anomalies
30% of children with duodenal atresia have Down’s syndrome
28. Plain radiograph of the abdomen in a patient with duodenal atresia creates
a double bubble appearance of the stomach and duodenum
29. WHIRLPOOL SIGN
The “whirlpool” sign is found on both cross-sectional imaging
as well as abdominal ultrasound in the presence of midgut
volvulus
The whirlpool appearance represents the swirling pattern of
the gut and the superior mesenteric vein as they wrap around
the superior mesenteric artery (SMA) in a clockwise rotation
It is the clockwise rotation of the bowel loops that result in the
whirlpool sign on cross-sectional imaging
30. WHIRLPOOL SIGN
Embryological explanation
Normally, the midgut undergoes a 270-degree counterclockwise
rotation during embryologic development.
Malrotation of the midgut represents a spectrum of developmental
anomalies that result in either an insufficient or total lack of
counterclockwise rotation of the midgut around the axis of the SMA.
These anomalies all lead to a shortened mesenteric base.
The shortened mesentery predisposes to volvulus that may result in
bowel obstruction.
Midgut volvulus is the most common complication of malrotation
of the small bowel in adults.
31. CT maximal intensity projection (MIP) demonstrates
the whirlpool appearance of the superior mesenteric
artery and vein wrapping around one another in a
patient with mid-gut volvulus.
32.
33. STRING OF PEARLS
The “string of pearls” sign indicates the presence of a small-
bowel obstruction. This sign is also commonly referred to as
the “string of beads” sign.
It represents a row of small gas bubbles oriented in a
relatively linear fashion within the abdomen on plain films
34. STRING OF PEARLS
The observed rows of gas bubbles represent gas trapped
between the valvulae conniventes of the nondependent wall of
small bowel.
These loops of small bowel are dilated and filled with fluid in
the setting of a small-bowel obstruction, thus the meniscal
effect of the surrounding fluid gives these pockets of gas a
rounded or ovoid appearance.
35. String of pearls sign in a patient with small-bowel obstruction (SBO).
Left lateral decubitus radiograph of the abdomen demonstrates a row
of small air bubbles (arrows), which represents air trapped between
the valvulae conniventes.
36. STACK OF COINS
The “stack of coins” sign typically indicates the presence of a
small-bowel hematoma
This sign is seen on plain films or MDCT images and
represents adjacent, thickened folds with sharp demarcation
and crowding of the valvulae conniventes
37. STACK OF COINS
Over-anticoagulation with warfarin is the most common
cause of spontaneous intramural small-bowel hematoma
Other Causes include
1. Idiopathic thrombocytopenic purpura
2. Leukemia
3. Pancreatitis
4. Pancreatic cancer
5. Hemophilia
6. Lymphoma
7. Myeloma
8. Chemotherapy
9. Vasculidites
38. Plain radiograph of the abdomen following the oral administration of
barium to a patient with a small bowel hematoma demonstrates a stack of
coins sign.
39. STRING SIGN
The string sign represents the marked narrowing of the
terminal ileum lumen secondary to symmetric, transmural
granulomatous inflammation and subsequent fibrotic
thickening of the bowel wall
Bowel-wall thickening is the most common manifestation of
Crohn’s disease on MDCT scans, occurring in up to 82% of
patients
40. STRING SIGN
In the setting of Crohn’s disease, the terminal ileum often
becomes markedly stenotic secondary to bowel-wall
inflammation and fibrosis.
This results in the lumen of this portion of the small bowel
resembling a piece of string on plain radiographs after
ingestion of high-density oral contrast material
41. A thin line of barium is seen in the terminal ileum (long arrows), which
resembles a frayed cotton string (the gastrointestinal string sign). Small
mesenteric border ulceration is seen (small arrow).
42. RIBBON SIGN
Fluoroscopic examinations performed with high-density oral
contrast material in patients with GVHD of the GI tract may
demonstrate marked fold thickening, luminal narrowing,
separation of folds, and ultimately complete effacement of
the valvulae conniventes. The latter causes the so-called
“ribbon sign”
Donor lymphoid cells damage host tissues in graft-versus-host
disease (GVHD).
The organs most commonly affected by GVHD include the
gastrointestinal tract, liver, and skin.
Marked bowel-wall thickening can occur both in the small and
large bowel
GVHD: Graft versus host disease
43. RIBBON SIGN
The ribbon bowel appearance can also occur with
multiple other clinical settings, such as
1. Infection
2. Irradiation
3. Allergy
4. Ischemia
5. Ingestion of corrosives or medications
6. Amyloid
7. Mastocytosis
8. Lymphoma
9. Crohn disease
10. Celiac disease
44. Plain radiograph of a small bowel follow through in a patient with
graft versus host disease illustrates marked luminal narrowing and
effacement of the valvulae conniventes producing a ribbon like
appearance of the small bowel
46. COMB SIGN
The “comb sign” is seen in the presence of Crohn’s
disease.
