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Barotrauma

KEY FACTS Terminology Alveolar rupture caused by elevated transalveolar pressure during mechanical ventilation Imaging CT is the definitive test for presence & source of extraluminal gas Pleural spaces, mediastinum, subcutaneous, intra- and retroperitoneal, bowel wall Radiographic findings Pneumothorax – Radiolucent gas between visceral and parietal pleura – Inferiorly displaced costophrenic angle on supine films (deep sulcus sign) Pneumomediastinum – Radiolucent streaks outlining heart and trachea Pneumoperitoneum…

Foreign Bodies

KEY FACTS Imaging Ingested foreign bodies Commonly affect children, developmentally challenged or psychiatric patients, and inebriated adults Most ingested foreign bodies traverse GI tract without problem: < 1% cause obstruction or perforation – Elongated or sharp objects may impact at point of intestinal narrowing or sharp angulation Foreign bodies vary in radiopacity and conspicuity on radiography vs. CT For most nonsharp foreign bodies, begin with visual inspection…

Abdominal Trauma

KEY FACTS Imaging CT of chest, abdomen, and pelvis can be performed in < 1 minute of scan time Multiplanar, multiphasic CECT shows extent of bowel and solid visceral injuries and bleeding Evaluation of brain and spine injuries can be done in same setting "Sentinel clot": High density (> 60 HU); near source of bleeding "Active extravasation": Isodense to enhanced arteries Active bleeding from spleen, liver,…

Eosinophilic Gastroenteritis and Esophagitis

KEY FACTS Terminology Inflammatory disease of GI tract characterized by tissue eosinophilia that can involve all layers of wall "Eosinophilic gastroenteritis" is misnomer; can affect any portion of GI tract Requires 4 criteria for diagnosis Presence of GI symptoms Biopsy proof of eosinophilic infiltration of 1 or more areas of GI tract Absence of eosinophilic involvement of multiple organs outside GI tract Absence of parasitic infestation…

Sarcoidosis

KEY FACTS Terminology Relatively common, chronic, multisystem disease of unknown origin characterized by presence of noncaseating epithelioid granulomas Imaging Contrast-enhanced CT of chest and abdomen is most efficient imaging study Can affect almost every organ Most common site of involvement is lung Also lymph nodes, spleen, liver, eyes, skin, salivary glands, nervous system, heart, GI, GU Most common abdominal imaging finding is nonspecific hepatosplenomegaly Diffuse parenchymal…

HIV/AIDS

KEY FACTS Terminology Abdominal opportunistic infections and neoplasms resulting from HIV/AIDS-related immunodeficiency Imaging Liver and spleen Small hypodense nodules may be microabscesses Larger hypodense lesions might be infectious, but AIDS-related lymphoma should be considered Pneumocystis may result in tiny calcifications Biliary tree Cholangitis or acalculous cholecystitis caused by opportunistic infections Stomach, small bowel, and large bowel Wall thickening raises concern for opportunistic infection, which can involve…

Jaundice

Overview Jaundice (icterus) is a condition characterized by yellow discoloration of the skin and mucus membranes resulting from deposition of bilirubin, a pigmented metabolite of heme. Jaundice is most commonly due to disorders of the liver or bile ducts, but precise diagnosis and management may be challenging. Patients may have isolated disorders of bilirubin metabolism (e.g., hemolysis, congenital or acquired errors of hepatocellular uptake or conjugation);…

Gastrointestinal (GI) Bleeding

Introduction Gastrointestinal bleeding (GIB) is a common clinical problem, the presentation of which may be acute or chronic. GIB is classified as arising from the upper (proximal to ligament of Treitz) or lower (distal to the ligament of Treitz) GI tract. Classically, acute upper GIB (UGIB) presents with overt hematemesis or melena, while acute lower GIB (LGIB) presents with hematochezia, although there is substantial overlap in…

Constipation

Clinical Classification of Functional Constipation Category Features Physiologic and Imaging Test Results Normal-transit constipation Incomplete evacuation; abdominal pain may be present but not predominant feature Normal; may show excessive stool in colon Slow-transit constipation Infrequent stools (e.g., ≤ 1/week), lack of urge to defecate, poor response to fiber and laxatives, generalized symptoms (e.g., malaise, fatigue); more prevalent in young women Delay in colonic transit [e.g., retention…

Diarrhea

Overview Diarrhea is a symptom experienced by nearly everyone, generally considered an increase in the volume, fluidity, &/or frequency of stools. Most episodes are transient and self-limited or self-treated with nonprescription medications. However, diarrhea may be persistent or complicated by pain, fever, rectal bleeding, or other factors that bring patients to medical attention. Chronic diarrhea may affect ~ 5% of people in industrialized countries, and acute…

Nausea and Vomiting

Overview Nausea and vomiting are experienced by almost everyone, and most episodes and causes are self-limited, rarely coming to medical attention. Patients are often aware of the common causes, such as acute viral infections, "travelers" nausea and diarrhea, or the after effects of excessive alcohol consumption, and self-medicate or wait for the symptoms to pass. Other episodes are sufficiently severe or atypical that patients seek medical…

Abdominal Pain

Overview The evaluation of the adult patient with abdominal pain is often challenging for the primary care, specialist, or emergency physician. While occasional abdominal pain is experienced by almost all adults and is usually self-limited, it can herald serious disorders, demanding immediate diagnosis and treatment. Much has been written about the clinical evaluation of acute abdominal pain and will be covered here only briefly, allowing us…