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The Soft Tissues of the Abdomen


THE ABDOMEN IN GENERAL

FIGURE 11-1, Skin folds producing an unusual appearance of the hepatic shadow in an infant.

FIGURE 11-2, Posterior skin folds lend a striking appearance to the abdomen in an elderly patient.

FIGURE 11-3, A, Simulated lucency of the psoas muscles produced by folding of the soft tissues of the back. B, This appearance is not seen in the subsequent film after alteration of the patient's position.

FIGURE 11-4, Lucent stripes in the shadow of the psoas muscle caused by fat between the muscle bundles.

FIGURE 11-5, Skin fold simulating a lucent psoas muscle shadow.

FIGURE 11-6, A, Good visualization of the right psoas muscle shadow but not of the left. B, CT scan shows a large right psoas muscle and a smaller left muscle. Such nonvisualization may also be caused by the obliquity of the muscle itself.

FIGURE 11-7, Simulated mass in the right flank produced by muscle splinting on that side.

FIGURE 11-8, Two examples of simulated pneumoperitoneum caused by the Mach effect of the rib superimposed on the diaphragm.

FIGURE 11-9, Simulated pneumoperitoneum caused by subdiaphragmatic fat.

FIGURE 11-10, Simulated pneumoperitoneum produced by subdiaphragmatic fat. A, B, Frontal films obtained on two different days. C, Lateral projection.

FIGURE 11-11, Fat may also be seen beneath the left hemidiaphragm, as illustrated in these two patients.

FIGURE 11-12, Left, Fat between the fundus of the stomach and the diaphragm. Right, Lateral projection shows fat located anteriorly, beneath the diaphragm.

FIGURE 11-13, Simulated pneumoperitoneum produced by fat between the fundus of the stomach and the diaphragm. Top, Two air-fluid levels are seen in the upright frontal film. Plain arrow (←) indicates fat; hatched arrow ( ) indicates stomach. Bottom, Lateral projection shows the anterior position of the stomach with a large air-fluid level ( ) and fat interposed between the stomach and the diaphragm (←). Note how far anteriorly the normal stomach may extend.

FIGURE 11-14, Simulated pneumoperitoneum produced by fat between the junction of the stomach and the diaphragm.

FIGURE 11-15, Simulated pneumoperitoneum produced by lucent interval between the two diaphragmatic shadows and an air-filled stomach.

FIGURE 11-16, Simulated pneumoperitoneum on the left produced by superimposition of the colon (←) on the stomach ( ).

FIGURE 11-17, A, B, Simulated pneumoperitoneum with an air-fluid level (←) that appeared to be distant from the stomach air bubble ( ). C, D, The problem is clarified by inflation of the stomach with more air, indicating that both gas collections are in the stomach. The apparent separation in B is the result of the two diaphragmatic contours, as shown in D ( ).

FIGURE 11-18, Simulated air-fluid level beneath the right hemidiaphragm resulting from through-projection of the different heights of the base of the diaphragm (←) and its dome ( ).

FIGURE 11-19, Air beneath the breasts simulating pneumoperitoneum.

FIGURE 11-20, Simulated pneumoperitoneum produced by fat around the lateral and superior aspects of the liver. The right side of the liver may also be visualized by ascites.

FIGURE 11-21, CT scan showing the fat around the liver that produces the radiolucency seen in Figure 11.20 .

FIGURE 11-22, The liver and spleen are demonstrated with unusual clarity (A) because of surrounding fat, as confirmed by CT scan (B).

FIGURE 11-23, Colonic interposition on the right simulating pneumoperitoneum.

FIGURE 11-24, Colonic interposition simulating pneumoperitoneum in the frontal film, clarified on lateral film.

FIGURE 11-25, Colonic interposition between the liver and the diaphragm (←) and between the spleen and the diaphragm ( ) in a 3-year-old child. This is a common finding in children and is not usually productive of symptoms. It should not be confused with pneumoperitoneum.

FIGURE 11-26, Colonic interposition between the liver and diaphragm in a 4-year-old boy (A) and its spontaneous reduction on the same day (B).

