86: Plain and contrast radiology


CHAPTER 86
Plain and contrast radiology


Stephen E. Rubesin and Marc S. Levine


Hospital of the University of Pennsylvania, Philadelphia, PA, USA,


Plain radiographs of the abdomen are useful for evaluating abdominal pain or distension, obstructive symptoms, or clinical signs of an acute abdomen. The combination of supine and upright or decubitus horizontal beam radiographs allows the diagnosis of adynamic ileus or obstruction of the small bowel or colon, free intraperitoneal air (pneumoperitoneum) (Figure 86.1), ischemic or necrotic bowel with air in the bowel wall (pneumatosis) (Figure 86.2), air in the bile ducts (pneumobilia), and portal venous gas (Figure 86.3). Nevertheless, computed tomographic (CT) scanning is a more sensitive modality for evaluating acute abdominal symptoms (see Chapter 89).


Double‐contrast radiography is a valuable technique for diagnosing a wide spectrum of pathological processes in the gastrointestinal tract. Because this technique can delineate normal mucosal surface patterns in the pharynx, upper gastrointestinal tract, small bowel, and colon, it is particularly helpful in detecting a variety of inflammatory or neoplastic diseases involving the mucosa. In some cases, barium studies may demonstrate abnormalities that are missed or misinterpreted at endoscopic examination. Double‐contrast radiography and endoscopy should be considered as complementary procedures for evaluating suspected gastrointestinal disease.


Double‐contrast radiography can delineate in detail the normal anatomical features of the pharynx (Figure 86.4). As a result, inflammatory (Figure 86.5) or neoplastic (Figures 86.6 and 86.7) lesions that disrupt or obliterate the normal anatomical landmarks can be demonstrated readily. In the upper gastrointestinal tract, double‐contrast techniques allow detection of esophagitis caused by plaques or ulcers (Figure 86.8), esophageal cancer (Figure 86.9), benign gastric ulcer (Figure 86.10), early gastric cancer (Figure 86.11), duodenal ulcer (Figure 86.12), erosive gastritis or duodenitis, and other inflammatory or neoplastic lesions. Today, most upper gastrointestinal series are used to demonstrate preoperative and postoperative anatomy, to explain severe symptoms (Figure 86.13) and demonstrate complications, such as leaks (Figure 86.14). Single‐contrast techniques demonstrate motility and the big picture better than double‐contrast studies (Figure 86.15).


The small bowel follow‐through examination can determine the site and cause of small bowel obstruction (Figure 86.16) and a variety of other abnormalities in the small bowel (Figures 86.17 and 86.18). Although double‐contrast barium enema examination is a valuable technique for detecting colonic polyps or carcinoma or inflammatory bowel disease, it has largely been replaced by endoscopy or virtual colonoscopy. Double‐contrast barium enema is still a relatively inexpensive and safe examination that provides a detailed examination of the colon (Figure 86.19). Single‐contrast water‐soluble enemas remain valuable to exclude leaks. Single‐contrast barium enemas are still used in debilitated patients and to exclude obstruction or fistula formation (Figure 86.20).

Photo depicts pneumoperitoneum.

Figure 86.1 Pneumoperitoneum. (a) Upright chest radiograph shows large amounts of free intraperitoneal air beneath both sides of the diaphragm in this patient with a perforated duodenal ulcer. (b) Supine plain radiograph of the abdomen of another patient shows an indirect sign of pneumoperitoneum, air on both sides of the bowel wall (Rigler sign; arrows) after perforation at colonoscopy.


Source: Levine MS. Plain radiograph diagnosis of the acute abdomen. Emerg Med Clin North Am 1985;3:541. Reproduced with permission of Elsevier.

Photo depicts pneumatosis caused by infarction of the left colon after a surgical procedure.

Figure 86.2 Pneumatosis caused by infarction of the left colon after a surgical procedure. Close‐up view of supine plain radiograph of the abdomen shows tiny, mottled and linear collections of gas in the wall of the descending colon.

Photo depicts close-up view of the right upper quadrant on supine plain radiograph of the abdomen shows linear, branching collections of gas in the portal venous system caused by intestinal infarction.

Figure 86.3 Close‐up view of the right upper quadrant on supine plain radiograph of the abdomen shows linear, branching collections of gas in the portal venous system caused by intestinal infarction. Gas shadows extend to the periphery of the liver. This appearance is characteristic of portal venous gas.


Source: Levine MS. Plain radiograph diagnosis of the acute abdomen. Emerg Med Clin North Am 1985;3:541. Reproduced with permission of Elsevier.

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Nov 27, 2022 | Posted by in GASTROENTEROLOGY | Comments Off on 86: Plain and contrast radiology

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