Imaging

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Imaging

  1. 1. Imaging GI Surgery Unit Faculty of Medicine University of Alexandria By: Mohamed Mourad University of Alexandria Assistant lecturer of general surgery
  2. 2. Different imaging modalities University of Alexandria
  3. 3. Plain chest x-ray University of Alexandria
  4. 4. Plain X-ray Chest postero-anterior view University of Alexandria
  5. 5. Ideal chest x-ray PA view  Trachea mid way between the 2 clavicles  1/3 of the heart lies in the Rt side of the midline  Visible upper diaphragmatic surface from one costophrenic angle to the other University of Alexandria
  6. 6. Normal plain chest x-ray PA veiw University of Alexandria
  7. 7. Plain chest x-ray PA veiw University of Alexandria
  8. 8. Plain standing x ray PA view showing Free air under diaphragm University of Alexandria
  9. 9. Plain standing x ray PA view showing Free air under diaphragm University of Alexandria
  10. 10. Air under diaphragm University of Alexandria
  11. 11. Plain x ray PA & lateral view showing Foreign body in thoracic esophagus University of Alexandria
  12. 12. Congenital diaphragmatic hernia University of Alexandria
  13. 13. Plain abdomen x-ray University of Alexandria
  14. 14. Plain X-ray abdomen supine University of Alexandria
  15. 15. Plain X-ray abdomen standing University of Alexandria
  16. 16. Plain X-ray abdomen University of Alexandria
  17. 17. Plain x ray abdomen and pelvis PA view showing Radio-opaque shadow University of Alexandria
  18. 18. DD radio-opaque shadow of Rt. hypochondrium   Gall bladder stones Renal stones (Dx Lat X-ray & US)       Porcelain gall bladder Calcified LN Fracture tr. Process of vertebra FB Fecolith Calcified hydatid cyst University of Alexandria
  19. 19. DD: renal & gall bladder stones University of Alexandria
  20. 20. Radio-opaque shadow of the abdomen x ray University of Alexandria
  21. 21. Chronic panreatitis University of Alexandria
  22. 22. Erect Plain x-ray abdomen &pelvis PA view showing Distended bowel loops  Distended Jejunal loops – – Central Valvae conniventes University of Alexandria
  23. 23. Plain x-ray abdomen &pelvis PA view showing Distended bowel loops  Distended loops – – Ileal Central featureless University of Alexandria
  24. 24. Plain x-ray abdomen &pelvis PA view showing Distended bowel loops  Distended Colon – – peripheral Colonic hausteration University of Alexandria
  25. 25. Plain x-ray abdomen & pelvis showing distended colonic loops University of Alexandria
  26. 26. Post operative adynamic ileus •Supine •Erect University of Alexandria
  27. 27. Plain x-ray abdomen and pelvis showing pneumatic tire appearance University of Alexandria
  28. 28. Plain x-ray abdomen and pelvis showing pneumatic tire appearance University of Alexandria
  29. 29. Plain x ray abdomen & pelvis showing double bubble sign University of Alexandria
  30. 30. Plain x-ray abdomen and pelvis Foreign body University of Alexandria
  31. 31. Plain x ray abdomen showing aeroblia University of Alexandria
  32. 32. Invertogram University of Alexandria
  33. 33. Oral Cholecystography University of Alexandria
  34. 34. Steps of oral cholecystography (OCG)  Control X-ray  Ingestion of telepaque  Another X-ray 12hrs latter  Intake of fatty meal  Another X-ray 2hrs latter Remember that 85% of gallstones are Remember that 85% of gallstones are radiolucent radiolucent University of Alexandria
  35. 35. Oral cholecystography (OCG) University of Alexandria
  36. 36. Oral cholecystography (OCG)  Site--- (bt. 12th rib & LV1)  Size--- (Contraction with fatty meal)  Shape  Filling defect  Function (concentration & contarction) University of Alexandria
  37. 37. Gall stones in OCG University of Alexandria
  38. 38. Non visualized gall bladder in OCG  Absent gall bladder  Stone in cystic duct  Non functioning gall bladder University of Alexandria
  39. 39. Barium swallow University of Alexandria
  40. 40. Barium swallow  Technique  Normal – – indentation Aortic arch Lt main bronchus University of Alexandria
  41. 41. Pathologies by barium swallow University of Alexandria
  42. 42. Achalasia of the cardia University of Alexandria
  43. 43. Barium swallow showing smooth narrowing of distal end of the oesophagus with proximal dilatation University of Alexandria
  44. 44. Barium swallow showing smooth long narrowing of middle 1/3 oesophagus  Corrosive – – – – – stricture Single or multiple Long segment Smooth tapering Usually in children Starts at aortic arch level University of Alexandria
  45. 45. Corrosive stricture University of Alexandria
  46. 46. Barium swallow showing Corkscrow oesophagus University of Alexandria
  47. 47. Irregular filling defect mostly Cancer oesophagus University of Alexandria
  48. 48. Oesophageal malignancy University of Alexandria
  49. 49. Oesophageal malignancy University of Alexandria
