GAS y học

ACUTE ABDOMEN
ABNORMAL GAS COLLECTIONS
TERRENCE C. DEMOS, MD
DEPARTMENT OF RADIOLOGY


OR

GAZ



ACUTE ABDOMEN EXAMINATION
• RADIOGRAPHS
–
–
–
–

LEFT LATERAL DECUBITUS ABDOMEN
UPRIGHT ABDOMENT
UPRIGHT CHEST
SUPINE ABDOMEN



PNEUMOPERITONEUM


FREE AIR
SENSITIVITY OF IMAGING STUDIES

• COMPUTED TOMOGRAPHY
• LATERAL UPRIGHT CHEST RADIOGRAPH
• AP UPRIGHT CHEST RADIOGRAPH

99%
98%
80 - 90%

• LEFT DECUBITUS ABDOMEN RADIOGRAPH 80- 90%
• 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

UPRIGHT CHEST



PNEUMOPERITONEUM
UPRIGHT RADIOGRAPHS

UNDER RIGHT HEMIDIAPHRAGM

UPRIGHT ABD CENTRAL TENDON
AND HEMIDIAPHRAGM


FREE AIR…….DECUBITUS VIEW
GAS BETWEEN LIVER AND BODY WALL
BUT MAY ALSO BE IN OR ONLY IN THE PELVIS


ACUTE ABDOMINAL PAIN
UPRIGHT AP CHEST & LEFT LATERAL DECUB NEGATIVE



PNEUMOPERITONEUM

SUPINE RADIOGRAPHS

GAS BUBBLE ON LIVER SURFACE


FREE AIR
CENTRAL TENDON


FREE AIR
CENTRAL TENDON


RIGLER’S SIGN
BOTH SIDES OF BOWEL WALL VISIBLE

DOUBLE WALL SIGN


MASSIVE PNEUMOPERITONEUM
FOOTBALL SIGN


FALCIFORM LIGAMENT
GAS BUBBLE OVER LIVER


FALCIFORM LIGAMENT


PNEUMOPERITONEUM
SUBHEPATIC GAS BUBBLE

DIVERTICULITIS
PNEUMOPERITONEUM


ANTERIOR ABDOMINAL WALL
ANATOMIC FOLDS