This sign is observed on contrast-enhanced CT or
magnetic resonance imaging (MRI) scans.
The teeth of the comb in this instance represent
engorged small arteries, the vasa recta, perfusing
the small bowel
47. COMB SIGN
The vasa recta of the small bowel seen in Crohn’s disease
become tortuous and enlarged.
They appear as prominent opacities on the mesenteric side of
the small bowel.
These small arteries become engorged due to increased
blood flow to the inflamed small bowel and are accentuated
due to the fibrofatty proliferation in the mesentery.
48. Contrast-enhanced
CT image in a
patient with
Crohn’s disease
demonstrating
engorged vasa
recta secondary to
hyperemia of the
bowel producing
the comb sign.
49. TARGET SIGN
The target sign is classically seen in patients with
Crohn’s disease.
This pattern of bowel wall enhancement has been
observed in patients with
1. Radiation enteritis
2. GVHD
3. Ischemic bowel
4. Intramural hemorrhage
5. Vasculitides such as Henoch-Schonlein purpura, and
6. Pseudomembranous colitis
50. TARGET SIGN
It represents an enhancement pattern of the bowel
wall seen in various disease processes on contrast-
enhanced CT or MRI scans.
This appearance is formed when a thickened bowel
wall demonstrates alternating degrees of
attenuation, with an inner and outer layer of higher
attenuation and a middle layer of lower attenuation
51. TARGET SIGN
The higher-attenuation inner and outer layers
represent the mucosa and muscularis propria,
respectively.
The high attenuation of these layers is believed to
be secondary to contrast enhancement from
inflammation.
The lower attenuation middle layer is thought to be
due to submucosal bowel wall edema.
52. Contrast-enhanced CT
image of the small
bowel in a patient with
Crohn’s disease reveals
rings of high attenuation
representing the
hyperemic mucosa and
muscularis propria of
the small bowel. The
hypodense ring
represents the
edematous submucosa.
This enhancement
pattern creates the
target sign.
53. COILED SPRING SIGN
The “coiled spring” sign can be seen anywhere in
the bowel where an intussusception has occurred.
These ring shadows represent contrast reflux within
the lumen between the walls of the intussusceptum
and intussuscipiens
54. COILED SPRING SIGN
Classically, this sign describes the appearance of
the cecum in the presence of appendiceal
intussusception, a rare entity.
It is thought that the coiled-spring appearance
results from intussusception of the cecal tip with the
invaginated appendix acting as the lead point for
variable amounts of cecocecal or cecocolic
intussusception
55. Plain radiograph of the abdomen following the administration
of contrast through a feeding tube in a patient who is status
postgastric bypass demonstrates a coiled-spring appearance
of the small bowel secondary to intussusception
56. ARROWHEAD SIGN
This perceived arrowhead shape is secondary to
focal, symmetric thickening of the cecal wall
secondary to spreading inflammation from
appendicitis
The cecal wall thickening causes funneling of oral
or rectal contrast material within the upper cecum,
which points to the obstructed appendiceal orifice
57. ARROWHEAD SIGN
The arrowhead sign, which is obtained after the
administration of oral and/or rectal contrast
material, is seen on computed tomographic (CT)
images as an arrowhead-shaped collection of
contrast medium localized to the upper part of the
cecum near the orifice of the appendix
58. Contrast-enhanced CT image in a patient with right lower-
quadrant pain demonstrates arrowhead-shaped
inflammatory changes of the cecal base secondary to acute
appendicitis. Note the thickened appendix.
59. THUMBPRINT SIGN
This sign is seen in roughly 75% of cases of
transient, nongangrenous ischemic colitis
Other conditions that may also produce the
thumbprint sign include
1. Pseudomembranous colitis
2. Ulcerative colitis
3. Lymphoma
4. Leukemia
5. Coagulopathies
60. THUMBPRINT SIGN
This sign describes smooth, rounded impressions
causing filling defects classically seen in barium
studies of ischemic colitis.
These nodular densities represent edema and
hemorrhage into the wall of the colon most
commonly secondary to ischemia
61. Plain radiograph of the abdomen in a patient with ischemic colitis
demonstrates thickening of the haustra secondary to edema and
hemorrhage resulting in the appearance of multiple thumbprints in the
wall of the colon
62. COBBLESTONE SIGN
The “cobblestone sign” is classically seen within the
small and large bowel on fluoroscopic studies in the
presence of active Crohn’s disease
The cobblestone appearance of the bowel wall is
due to a combination of extensive, broad, linear
transverse and longitudinal ulcerations within an
inflamed mucosal surface. Only scattered islands of
normal mucosa remain in this setting
63. Radiograph of a small bowel follow-through in a patient with Crohn’s
disease demonstrates scattered islands of normal intestinal mucosa
adjacent to multiple ulcerations resulting in the cobblestone
appearance of the distal ileum
64. BOWLER HAT SIGN
The “bowler-hat sign” represents the appearance of
a sessile colonic polyp on a double contrast barium
enema
A colonic diverticulum can partially fill with barium
and also produce a bowler hat appearance
65. BOWLER HAT SIGN
The bowler-hat sign is formed by a ring of barium
adjacent to the base of the polyp surrounding a
domed layer of barium coating the surface of the
polyp
The orientation of the dome of the bowler hat sign
can help differentiate a polyp from a diverticulum.