  50. 50. DD between achalasia and malignancy •The cardia is normally below the diaphragm •In X-ray 1, the oesophagus is interrupted above the diaphragm •In X-ray 2, the cardia below the diaphragm is closed with “bird beak-like” shape University of Alexandria
  51. 51. serpiginous filling defects in the oesophagus Oesophageal varices University of Alexandria
  52. 52. Barium swallow with outpouch of the barium--Oesophageal diverticula University of Alexandria
  53. 53. Epiphrenic and Zenker’s diverticulum University of Alexandria
  54. 54. Oesophageal web University of Alexandria
  55. 55. Barium meal University of Alexandria
  56. 56. Barium meal University of Alexandria
  57. 57. Barium meal  Large volume low density  Distension of stomach by volume  Small volume high density+ effervescent  Distension of stomach by buscopan University of Alexandria
  58. 58. Barium meal (Single & Double) University of Alexandria
  59. 59. Barium meal  1, Gastric antrum  2, pyloric canal  3, duodenal cap  4, duodenal loop University of Alexandria
  60. 60. Pathological findings in barium meal University of Alexandria
  61. 61. Hiatal hernia University of Alexandria
  62. 62. Barium meal in trendlenberg position showing Sliding hiatal hernia University of Alexandria
  63. 63. Barium meal in trendlenberg position showing Sliding hiatal hernia University of Alexandria
  64. 64. Barium meal in trendlenberg position showing Sliding hiatal hernia University of Alexandria
  65. 65. Barium meal in trendlenberg position showing paraoesophageal hiatal hernia University of Alexandria
  66. 66. Barium meal showing paraoesophageal hiatal hernia University of Alexandria
  67. 67. Barrett’s oesophagus University of Alexandria
  68. 68. Benign gastric ulcer University of Alexandria
  69. 69. Benign gastric ulcer  On lesser curvature  Convergence of mucosal folds  Out pouch University of Alexandria
  70. 70. Barium meal showing ulcer nich at the middle of lesser curvature with mucosal convergence Benign gastric ulcer University of Alexandria
  71. 71. Hour glass deformity University of Alexandria
  72. 72. Normal duodenal cap and DU University of Alexandria
  73. 73. 2 kissing duodenal ulcers University of Alexandria
  74. 74. Trifoliate deformity of DU University of Alexandria
  75. 75. Gastric tumors University of Alexandria
  76. 76. Malignant gastric ulcer University of Alexandria
  77. 77. Malignant gastric ulcer  Any site of stomach mainly antrum and greater curvature  Ulcer dose not protrude to the outside  Mucosal folds obliterate before the edges of the ulcer University of Alexandria
  78. 78. Lintis platica University of Alexandria
  79. 79. Lintis plastica University of Alexandria
  80. 80. Pyloric filling defect of malignant origin University of Alexandria
  81. 81. Pre-pyloric tumor University of Alexandria
  82. 82. Duodenal diverticulum University of Alexandria
  83. 83. Barium meal showing dilated stomach reaching pelvis with mottled dye without passage of dye to dudenum (Gastric outlet obstruction) University of Alexandria
  84. 84. Barium meal showing Soap dish appearance University of Alexandria
  85. 85. Congenital hypertrophic pyloric stenosis University of Alexandria
  86. 86. GOO by compression from outside University of Alexandria
  87. 87. GOO by pseudopancreatic cyst University of Alexandria
  88. 88. Volvulus of the stomach •Organoaxial volvulus •Mesenteroaxial volvulus University of Alexandria
  89. 89. Organo-axial volvulus University of Alexandria
  90. 90. Duodenal atresia University of Alexandria
  91. 91. Barium follow through University of Alexandria
  92. 92. Barium follow through University of Alexandria
  93. 93. Stricture of small intestine •Chron’s •Lymphoma •TB •Radiation University of Alexandria
  94. 94. Chron’s stricture  Commonly at terminal ileum  Multiple, rigid, irregular stricture (string sign of Kantor)  Skip lesions  Cobble stones  Polyps  Fistula University of Alexandria
  95. 95. Barium enema University of Alexandria
  96. 96. Barium enema University of Alexandria
  97. 97. Normal barium enema filling phase University of Alexandria
  98. 98. Pathological findings in barium enema University of Alexandria
  99. 99. Transverse colon filling defect University of Alexandria
  100. 100. Transverse colon filling defect (colonic malignancy) University of Alexandria
  101. 101. Cancer ascending colon University of Alexandria
  102. 102. Barium enema showing arrest of the dye at the level of rectosegmoid junction due obstruction of the lumen University of Alexandria
  103. 103. Diverticulosis University of Alexandria
  104. 104. Chron’s disease  Commonly  Multiple,  Skip at terminal ileum rigid, irregular lesions  Cobble stones  Polyps  Fistula  Loss of hausterations University of Alexandria
  105. 105. Ulcerative colitis  Rectosegmoid  Loss of hausteration  Polyps  No skip lesion  Narrow colon (lead pipe) University of Alexandria
  106. 106. Ischemic colitis  segmental narrowing of the entire transverse colon.  Within the narrowed segment, there are multiple nodular indentations, many of which have the appearance of thumbprinting University of Alexandria
