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ABNORMAL GAS COLLECTIONS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY
ACUTE ABDOMEN ABNORMAL GAS COLLECTIONS TERRENCE C. DEMOS, MD DEPARTMENT OF RADIOLOGY
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OR GAZ
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ACUTE ABDOMEN EXAMINATION
RADIOGRAPHS LEFT LATERAL DECUBITUS ABDOMEN UPRIGHT ABDOMENT UPRIGHT CHEST SUPINE ABDOMEN
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PNEUMOPERITONEUM
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FREE AIR SENSITIVITY OF IMAGING STUDIES
COMPUTED TOMOGRAPHY % LATERAL UPRIGHT CHEST RADIOGRAPH % AP UPRIGHT CHEST RADIOGRAPH % LEFT DECUBITUS ABDOMEN RADIOGRAPH % SUPINE ABDOMEN RADIOGRAPH ?
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PNEUMOPERITONEUM SENSITIVITY OF IMAGING STUDIES
RADIOLOGIC DEMONSTRATION DEPENDS ON: VOLUME OF FREE AIR TIME INTERVAL BEFORE IMAGING TYPE OF IMAGING CONDUCT OF IMAGING EXAMINATION AS LITTLE AS ONE CC CAN BE DEMONSTRATED 10% OF PATIENTS WITH PERFORATED ULCERS DO NOT DEMONSTRATE PNEUMOPERITONEUM
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UPRIGHT CHEST
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PNEUMOPERITONEUM UPRIGHT RADIOGRAPHS
UPRIGHT ABD CENTRAL TENDON AND HEMIDIAPHRAGM UNDER RIGHT HEMIDIAPHRAGM
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FREE AIR…….DECUBITUS VIEW GAS BETWEEN LIVER AND BODY WALL BUT MAY ALSO BE IN OR ONLY IN THE PELVIS
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ACUTE ABDOMINAL PAIN UPRIGHT AP CHEST & LEFT LATERAL DECUB NEGATIVE
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PNEUMOPERITONEUM SUPINE RADIOGRAPHS
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GAS BUBBLE ON LIVER SURFACE
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FREE AIR CENTRAL TENDON
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FREE AIR CENTRAL TENDON
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RIGLER’S SIGN BOTH SIDES OF BOWEL WALL VISIBLE
DOUBLE WALL SIGN
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MASSIVE PNEUMOPERITONEUM FOOTBALL SIGN
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FALCIFORM LIGAMENT GAS BUBBLE OVER LIVER
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FALCIFORM LIGAMENT
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PNEUMOPERITONEUM SUBHEPATIC GAS BUBBLE
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DIVERTICULITIS PNEUMOPERITONEUM
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ANTERIOR ABDOMINAL WALL ANATOMIC FOLDS
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FREE AIR INFERIOR EPIGASTRIC VESSELS (LATERAL UMBILICAL LIGAMENTS)
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FREE AIR 2 DAYS AFTER OHT CT 3 DAYS LATER: DIVERTICULITIS
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PNEUMOPERITONEUM WITH PERITONITIS
PERFORATED VISCUS ULCER NEOPLASM BOWEL OBSTRUCTION ISCHEMIC BOWEL TRAUMA PERITONITIS GAS FORMING ORGANISM
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PSEUDO-PNEUMOPERITONEUM
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CENTRAL TENDON GAS YES, BUT JUST THE STOMACH
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GAS UNDER THE RIGHT HEMIDIAPHRAGM
HEPATIC FLEXURE ANTERIOR-SUPERIOR TO LIVER
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SUBDIAPHRAGMATIC FAT SIMULATING FREE AIR
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FREE AIR OR NOT FREE AIR? THAT IS THE QUESTION
PNEUMOTHORAX SIMULATES FREE AIR
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GAS IN SUBPHRENIC ABSCESS SIMULATES FREE AIR
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RETROPERITONEAL GAS SIMULATES FREE AIR
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RETROPERITONEAL GAS
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RETROPERITONEAL GAS IMAGING
