Plain Abdominal Radiography & GI series 腹部與腸胃道之放射線學

Transcription

1 Plain Abdominal Radiography & GI series 腹部與腸胃道之放射線學 陳潤秋台北市立聯合醫院

2 Jen-Ai H.

3 Standing abdomen Jen-Ai H.

4 Supine KUB Jen-Ai H. medicalcenter.osu.edu

5 Jen-Ai H.

6 Checklist: bones and stones, gas and mass Jen-Ai H. Free air Bowel gas pattern Bowel wall Pathologic extra or intraperitoneal gas Gas bubbles in organ parenchyma Intraluminal gas collections in tubular structures or hollow viscera Intraperitoneal fluid collections

7 Checklist: bones and stones, gas and mass Jen-Ai H. Presence or nonvisualization of physiologic soft-tissue structures (psoas muscle, flank stripe, hepatic, splenic and renal outlines, bladder, perivesical fat, rectal air) Soft-tissue mass Pathologic calcification or foreign bodies Pathologic skeletal changes Lung bases

8 Gas: GI tract Jen-Ai H. Esophagogram, Stomach, Small bowel: duodenum, jejunum, and ileum. Large bowel: cecum, ascending, transverse, and descending colon, rectum.

9 Gastric volvulus ebsco.smartimagebase.com Jen-Ai H.

10 Jen-Ai H. 1 week newborn, vomiting after birth

11 Jen-Ai H. GI series: 1. a.esophagogram b.ugi series c.small bowel series Enteroclysis e.lgi series 2. a.single contrast b.double contrast c.water-soluble contrast

12 Jen-Ai H. UGI series

13 UGI: Esophagus A muscular tube about 20-24cm. Three phase of peristalsis: Primary: major stripping wave initiated by swallowing. Secondary: similar stripping waves but by irritation or distention along esophageal wall. Tertiary: segmental contraction, non-peristaltic.

14 Stomach: Cardiac Fundus Body Antrum Pyloric canal Duodenum: Duodenal bulb 2nd to 4th portion of duodenum (retroperitoneum, fixed). Jen-Ai H.

15 Small bowel series Jen-Ai Single H. contrast: jejunum,ileum enteroclysis

16 Jen-Ai H. LGI series

17 Jen-Ai H. LGI series: cecum, ascending,transversedescending, sigmoid, rectum, terminal ileum

18 GI lesions Jen-Ai H. 1. Mucosa 2. Submucosa, muscle 3. Serosa 4. Extraluminal

19 Jen-Ai H. Mucosa

20 Jen-Ai H. submucosa

21 Jen-Ai H. Serosa

22 Jen-Ai H. Extraluminal

23 Anatomy position: Hiatal Hernia Sliding hernia: GE junction is above the diaphragm Paraesophageal hernia: Part of fundus herniated Jen-Ai H. above the diaphragm

24 Anatomy abnormal: Achalasia The gastroesophgeal sphincter fails to relax. Primary and secondary peristalsis must absent Low esophgeal sphincter must fail to relax completely on swallowing.. Jen-Ai H. Bird s sign

25 Disease: Esophageal cancer Squamous cell carcinoma Annular Ulcerative Jen-Ai H.

26 Benign gastric ulcer 1. Projection of ulcer crater beyond wall. 2. Radiating fold to edge of ulcer. 3. Ulcer in the center of swelling lesion. 4. Collar sign, Hampton s line. 5. Incisura opposite. Jen-Ai H.

27 Simeon Abramson, M.D. Thomas E. Herbener, M.D. Jen-Ai H. Benign gastric ulcer

28 Malignant ulcer 1. Intraluminal ulcer crater. 2. Abrupt between ulcer and regional fold. 3. Thick rigid fold surrounding lesion. 4. Ulcer crater wide and eccentric 5. Carmen s meniscus sign Jen-Ai H.

