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Helical CT in the Evaluation of the Acute Abdomen

¹ Department of Radiology, Evanston Hospital-Northwestern University, 2650 Ridge Ave., Evanston, IL 60201.
² Department of Radiology, Northwestern Memorial Hospital, Northwestern University Medical School, 675 N. St. Clair St., Chicago, IL 60611.

View larger version (138K): [in a new window]   Preston M. Hickey, 8th President of ARRS, 1907–1908

View larger version (103K): [in a new window]   Eugene W. Caldwell, 9th President of ARRS, 1908–1909

View larger version (119K): [in a new window]   Fig. 1A. —40-year-old man with acute appendicitis and 2-day history of mid epigastric and mid abdominal pain. Imaging used scan protocol III. CT scan shows distended appendix with enhancing wall (arrow) and periappendiceal inflammation. Note intraluminal appendicoliths.

View larger version (137K): [in a new window]   Fig. 1B. —40-year-old man with acute appendicitis and 2-day history of mid epigastric and mid abdominal pain. Imaging used scan protocol III. Coronal reformation shows complete course of appendix and mural disruption (arrow) in region of appendicolith.

View larger version (133K): [in a new window]   Fig. 2. —36-year-old woman with acute appendicitis and 12-hr history of right lower quadrant pain. CT scan using scan protocol II shows focal cecal apical thickening (arrow). Intraluminal contrast material funneled between each side of cecal apical thickening produces arrowhead sign of appendicitis (arrowhead).

View larger version (159K): [in a new window]   Fig. 3A. —60-year-old man with diverticulitis, fever, and left lower quadrant pain. Imaging used scan protocol V. CT scans show mural thickening of sigmoid colon associated with diverticula, inflammatory changes, and gas bubbles (arrow, B) in subperitoneal fat of sigmoid mesocolon. Rectal contrast material can help in determining degree of mural thickening but is unnecessary for diagnosis.

View larger version (132K): [in a new window]   Fig. 3B. —60-year-old man with diverticulitis, fever, and left lower quadrant pain. Imaging used scan protocol V. CT scans show mural thickening of sigmoid colon associated with diverticula, inflammatory changes, and gas bubbles (arrow, B) in subperitoneal fat of sigmoid mesocolon. Rectal contrast material can help in determining degree of mural thickening but is unnecessary for diagnosis.

View larger version (113K): [in a new window]   Fig. 4. —42-year-old man with diverticulitis, left-sided flank pain, and suspected kidney stone. CT scan using scan protocol I shows inflamed diverticulum with increased attenuation (arrow). Note inflammation of surrounding fat and thickening of Gerota's and lateroconal fasciae. In patients with sufficient intraabdominal fat, diagnosis can be made without oral, rectal, or IV contrast material.

View larger version (106K): [in a new window]   Fig. 5A. —Bowel obstruction, Imaging used scan protocol IV. 64-year-old woman with adenocarcinoma of stomach. CT scan shows metastases to small bowel (arrows). Fluid in obstructed small bowel serves as natural luminal contrast agent and allows more accurate assessment of bowel perfusion, which is normal on this scan.

View larger version (111K): [in a new window]   Fig. 5B. —Bowel obstruction. Imaging used scan protocol IV. 50-year-old woman with crampy abdominal pain and gallstone ileus. CT scan shows obstructing gallstone (arrow).

View larger version (88K): [in a new window]   Fig. 6A. —Intestinal ischemia. Imaging used scan protocol III. 63-year-old woman with mesenteric venous thrombosis and pneumatosis of small bowel. CT scan shows gas bubbles overlooked on abdominal radiograph.

View larger version (102K): [in a new window]   Fig. 6B. —Intestinal ischemia. Imaging used scan protocol III. 72-year-old man with ischemic colitis of descending colon and left upper quadrant pain. CT scan shows mural thickening associated with extensive submucosal edema. Fluid is present in surrounding fat.

View larger version (138K): [in a new window]   Fig. 7A. —Peptic ulcer disease. Imaging used scan protocol III. 30-year-old man with suspected pancreatitis. CT scan reveals benign gastric ulcer in lesser curvature (arrow).

View larger version (94K): [in a new window]   Fig. 7B. —Peptic ulcer disease. Imaging used scan protocol III. 68-year-old man with perforated duodenal ulcer (solid arrow), severe epigastric pain, and diffuse peritoneal signs. CT scan shows free air and extravasated contrast material in periphepatic space (open arrow).

