Lower GI pathology and Image critique

what is chron’s disease

chronic inflammatory disease of the intestines

what is the radiogrpahic appearance of chron’s disease

inflammation and fibrosis with narrowing

• string sign, skipped pattern

• cobblestone appearance

what is this an example of?

chron’s disease

what are these a picture of

chron’s disease

what side of the body is most likely to have chron’s disease

right side

what are these an image of?

the cobblestone effect of chron’s disease

what is colonic diverticula

outpouchings, herniation of mucosa and submucosa through the muscular layers at points of weakness of the bowel wall

• condition of: diverticulosis

what is the radiographic appearance of colonic diverticula

• round or oval outpouchings, tend to be in clusters

• abscesses

• extravasation

what is diverticulitis

complication of diverticulosis; inflammation of the diverticula

• typically in the sigmoid region

what is this an example of?

retained barium in diverticulum

what is this an image of?

colonic diverticula

what is this an image of?

perforation with intramural absecc (diverticula)

what is ulcerative colitis

inflammatory bowel disease

• can lead to toxic mega colon, perforation

what is the radigraphic appearance of ulcerative colitis

• earliest detection: fine granulatrity of the mucosa

• chronic: haustra pattern absent, tubular looking colon

what is this an image of?

ulcerative colitis (haustra smooth)

what is this an example of?

ulcerative colitis- granularity

what is colon cancer?

cancer found in the colon

what is the radiographic appearance of colon cancer?

• polyps

• apple core

what is this image of?

colon cancer (apple core)

what is intussusception

telescoping of one part of the intestinal tract into another becuase of the peristalsis which forces the proximal segment of bowel to move distally w/ in the ensheathing outer portion

what is the radiographic appearance of intussusception

coiled- spring

what is this an imge of?

intussusception (barium)

what is this an image of?

intussusception (CT)

what is this an image of?

intussusception (ultrasound)

what is disk herniation

protrusion of an intervertebral disk

• L4-L5, L5-S1, C5-C6, C6-C7, T9-T12

what is the radiographic appearance of disk herniation

requires CT, MRI, or myelo to demostrate impression of hte disk on the spinal cord or individual nerve roots

what is this an image of?

disk herniation

for the small bowel PA stomach what do you annotate

0 minute

what is best seen of a PA stomach (0min image)

• body of stomach

• medial and lateral margins

what is best seen on an RAO stomach

the duodenal bulb filled with barium

what is best seen on a right lateral stomach

9see the retrogastric area and loop in profile; anterior and posterior margins

you do not need to annotate times for which views

• RAO stomach

• right lateral stomach

what do you need to see on the PA/AP follow through image

small intestines/ small bowel

• ok if you cut stomach

what are the views for a single BE

• scout

• PA

• LPO

• RPO

• PA axial sigmoid

• Left Lateral rectum

• post evacuation PA

BE scout (single) image requirements

• all bowel pattern and need to have symph

for RPO and LPO BE (single) you do not need ____

symph (do not need rectum)

for an RPO BE (single) you will see

• right pelvic wing flattened

• LEFT splenic flexure open

for an LPO BE (single) you will see

• left pelvic wing flattened

• RIGHT hepatic flexure open

PA BE (single) you need

• entire large intestine

• symphysis

• RH: can also see the enema tip

PA axial (sigmoid) angle (single)

30 degrees caudad

• 17×17 collimation

PA axial (sigmoid) you will see (single)

all of the signoid colon and rectum included

• can see end of descending colon

Left lateral rectum RH protocol (single)

need to deflate balloon prior to exposure

what is seen on a Left lateral rectum (single)

rectosigmoid area in the center of the image

• leave the tip in

what is circled in red

the BE balloon

Post Evac PA (single) what is seen

• entire large intestine

• symph (need rectum)

• POST marker

• residual barium will be in the bowel

views for a double BE

• scout

• PA

• AP

• RLD
  LLD
  PA axial sigmoid

• Cross table lateral rectum

Right lateral decub Double BE

air inflated portion of the colon is of primary importance- descedning colon

• splenic to symph

• mark side up (looking at air side)

• DONE AP

Left Lateral Decub double BE you will see

the air inflated portion of hte colon is primary importance

• ascending colon

• mark side up (right)

• RH pt faces the IR

#1

prone/PA

#2

supine/AP

AP supine double BE what is seen

need the entire colon

• air seen in transverse colon

PA prone double BE what is seen

the entire colon

• barium seen in transverse colon

PA axial sigmoid double BE

rectosigmoid area

• 30 degree cauda

• all sigmoid colon and rectum included

• can see end of descending colon

right lateral X-table rectum double BE what is seen

rectosignoid area visualized, air fluid level demonstrated

• deflate balloon and remove tip prior to exposure

if the patient cannot lay prone for the PA axial (sigmoid images what direction do you angle)

30 degrees cephalad