LITTLE CHANGE IN POSITION OR SHAPE WHEN COMPARING SUPINE, UPRIGHT, DECUB RADIOGRAPHS BUT FREE INTRAPERITONEAL GAS IS FREELY MOBILE TENDS TO STAY IN ONE RETROPERITONEAL COMPARTMENT DUODENAL PERFORATION…..RUQ ANTERIOR PARARENAL SPACE SIGMOID DIVERTICULITIS….. LLQ PERIRENAL ABSCESS…………. PERINEPHRIC SPACE OFTEN FORMS LINEAR, CURVILINEAR GAS COLLECTIONS
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49-YEAR-OLD MAN WITH FEVER AND DIARRHEA FOR 2 WEEKS
49-YEAR-OLD MAN WITH FEVER AND DIARRHEA FOR 2 WEEKS. HE HAS INFECTED URINE
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RETROPERITONEAL GAS IMAGING
BENEATH DIAPHRAGM CAN SIMULATE PNEUMOTHORAX BUT MEDIAL, LATERAL, LOW NOT DIRECTLY UNDER APEX AS FREE AIR DIFFERENTIATE BY OBTAINING UPRIGHT OR DECUBITUS VIEWS LARGE VOLUME OF GAS CAN OUTLINE RETROPERITONEAL STRUCTURES KIDNEY, LIVER MARGIN, PSOAS, FLANK STRIPE RETROPERITONEAL GAS CAN EXTEND CEPHALAD TO MEDIASTINUM FASCIAL PLANES OF BODY WALL AND EXTREMITIES INTO PERITONEAL CAVITY
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RETROPERITONEAL GAS
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13-YEAR-OLD GIRL WITH CROHN’S DISEASE HAS SUBACUTE FEVER AND ABD PAIN
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RETROPERITONEAL GAS EXTENDS TO POSTERIOR PARARENAL SPACE & THEN PROPERITONEAL FAT
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ABDOMINAL PAIN 4 HOURS AFTER COLONOSCOPY AND BIOPSY
EXTENSIVE RETROPERITONEAL GAS
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BAROTRAUMA MEDIASTINUM – RETROPERITONEUM – FREE AIR
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RETROPERITONEAL GAS CAUSES
IATROGENIC SURGERY DIAGNOSTIC PROCEDURE TRAUMA PENETRATING RUPTURED VISCUS RETROPERITONEAL DUODENUM, COLON, RECTUM PERFORATED BOWEL SECONDARY TO TUMOR, INFECTION, OBSTRUCTION, NECROSIS CAUDAL EXTENSION OF PNEUMOMEDIASTINUM GAS WITHIN ABSCESS
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BOWEL WALL GAS
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PNEUMATOSIS OF COLON INFANT ADULT
NECROTIZING ENTEROCOLITIS ISCHEMIC COLITIS
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WHAT IS THE ABNORMALITY HERE?
USE LUNG WINDOWS TO LOOK FOR GAS
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72-YEAR-OLD WOMAN WITH DIARREHA FOR 2 DAYS NORMAL PHYSICAL EXAMINATION
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58-YEAR-OLD WOMAN MILD ABDOMINAL PAIN FOR 2 DAYS DIFFERENTIAL DIAGNOSIS?
SCLERODERMA, GAS IN COLON WALL
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PNEUMATOSIS 2 DAYS AFTER SEGMENTAL SB RESECTION RESOLVED SPONTANEOUSLY, DISCHARGED AFTER 1 WEEK
BOWEL WALL GAS MAY BE INNOCUOUS
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ASYMPTOMATIC 40-YEAR-OLD MAN
BENIGN STEADY STATE PNEUMATOSIS
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ISCHEMIC BOWEL
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ISCHEMIC BOWEL IMAGING SIGNS
DILATION PSEUDOOBSTRUCTION BOWEL WALL THICKENED PNEUMATOSIS UNENHANCING GAS IN VESSELS MESENTERIC, SMV, PORTAL VEINS OBSTRUCTED VESSELS SMA, SMV HIGH DENSITY CLOT ON UNENHANCED CT FILLING DEFECTS ON CT WITH IV CONTRAST ASCITES, FREE AIR AFTER PERFORATION
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ACUTE ONSET OF ABDOMINAL PAIN
SMA EMBOLIS
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ISCHEMIC COLITIS IN TWO PATIENTS
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ISCHEMIC SB AND COLON THICKENED MUCOSAL FOLDS
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SBO ISCHEMIC BOWEL AT SURGERY: SB TWISTED UNDER
ADHESION WITH OBSTRUCTI0N & SEGMENT OF DEAD BOWEL
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61-YEAR-OLD MAN WITH PROSTHETIC AORTIC VALVE HAS ACUTE GI BLEEDING
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ISCHEMIC COLITIS
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ISCHEMIC SMALL BOWEL ETIOLOGY ?