29 Jen-Ai H.

30 Jen-Ai H. Gastric cancer

31 Distention limited to the small bowel Jen-Ai H.

32 Jen-Ai H. Ileus: Gall stone ileus

33 Ileus: Torsion of a Meckel diverticulum and enterolith Jen-Ai H.

34 Duodenal ulcer: Ulcer crater, linear ulcer Healed ulcer--cloverleaf or butterfly appearance All benign, if multiple or postbulbar Zollinger-Ellison syndrome (excessive gastrin secretion--gastrinoma) R. J. Alfidi, M.D. Jen-Ai H.

35 Jen-Ai H. Submucosal tumor in duodenum smooth surface, less acute angle

36 Duodenum external compression widening the C sweep-- pancreatic head lesion Jen-Ai H.

37 Crohn s disease Recurrent inflammatory condition of bowel of unknown etiology Aphthoid ulcer deep ulcer with fistula and sinuses Skip lesions (ulcer scattered in GI) cobblestone mucosal pattern String sign, wall thickening, stenosis Jen-Ai H.

38 Jen-Ai H.

39 Distention limited to the colon Most frequently cause, especially in elderly patients, is colorectal carcinoma (60%) Jen-Ai H.

40 Jen-Ai H. Sigmoid colon cancer with obstruction

41 Jen-Ai H. Colon cutoff sign in acute pancreatitis

42 Jen-Ai H. Colon cutoff sign in acute pancreatitis

43 Jen-Ai H. Volvulus of colon

44 coffee bean sign in sigmoid volvulus Jen-Ai H.

45 Pathologic thickening of bowel wall Pseudomembranous colitis Jen-Ai H.

46 Jen-Ai H. Colon polyp Size: 1-2cm: 10% malignant, >2cm: 50% malignant, Stalk: Single or Multiple: Familial polyposis syndromes. Adenomaous polyp (most commonly): tubular, tubulovillous,villouw Location: rectosignmoid 70%

47 Jen-Ai H. staclk

48 Jen-Ai H. Colon cancer Ulcerative Annular (apple core) Polypoid Plaque like Scirrhous carcinoma Kim LH

49 Jen-Ai H. Protruding lesion Colon cancer Polypoid or plaque like

50 Ulcerative colitis Shallow ulcer,mainly from left side. Loss of haustration, circumferential bowel involvement. Pseudopolyps ( rode like, Y-shape,linear ) Toxic megacolon. Backwash ileitis (mild) Cancer coexisting, rare. Jen-Ai H.

51 Jen-Ai H.

52 Diverticular Disease Herniated mucosa through bowel wall Diverticulum,95% in sigmoid colon Diverticulosis Diverticulitis: Extravasation of barium Intramural abscess, fistula Jen-Ai H.

53 Lymphoma Submucosal pattern produces thumbprinting sign Jen-Ai H.

54 Fixed intraperitoneal gas on a supine film Jen-Ai H.

55 Pneumoperitoneum (free air) on supine film Jen-Ai H. Football sign Visible falciform ligament (the laces of the football) Rigler s sign Gas in the hepatorenal recess (Morison s pouch) Para- and prehepatic gas Inverted V sign

56 falciform ligament outlined by free air Jen-Ai H.

57 Pneumoperitoneum:Rigler s sign Jen-Ai H.

58 Jen-Ai H. NEC with pneumoperitoneum

59 Jen-Ai H. Liver abscess

60 Emphysematous pyelonephritis and cystitis Jen-Ai H.

61 Jen-Ai H. Calcification and calculi

62 Jen-Ai H. Gall bladder stone

63 Jen-Ai H. staghorn stone

64 Jen-Ai H. Porcelain gall bladder

65 Intraperitoneal fluid collection Jen-Ai H.

66 Jen-Ai H. Pseudocyst of pancreas

67 Jen-Ai H. Intraabdominal mass

68 Ingested watch battery in fundus of stomach and then in transverse colon Jen-Ai H.

69 Jen-Ai H. Skeletal change

70 bones and stones, gas and mass Jen-Ai H.

71 Summary Jen-Ai H. Bones, stones, gas and mass Esophagus Anatomy abnormal: Achalasia Benign gastric ulcer Malignant ulcer Colon polyp Ulcerative colitis Pneumoperitoneum (free air) on supine film