Objectives

After viewing the exhibit, learners will understand:

1. Where to find the most common sites of extraluminal gas accumulation on a supine frontal abdomen radiograph

2. The common and uncommon radiographic appearances that allow diagnosis of pneumoperitoneum and pneumoretroperitoneum on a supine frontal abdomen radiograph

Background

Because CT offers so much more, abdomen radiographs often are dismissed as providing no clinically useful diagnostic information, particularly by more recently trained radiologists. Yet radiographic evaluation of the abdomen continues to be performed, and often for the sickest patients.

Supine frontal views are the most frequently obtained abdomen radiographs. Identification of extraluminal gas on these studies remains a clinically relevant skill, since early detection can be vital.

Imaging findings OR Procedure findings

The exhibit provides examples of the most common sites of accumulation of extraluminal gas on supine frontal abdomen radiographs.

Specific diagnostic signs are depicted, including Rigler's, the Lucent Liver, Leaping Dolphin, Cupola, and Inverted V.

Conclusion

While CT is more sentitive for diagnosing extraluminal gas, a supine frontal abdomen view still can be the initial opportunity to make that diagnosis, particularly in very ill hospitalized patients. Knowing where to look for free air and the signs that reveal it can be key to early detection and prompt treatment.

Objectives

Viewers of the exhibit will learn:

1. Contrast enema technique, including factors affecting choice of contrast material

2. Clinical scenarios in which the contrast enema can be particularly helpful for problem solving

3. Key findings in the interprtation of contrast enemas

Background

In recent decades, the number of contrast enemas performed has decreased preciptously, concurrent with the ascendancy of optical colonoscopy and cross-sectional imaging. Consequently, facility with the technique and image interpretation skills have fallen concomittanly, particularly for more recently trained radiologists.

This exhibit provides a guide to performance of contrast enemas, offers examples of clinical situations in which the study can be particulaly helpful, and reviews findings that are key to accurate interpretation of contrast enemas.

Imaging findings OR Procedure findings

The exhibit will provide examples of imaging findings that can be well depicted with contrast enema for clinical problem solving, including leak, fistula, stricture, volvulus, post-surgical complications, and neoplasm.

Conclusion

The contrast enema still offers a rapid, adaptable, and "real-time" means of anatomic assessment of the colon, including in the post-surgical setting. Consequently, radiologist would be wise to maintain their skills in enema performance and interpretation, rather than relegating it to the dustbin of imaging history.

Objectives

After viewing the exhibit, the learner will:

1. Have an instructional guide for performing a dual-phase esophagram, and how best to demonstrate esophagitides

2. Recognize the findings of esophagitis at fluoroscopy

3. Use those findings to facilitate diagnosis of specific inflammatory and infectious esophagitides

Background

While most gastrointestinal tract fluoroscopy numbers have fallen precipitously, esophagrams and swallowing studies still are frequently performed. The dual phase esophagram remains an excellent test for diagnosis of esophagitis.

Because of the increasing prevalence of gastroesophageal reflux, reflux esophagitis is familiar to radiologists. Other inflammatory and infectious esophagitides (for example, herpetic, eosinophilic, lichen planus) are less well known. This exhibit teaches how to perform an optimum study, the appearance of the types of esophagitis, and how to narrow the differential diagnosis.

Imaging findings OR Procedure findings

After supplying a synopsis of how to perform a dual-phase esophagram, the exhibit provides imaging examples of the varieties of esophagitis, focusing particularly on the types of luminal contour changes, ulceration, and stricture formation.

Conclusion

Diagnosis of esophagitis is possible without the expense and invasiveness of endoscopy. The barium esophagram remains a simple, cost-effective means of evaluation.

While reflux disease is the most common form of esophagitis, radiologist must be able to recognize other types of inflammatory and infectious esophagitides to spare patients from unnecessary further testing.

Objectives

After viewing the exhibit, learners will understand:

1. Where to find the most common sites of extraluminal gas accumulation on a supine frontal abdomen radiograph

2. The common and uncommon radiographic appearances that allow diagnosis of pneumoperitoneum and pneumoretroperitoneum on a supine frontal abdomen radiograph

Background

Because CT offers so much more, abdomen radiographs often are dismissed as providing no clinically useful diagnostic information, particularly by more recently trained radiologists. Yet radiographic evaluation of the abdomen continues to be performed, and often for the sickest patients.

Supine frontal views are the most frequently obtained abdomen radiographs. Identification of extraluminal gas on these studies remains a clinically relevant skill, since early detection can be vital.

Imaging findings OR Procedure findings

The exhibit provides examples of the most common sites of accumulation of extraluminal gas on supine frontal abdomen radiographs.

Specific diagnostic signs are depicted, including Rigler's, the Lucent Liver, Leaping Dolphin, Cupola, and Inverted V.

Conclusion

While CT is more sentitive for diagnosing extraluminal gas, a supine frontal abdomen view still can be the initial opportunity to make that diagnosis, particularly in very ill hospitalized patients. Knowing where to look for free air and the signs that reveal it can be key to early detection and prompt treatment.