SMV CLOT
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47-YEAR-OLD WOMAN 2 WEEKS AFTER MI ACUTE ABDOMINAL PAIN OCCULT BLOOD + STOOL
SMA EMBOLIS FROM MURAL THROMBUS
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BILE DUCT GAS
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BILE DUCT GAS IATROGENIC BILIARY FISTULA CHOLANGITIS BILE DUCT SURGERY
SPHINCTEROTOMY BILIARY FISTULA GALLSTONE ERODING INTO BOWEL DUODENAL ULCER UPPER ABDOMINAL MALIGNANCY TRAUMA CHOLANGITIS GAS FORMING ORGANISM
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BILE DUCT GAS BILE DUCT GAS CHUNKY AND CENTRAL
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59-YEAR-OLD MAN HISTORY OF DUODENAL ULCER
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BILE DUCT GAS AND SBO
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SBO GALLSTONE ILEUS
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GALLSTONE ILEUS
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GALLSTONE ILEUS
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GALLSTONE ILEUS BILE DUCT GAS, SBO, STONE
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GALLSTONE ILEUS
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86-YEAR-OLD MAN ABD PAIN, VOMITING X 2 DAYS NO HISTORY OF PRIOR SURGERY AND NO HERNIAS
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82-YEAR-OLD MAN COMES TO ER ABDOMINAL PAIN AFEBRILE, NORMAL WBC
ABD 1 DAY LATER
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THE 82-YEAR-OLD MAN NOW HAS THE DIAGNOSIS OF SBO AND A CT STUDY IS DONE
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73-YEAR OLD MAN SIGNED OUT AMA AFTER UGI
ONE YEAR LATER ADMITTED WITH ABD PAIN, VOMITING
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75-YEAR-OLD WOMAN NAUSEA AND VOMITING X 1 DAY
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GALLBLADDER COLON FISTULA
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49-YEAR-OLD MAN WITH INTRACTABLE DIARRHEA
RADIOGRAPH 2YEARS EARLIER
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GALLBLADDER GAS
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GALLBLADDER GAS GALLBLADDER LUMEN GALLBLADDER WALL GAS
GALLBLADDER-BOWEL FISTULA GALLSTONE ILEUS EMPHYSEMATOUS CHOLECYSTITIS GALLBLADDER WALL GAS
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EMPHYSEMATOUS CHOLECYSTITIS
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EMPHYSEMATOUS CHOLECYSTITIS
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EMPHYSEMATOUS CHOLECYSTITIS
38 Emph Chole
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53-YEAR-OLD WOMAN RUQ PAIN AND FEVER
SUPINE UPRIGHT LEFT LAT. DECUBITUS
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2 WEEKS POST HEART TRANSPLANT FEVER AND ABDOMINAL PAIN
PREOPERATIVE RADIOGRAPH
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PORTAL VEIN GAS
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SMALL BOWEL ISCHEMIA GAS IN MESENTERIC AND PORTAL VEINS
48 SubPhrenic Abs CT
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65-YEAR-OLD MAN ABDOMINAL PAIN, NORMAL PX
PORTAL VEIN GAS DELICATE AND PERIPHERAL
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36-YEAR-OLD MAN MULTIPLE CONGENITAL ANOMALIES FEVER , WBC 17
36-YEAR-OLD MAN MULTIPLE CONGENITAL ANOMALIES FEVER , WBC 17.8, 15 BANDS ISCHEMIA OF SB AND STOMACH
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ISCHEMIC BOWEL MESENTERIC VEIN GAS
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ABSCESS
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ABSCESS SUSPECT AN ABSCESS WHEN RADIOGRAPHS SHOW A GAS COLLECTION THAT IS ABNORMAL BECAUSE OF PERSISTENCE ON MULTIPLE VIEWS GET HISTORY, PX, LAB DATA BY CONSULTATION WITH ORDERING MD AND BY LOOKING IN EMR CONFIRM WITH CROSS-SECTIONAL IMAGING
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APPENDICEAL ABSCESS RETROCECAL APPENDIX
ABNORMAL GAS… UNCHANGED ON MULTIPLE VIEWS
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SIGMOID DIVERTICULITIS GAS FILLED “DIVERTICULUM
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GIANT ABSCESS 2 WEEKS AFTER ANEURYSM SURGERY
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8 DAYS POST LEFT HEMICOLECTOMY TEMP 39.1, WBC 16,OOO 15 BANDS
PERIHEPATIC ABSCESS. CONNECTION TO BOWEL SHOWN BY UGI
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SUBPHRENIC ABSCESS
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FEVER 10 DAYS AFTER ABDOMINAL SURGERY
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CROHN’S DISEASE WITH ABSCESS
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54-YEAR-OLD WOMAN TRANSFERRED WITH PERSISTENT FEVER AND ELEVATED WBC POST DIVERTICULAR ABSCESS DRAINAGE
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47-YEAR-OLD WOMAN HAS FEVER, WBC 29.6 7 DAYS POST HEMICOLECTOMY
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PERCUTANEOUS DRAINAGE OF ABSCESS
ABSCESS WITH FISTULA TO SMALL BOWEL SHOWN BY DELAYED SCANNING
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PERITONITIS THICKENED, ENHANCING PERITONEUM
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PANCREATIC ABSCESS
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PANCREATIC GAS GAS IN PANCREATIC BED ABSCESS
POST PANCREATIC DRAINAGE PROCEDURE PERCUTANEOUS OR SURGICAL PUESTOW PROCEDURE PSEUDOCYST PANCREATIC FISTULA
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PANCREATITIS WITH ABSCESS
LESSER SAC ABSCESS GAS IN PANCREATIC ABSCESS
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PANCREAS-COLON FISTULA
PANCREAS-GAS BUT NO ABSCESS POST PUESTOW PROCEDURE PANCREAS-COLON FISTULA
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LESSER SAC
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LESSER SAC
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GASTRIC ULCER PERFORATION INTO LESSER SAC
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GALLBLADDER IN LESSER SAC
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GAS IN LESSER SAC PERFORATED GASTRIC ULCER
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CULTURE HISTORY OF RADIOLOGY
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INTERMITTENT ABDOMINAL PAIN FOR 3 WEEKS TAKING NSAIDS FOR 2 MONTHS
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68-YEAR –OLD MAN SUDDEN ONSET OF SEVERE ABDOMINAL PAIN
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