An intraluminal polyp will result in a bowler-hat sign
with its dome pointed inward toward the lumen,
while a diverticulum will produce a bowler hat sign
pointed outward
66. Magnified view of the sigmoid colon demonstrates " the
bowler hat sign" of the mid-sigmoid sessile polyp seen
obliquely (arrowhead) and diverticula en face (arrow).
67. MEXICAN HAT SIGN
Pedunculated colonic polyps form the “Mexican hat
sign”
The Mexican hat sign is formed by the appearance
of 2 concentric rings
The outer ring represents the “en face” visualization
of barium coating the surface of the head of a
pedunculated polyp, while
The inner ring represents a meniscus of barium
surrounding the stalk of the polyp visualized
through the head
68. Radiograph of an upper gastrointestinal series demonstrates a
pedunculated gastric polyp demonstrating a close resemblance to a
Mexican hat.
69. COLLAR BUTTON SIGN
“Collar button ulcers” are manifestations of
inflammatory processes within the bowel.
These deep ulcerations are classically seen in the
colon associated with active ulcerative colitis
However they have also been observed in the
setting of other inflammatory bowel processes,
such as
1. Crohn’s disease
2. Ischemic colitis
3. Shigellosis
70. COLLAR BUTTON SIGN
The collar button appearance is formed by mucosal
ulceration with associated undermining of the
ulcer’s edge by lateral submucosal extension
Vertical penetration into the bowel wall is limited
due to the resistance of the underlying muscularis
mucosa, thus resulting in the discoid collar button
appearance of these ulcers
71. Radiograph from a single contrast barium enema in a patient with active
ulcerative colitis shows a deep ulcer within the descending colon that
demonstrates a collar button appearance
72. APPLE CORE SIGN
The apple core sign is classically seen in cases of colon
carcinoma
This appearance is most commonly located in the
sigmoid colon as well as in the ascending, transverse,
and descending colon.
The apple core sign is not seen in the larger-caliber
cecum.
73. APPLE CORE SIGN
The differential diagnosis of a lesion with an apple
core appearance is
1. Focal diverticulitis
2. Ischemic colitis
3. Ulcerative colitis
4. Endometriosis
5. Amebiasis
6. Serosal metastatic implants
7. Infectious colitis
74. APPLE CORE SIGN
The apple core appearance is the visual manifestation of
an annular lesion of the bowel with irregular overhanging
edges and shouldered margins
75. Fluoroscopic image from a double contrast barium enema in
a patient with changing bowel habits reveals an annular
lesion with overhanging edges within the colon closely
resembling an apple core.
76. ACCORDION SIGN
The “accordion sign” describes the appearance of
colonic wall thickening in the setting of colitis
The accordion sign has also been observed with
1. colonic edema secondary to cirrhosis
2. Crohn’s disease
3. Ischemic colitis
4. Lupus vasculitis
5. Infectious colitis.
77. ACCORDION SIGN
This sign describes the appearance of alternating,
edematous haustral folds that are due to transmural
edema and are separated by transverse mucosal
clefts filled with oral contrast .
Oral contrast is trapped between thickened,
edematous colonic folds and pseudomembranes in
the setting of C. difficile-induced
pseudomembranous colitis
78. White oval highlights markedly thickened bowel wall with
oral contrast trapped between haustral folds in a patient
with known C difficle colitis. This is the "accordion sign."
79. LEAD PIPE SIGN
The lead pipe appearance of the colon is classically
seen with chronic, smoldering ulcerative colitis.
The differential diagnosis for a lead pipe
appearance of the colon includes
1. Crohn’s disease
2. Tuberculosis
3. Amebiasis
80. LEAD PIPE SIGN
The lead pipe appearance likely represents the
visual manifestation of multiple pathophysiological
processes
There is increased regeneration of the colonic
mucosa in ulcerative colitis.
This mucosal regeneration may lead to hypertrophy
of the muscularis mucosae.
Contraction of this hypertrophic muscle layer gives
the colon the lead pipe-like narrowed, ahaustral,
and foreshortened appearance
81. Radiograph from a double contrast barium enema in a
patient with chronic, smoldering ulcerative colitis
demonstrates an ahaustral, pipe-like appearance of the
colon
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Curr Imaging