FIGURE 11-27, Colonic interposition simulating a subphrenic abscess. A, Supine film. B, Upright film.

FIGURE 11-28, In the supine position, the fluid-filled fundus of the stomach simulates a mass lesion. Left, Plain film. Right, Tomogram. This pseudotumor may opacify on angiography, thus further obscuring its proper identification.

FIGURE 11-29, A, Fluid-filled duodenal bulb may manifest as a right upper quadrant mass in the prone position. B, Supine film shows the mass less distinctly. C, Barium examination shows the mass effect to be caused by the duodenal bulb.

FIGURE 11-30, A, In the prone position, the fluid-filled gastric antrum may also simulate a right upper quadrant mass. B, Antrum filled with barium in same position as A.

FIGURE 11-31, Gas-filled gastric fundus displacing the shadow of the spleen (←) from the diaphragm, simulating a mass.

FIGURE 11-32, Left lobe of the liver encroaching on the stomach gas bubble, simulating a neoplasm (see Fig. 11.84 ).

FIGURE 11-33, Liver shadow encroaching on the stomach gas bubble in both projections.

FIGURE 11-34, Fluid-filled antrum of the stomach with the lucent folds of the pylorus simulating a gallstone with fissures within it.

FIGURE 11-35, The antrum and pylorus superimposed.

FIGURE 11-36, Gas in the small bowel in the flank that can simulate colon or free air in the peritoneal cavity. A, Supine film. B, Left lateral decubitus film.

FIGURE 11-37, Fluid-filled splenic flexure of the colon simulating a mass encroaching on the stomach.

FIGURE 11-38, Posterior lung margins simulating an abdominal mass.

FIGURE 11-39, Simulated properitoneal fat line produced by the contact of the patient's arm with the abdomen (←). A true properitoneal fat line is seen on the opposite side ( ).

FIGURE 11-40, Fat around the ligamentum teres of the liver produces a bilobed appearance of the liver or simulates a mass.

FIGURE 11-41, Riedel's lobe of the liver, which may be mistaken for a right lower quadrant mass.

FIGURE 11-42, Riedel's lobe of the liver (←) and perinephric fat ( ) produce an appearance suggesting gas in the perirenal space.

FIGURE 11-43, Two examples of the “double wall” sign. The ability to see both sides of the bowel wall is not reliable evidence of pneumoperitoneum. In these cases, it is caused by two loops of distended intestine in contact with each other.

FIGURE 11-44, Extensive mesenteric fat simulating pneumoperitoneum.

FIGURE 11-45, Air in the appendix is a normal phenomenon and should not be considered as evidence of acute appendicitis.

FIGURE 11-46, Shadow of the umbilicus seen in the oblique projection of the abdomen.

FIGURE 11-47, Gastric contents simulating the changes of bronchiectasis at the base of the left lung.

FIGURE 11-48, Visualization of the diaphragmatic attachments.

FIGURE 11-49, Ring-shaped calcified costal cartilage simulating gallstones.

FIGURE 11-50, Calcified costal cartilage in the left upper quadrant simulating a renal calculus.

FIGURE 11-51, Calcification in a tortuous splenic artery.

FIGURE 11-52, Ingested seeds in the transverse colon simulating pancreatic calcification.

FIGURE 11-53, Enteroliths in the cecum formed around ingested prune pits.

FIGURE 11-54, Ossification center of the last coccygeal segment in a 10-year-old boy, which should not be mistaken for a calculus.

FIGURE 11-55, Calcified epiploic appendage still attached to colon. A, Frontal film. B, Oblique projection. C, Same entity in another patient.

FIGURE 11-56, Calcified epiploic appendage. Such appendages have a characteristic oval shape with a more lucent center.

FIGURE 11-57, Dystrophic calcification in obliterated umbilical arteries in a 2-year-old child, an unusual normal finding in infants.

FIGURE 11-58, Edge of the sacroiliac joint simulating calcification in the appendix. The appearance is less marked on the opposite side.

THE GASTROINTESTINAL TRACT

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