  107. 107. DD of colonic stricture  Chron’s  TB  Cancer  Diverticulitis  Ischemic colitis caecum iliocecal segmoid segmoid splenic flexure University of Alexandria
  108. 108. Hirschsprung disease  Stenotic segment  Dilated rectum  Transitional zone (funnel)  Delayed evacuation University of Alexandria
  109. 109. Rounded filling defect (polyps) University of Alexandria
  110. 110. Rectosegmoid polyps University of Alexandria
  111. 111. Barium enema showing hundreds of filling defects of the entire colon (FAP) University of Alexandria
  112. 112. Intussusception University of Alexandria
  113. 113. Intussusception University of Alexandria
  114. 114. Barium reduction of intussusception •Head of intussusception is at hepatic flexure •Partial reduction •Free flow of contrast into distal small bowel indicates complete reduction University of Alexandria
  115. 115. Biliary imaging University of Alexandria
  116. 116. Types University of Alexandria
  117. 117. PTC University of Alexandria
  118. 118. Normal PTC University of Alexandria
  119. 119. CBD stone-PTC University of Alexandria
  120. 120. CBD stone-PTC  One or more intraluminal defects (round, faceted or lobulated) which produce varying degrees of biliary obstruction are seen.  Occasionally stones are noted as small multiple free-floating defects in a non-dilated duct. University of Alexandria
  121. 121. CBD stricture PTC Transhepatic cholangiogram showing a stricture of the common hepatic duct University of Alexandria
  122. 122. ERCP University of Alexandria
  123. 123. Normal ERCP •Common bile duct •Gall bladder •Common hepatic duct •Rt. & Lt. hepatic ducts University of Alexandria
  124. 124. CBD stone-ERCP University of Alexandria
  125. 125. CBD stone-ERCP University of Alexandria
  126. 126. CBD stone-ERCP University of Alexandria
  127. 127. Multiple intrahepatic & extrahepatic stones University of Alexandria
  128. 128. Bile duct carcinoma-ERCP A short segment constricting lesion with irregular margins was noted at the bifurcation of the common hepatic duct (Klatskin tumour) University of Alexandria
  129. 129. Stents insertion-ERCP University of Alexandria
  130. 130. Cholangiogram University of Alexandria
  131. 131. Normal T-tube cholangiogram University of Alexandria
  132. 132. Normal T-tube cholangiogram University of Alexandria
  133. 133. CBD stone, T-Tube University of Alexandria
  134. 134. CBD stone, T-Tube University of Alexandria
  135. 135. Transcystic IO cholangiogram University of Alexandria
  136. 136. Transcystic IO cholangiogram University of Alexandria
  137. 137. Radiological pattern reflecting the cause of biliary obstruction  Choledocholithiasis (biliary duct stones) – – – One or more intraluminal defects (round, faceted or lobulated) Occasionally stones are noted as small multiple free-floating defects in a non-dilated duct. Sometimes impacted with crescent sign. University of Alexandria
  138. 138. Radiological pattern reflecting the cause of biliary obstruction  Pancreatic carcinoma – – Complete or almost complete obstruction of the mid or distal common duct, usually over a long segment (3-4 cm) of the distal duct (intrapancreatic portion) is seen. A "rat-tail" configuration is the typical appearance University of Alexandria
  139. 139. Radiological pattern reflecting the cause of biliary obstruction  Cholangiocarcinom a – – The narrowing may occur at any level and typically presents as a segmental stenosis. When the lesion is located at the bifurcation, it is referred to as a Klatskin tumor University of Alexandria
  140. 140. Radiological pattern reflecting the cause of biliary obstruction  Benign stricture – – There is a short segmental circumferential stricture in the mid-common duct in a patient with a previous cholecystectomy. Most benign strictures are secondary to ductal injury during cholecystectomy. (iatrogenic) University of Alexandria
  141. 141. Radiological pattern reflecting the cause of biliary obstruction  Ampullary carcinoma – – Focal obstruction of very distal CBD is noted. A smooth constriction or an irregular polypoid mass growing into distal CBD may be seen. University of Alexandria
  142. 142. Radiological pattern reflecting the cause of biliary obstruction  Ascariasis – Worms are seen extending through the common bile duct and major hepatic ducts University of Alexandria
  143. 143. MRCP University of Alexandria
  144. 144. Normal MRCP University of Alexandria
  145. 145. CBD stones-MRCP University of Alexandria
  146. 146. Klatskin tumor-MRCP University of Alexandria
  147. 147. Biliary injury-MRCP University of Alexandria
  148. 148. Liver imaging University of Alexandria
  149. 149. Hydatid liver cyst  Fluid attenuation  No peripheral enhancement  Daughter  Well cysts defined  Rounded or oval University of Alexandria
  150. 150. Imaging Thank You University of Alexandria

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