View larger version (94K): [in a new window]   Fig. 8. —47-year-old man with epiploic appendagitis and diverticulitislike symptoms. CT scan using scan protocol V shows fat-attenuation mass (arrow) surrounded by fluid and fat stranding. Mass is inflamed and ischemic epiploic appendage.

View larger version (151K): [in a new window]   Fig. 9. —43-year-old man with jejunal diverticulitis, mid epigastric pain, and fever. CT scan using scan protocol V shows extraluminal gas bubbles associated with inflammatory changes in jejunal mesentery (arrows). This process causes inflammatory changes in adjacent colon.

View larger version (105K): [in a new window]   Fig. 10. —21-year-old immunocompromised woman with typhlitis, fever, and right lower quadrant pain. CT scan using scan protocol III shows thickened inhomogeneous cecal wall and pericolic inflammatory change.

View larger version (123K): [in a new window]   Fig. 11. —43-year-old woman with pseudomembranous colitis, lower abdominal pain, and tenesmus. CT scan of sigmoid colon using scan protocol V shows diffuse mural thickening. Contrast material trapped between large edematous haustra simulates ulcerations (arrow).

View larger version (130K): [in a new window]   Fig. 12. —43-year-old woman with AIDS, cryptosporidial colitis, fulminant colitis, and abdominal pain. CT scan using scan protocol III shows diffuse mural thickening of colon with enhancement of mucosal muscularis propria associated with severe submucosal edema (arrows). (Courtesy of Balthazar EJ, New York, NY)

View larger version (120K): [in a new window]   Fig. 13A. —Complications of Crohn's disease. 42-year-old woman with Crohn's disease, mesenteric abscess (A) with central necrosis, gas bubbles, and thick enhancing wall. CT scan using scan protocol III shows mural thickening of adjacent small-bowel loops (arrowheads).

View larger version (117K): [in a new window]   Fig. 13B. —Complications of Crohn's disease. 55-year-old woman with Crohn's disease and distal small-bowel obstruction. CT scan using scan protocol IV reveals mural stratification of diseased ileal segment (arrow), suggesting obstruction may improve with medical therapy. (Reprinted from [89])

View larger version (107K): [in a new window]   Fig. 14A. —67-year-old woman with acute cholecystitis and epigastric pain. Imaging used scan protocol III. CT scan shows multiple gallstones associated with gallbladder wall thickening. Note enhancing mucosa (arrow).

View larger version (109K): [in a new window]   Fig. 14B. —67-year-old woman with acute cholecystitis and epigastric pain. Imaging used scan protocol III. CT scan obtained just above gallbladder fossa shows hyperemia of adjacent liver (arrows).

View larger version (136K): [in a new window]   Fig. 15. —73-year-old woman with gallstones and choledocholithiasis causing biliary obstruction and right upper quadrant pain. CT scan using scan protocol III shows distal common bile duct stone (arrow) enhanced by low-density bile in surrounding dilated duct.

View larger version (120K): [in a new window]   Fig. 16. —57-year-old man with acute necrotizing pancreatitis and severe back pain. CT scan using scan protocol III shows large region of unenhancement (necrosis) involving most of body and tail of pancreas. Inflammatory fluid is present in anterior pararenal space. Note ascites around liver.

View larger version (108K): [in a new window]   Fig. 17A. —72-year-old man with aortic dissection and severe chest and abdominal pain. Imaging used scan protocol IV. CT scan reveals intimal flap.

View larger version (90K): [in a new window]   Fig. 17B. —72-year-old man with aortic dissection and severe chest and abdominal pain. Imaging used scan protocol IV. Arterial phase thin-collimation scans after rapid injection of contrast material are ideal for image reformation that shows extent of vascular abnormality.

View larger version (142K): [in a new window]   Fig. 18. —72-year-old man with aortic rupture and right-sided flank pain. CT scan using scan protocol III shows abdominal aortic aneurysm (A) and blood in retromesenteric plane (arrow).

View larger version (134K): [in a new window]   Fig. 19. —69-year-old man with left psoas muscle and posterior pararenal space hematoma and abdominal and left-sided flank pain. CT scan using scan protocol I shows hematocrit effect (arrow) in hematoma.

View larger version (140K): [in a new window]   Fig. 20. —57-year-old man with hepatic infarction and severe right upper quadrant pain. CT scan using scan protocol III shows regions of low attenuation in liver.

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