Radiology of chest/ab: ch 9 abnormal collections of air

What can cause abnormal collections of gas?
Mechanical small bowel obstruction
Large bowel obstruction
Adynamic ileus
Hiatal hernia
MCCs of small bowel obstruction AKA ileus
Adhesion from past surgery
Intussusception in children
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Clinical signs of small bowel obstruction
Crampy periumbilical pain
Increased bowel sounds early
Decreased bowel sounds late, indicating infarction
Radiology findings of SBO
Distention of small bowel wall lumen (>3cm)
Prominent valvulae conniventes
-stacked coins appearance
Multiple air-fluid levels at varying levels (seen in upright images)
Valvulae conniventes can also be known as…
Plicae semicirculares
Treatment of a partial obstruction…
Treatment of a complete obstruction….
2 types of volvulus
Sigmoid and cecal
Which type of volvulus is more common?
Sigmoid volvulus
Sigmoid volvulus is secondary to….
Twisting of elongated sigmoid
Radiographic features of a sigmoid volvulus
Angles away from the point of obstruction
(usually in RUQ)
Radiographic features of a cecal volvulus
Coffe bean shaped distention of cecum
Usually points toward right side of abdomen
Air in the biliary tree
Causes of pneumobilia
Following cholecystectomy surgery
Incompetent sphincter of Oddi
Gallstone obstruction
2 types of hiatal hernias
Most common type of hiatal hernia
Radiographic findings of hiatal hernia
Rounded mass-like structure w/ air-fluid level
Superimposed on heart on frontal view
Retrocardiac on lateral view
T/F: you cannot tell the difference between hiatal hernias on plain film
Free intraperitoneal air
Causes of pneumoperitoneum
Laparascopic surgery
Rupture of hollow viscus (perforated ulcer, diverticulitis, post surgical dehiscence)
Radiographic findings of pneumoperitoneum
Crescent-shaped air underneat the right and/or left hemidiaphragm
CXR is superior to AXR
Pneumoperitoneum prognosis
Surgical emergency due to risk of infection by spillage of intestinal contents

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