Role of radiology and imaging in the daignosis of ... - Orion Group

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Review Articlegraded compression technique.The fat and the bowel loops are displaced bycompression. Inflamed appendix appears tobe a thick walled incompressible sausage liketube with concentric layers in transverseplane . Perifocal oedema is also present. Fluidis also seen in the lumen of appendix. It iselongated tube with one end blind. When wallthickness exceeds 6 mm it is suggestive ofinflammation.Fig. no.4- -Abdomensupine -A triangularcollection of free gas inthe sub -hepatic regionFig. no.5--A band ofcurvilinear pulmonarycollapse with acrescent of normal lungbeneath it- simulatingPseudo -pneumoperitoniumFig. no.l-Shows inflamedappendix in transverse plane.The ORION Vol. 9, May 2001Fig. no.2-Showsinflamed appendix inlong axis.(B)Pneumoperitonium: Demonstration ofsmall pneumoperitonium is very essential.Most of the cases the cause of thepneumoperitonium will require emergencysurgery.Fig. no.3-(a) Erect chest film- Free gasseen under both domes ofdiaphragm.(b) Abdomen erect ,free gas under tIledomes 6(diaphragm.(C) Pseudopneumoperitonium: A number ofconditions which simulate pneumoperitoneume.g.-1. Chilaiditis syndrome -Distended bowelbetween liver and right. dome of diaphragm2. Sub diaphragmatic fat-omental fat3. Curvilinear pulmonary collapse(D)lntestinal obstruction: Dilation of boweloccursin1. Mechanical intestinal obstruction 2.Pseudoobstruction 3. Paralytic ileus 4. Airswallowing5. Several other conditions.Radiological differentiation depends mainlyon the size, mucosal appearance and thedistribution of loops of bowel. The diagnosisof intestinal obstruction depends on thedemonstration of dilated loops of bowelproximally with non-dilated or collapsedbowel distal to the presumed point ofobstruction.(A)Acute gastric dilatation:Dilatation of the stomach can be caused by 4main groups of conditions--(I)Mechanical gastric outlet obstruction maybe a sequel of peptic ulcer or a carcinoma ofthe antrum.(II)Paralytic ileus- This group of conditions isfrequently referred to as acute gastricdilatation.(III)Volvulus and air swallowing are usuallyuncommonconditions.(B)Small bowel obstruction:Usual causes are the bands,adhesions andstrangulations. Complete obstructionof the small bowel usually causes small boweldilatation with accumulation of both gas andfluid and a reduction in calibre of the largebowel. Plain film changes in small bowelobstruction may appear after 3-5 hours ifwww.orion-group.net/journals
Review Articlethere is complete small bowel obstruction andsuch changes are usually marked after 12hours. In incomplete obstruction early filmsmay be normal.This slide shows the feature of gall stone ileus.Here you see multiple dilated loops of smallbowel with a band of gas within the CBD.Gallstone ileus is a mechanical obstruction causedby the impaction of one or more gall stones inthe intestine, usually in the terminal ileum andrarely in the duodenum.Fig, No.9-Gall stoneileus.Slide no.6-Shows acutegastric dilatationThe ORION Vol. 9, May 2001Slide no. 7-ShowsSmall bowelobstruction: Multipledilated loops and airfluid level. A verysmall amount of gasesare noted in the largebowel.Differentiating points between a small andlarge bowel obstruction:String of beads sign:What is that: In dilated small bowel which isalmost completely filled with fluid. Smallbubbles of gas may be trapped in rowsbetween the Volvulae connivanties onhorizontal ray films- this is known as Stringof beads sign. This sign if present is virtuallydiagnostic of small bowel obstruction.Fig. No.8- -Anotherslide of small bowelobstruction showingString of beads sign.Signs of gallstone ileusa) Gas within the bile duct b)Features of smallbowel obstruction c)Abnormallocation ofgallstone d)Other previous findings whichcoincides biliary stone.What are the other causes of gas in the biliarytree:a)Physiological if the sphincter is laxed.b)Following biliary surgery c)Malignantfistula d)Perforated peptic ulcer into the bileduct.Its a case of intussusception is seenin children under 2 years of age. In children itusually commences in the ileum as the resultof inflammation of the lymphoid tissue andtends to be associated with mesentericadenitis. The enlarged lymphatic patches areforced into the ileum by peristaltic movementand acting as a tumour. So one part of theileum is pushed into the other and causingintussusception. In adults intussusception isinvariably caused by a tumour of bowel. Abarium enema examination is frequentlyrequired to establish a definite diagnosis andsometimes also relieves the patient.Fig. no. 10(a)--Multiple gas filledloops of dilated smallbowel there is a softtissue mass in the rightiliac fossa,Contrast enema examination of large gut of ababy shows the intussusception producing awww.orion-group.net/journals
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Role of radiology and imaging in the daignosis of ... - Orion Group

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