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Dept.of Radiology
Medical Faculty Hasanuddin University
General Objective
Liver
Biliary tract
Pancreas
Imaging modalities
Plain abdominal radiography
Technique of Examination :
The patient is asked to swallow a thick Barium
Sulphate (1:1) or Iodine ( for baby) and followed by
fluoroscopy & taking radiography
B. Abnormalities :
Congenital malformation
- Esophageal atresia
- Short esophagus with a thoracic stomach
(Brachy-esophagus)
- Duplication
Traumatic Disorders rupture
Abnormalities in density foreign bodies
Abnormalities in Size (length & diameter)
Abnormalities in architecture
Radiography positions : - AP
- Right Anterior Oblique
projection (RAO)
- Left Anterior Oblique
projection (LAO)
- Spot Film (optional)
Radiological Signs :
A. Normal Indentations : - Knob aorta
- Left main bronchus
- Left atrium
- Hiatus hernia
Esophageal atresia
Esophageal varices
Caused by portal hypertension,
commonly seen in cirrhosis
hepatis
cobble stone appearance
Esophageal stricture
Sliding /axial
Paraesophageal hernia
GASTRODUODENOGRAPHY
(= Maag Duodenum/MD Foto)
Is a radiographic evaluation of the stomach &
duodenum by introducing contrast media inside
[Barium sulfat (+) & air/gas (-)
Indication : - Dyspepsia
- Epigastric pain
- Vomiting
- Haematemesis/melaena
Procedure Of Examination
1. Preparation : fasting 4-6 hours
2. The patient swallows contrast Barium Sulfat
(& air) followed by fluoroscopy and taking
radiography in various position
3. Usually in Supine, Prone, Prone oblique,
Erect. Spot-Film Compression
(recommended)
Radiographic Abnormalities of Gastroduodenal
Disease.
It can be classified as changes in :
Position
Size (redundancy, enrlargement/widening,
narrowing/shrinkage)
Contour
Rugae abnormalities
Filling defect
Function
Fig. 28-14.Left lateral
erect film of the
stomach
Pyloric stenosis
= Infantile Hypertrophic Pyloric Stenosis
DIVERTICLE
- Protrution of mucosa and submucosal outward
- Additional shadow
Gastritis
Mucosal atrophy
Mucosal hypertrophy-
hypersecretion
three level density
Peptic ulcer
Mostly seen in pyloric antrum and duodenal bulbus
Primary Signs :
- En face (frontal view)barium spot with halo (active ulcer) and star
sign ( inactive)
- En profile (lateral view)additional shadow , globular shape (active
ulcer), conus (inactive)
Secondary signs
Contralateral/opposite spastic
insicura
Hypersecretion
Bulb deformity
DUODENUM
Congenital :
Stenosis post bulbar
duodenal atresia
Two bubbles app.
SMALL INTESTINE (JEJENUM & ILEUM)
Normal size: - 20 feets (length)
- 2,5 cm (jejenum); 1,75 cm (ileum)
in diameter
Indications:
Anemia (unclear origin)
Persistent diarrhoe
Abdominal pain
Palpable mass
Excessive protein loss
Malabsorbtion
Contraindication:
Obstruction signs
Perforation
Paralytic ileus
Peritonitis
Technique of Examination
1. Plain abdominal radiography
2. Follow Through
Patient is asked to swallow 200-300 cc Barium
sulfat (1:2-3 water),followed by taking pictures
30-60 minutes interval until contrast seen in
caecum
Abnormalities
Crohns Disease = Regional
ileitis
Adhesion
Fistula
COLON
Indication : Haematochesia
Persistent diarrhea
Abdominal mass
Obstructive symptoms
Congenital abnormalities
High level
Dilatation/Distension :
- Idiopathic symptomatic megacolon (older age)
- Hirschsprungs disease (megacolon congenital)
Disease of childhood, mostly males
Abscent of ganglion cells in the mesenteric
Radiographically :
- Plain abdominal films veriable degrees of
distension of GIT above the obstruction
- Barium enema/colon inloop
- Colon in loop :
Narrowing along the site of aganglionosis
Dilatation above the narrowing, might be
associated
with irregularity/sawtoothing/ulcerative
Colitis
Narrowing of the Colonic Lumen :
Obstruction of colon
Obstruction to the flow of Barium can be caused by :
Spasm
Annular Carcinoma
Intusussception
Volvulus
Diverticulitis
Intussusception = Invagination
A proximal segment of bowel (intussusceptum)
into lumen of a distal segment (intussuscepiens)
Location : Ileoileal > ileocolic > colocolic
Radiographic sign :
- Coiled spring or cupping sign
-proximal bowel dilatation
-absence of gas in dist segment
Cupping sign
Coiled spring
US findings :
-Target sign, doughnut sign or bulls eye
sign (transverse scan )
- pseudokidney sign ( longitudinal scan)
Necrotizing enterocolitis ( NEC)
Pneumatosis intestinalis
( Gas within bowel wall )
Inflammation :
- Ulcerative colitis
- Crohns Disease
Ulcerative Colitis
- Loss of haustra
- Contracted,shortened & small calibre
- Saw-toothing/ulceration
- Stringiness/String sign
Diverticle
Acute appendicitis
Acute appendicitis acute appendiceal inflammation due
to luminal obstruction and superimposed infection
Most common abdominal surgical emergency.
Diagnosis clinical history, physical examination &
laboratory studies.
Imaging is useful and advisable in patients with atypical
symptoms.
Mortality rate in developing countries : 1%.
() to 5% in small children & elderly.
Surgical aim to operate early before complications such as
appendiceal rupture & peritonitis developed.
Helical CT scan & graded compression US powerful
imaging methods in appendicitis
IMAGING IN APPENDICITIS
ABDOMINAL PLAIN FILMS
APPENDICOGRAPHY
ULTRASOUND
CT SCAN
TUMOR METASTASIS
Noduler bull-eye, usually multiple,
Well defined
Liver abscess
Hypoechoic mass
Irregular and thicken wall
Liver cyst
Free-echoic mass, well defined,
Solitary or multiple
Biliary obstruction
Causes :
- Stone
- Tumor intra/extraluminer.
such as Panreatic cancer,
cholangiocarcinoma
- Strictur cholangitis, etc
Biliary obstruction due to cancer of caput pancreas
Acute pancreatitis