Bowel obstruction versus ileus, free air, appendicitis, pancreatitis, fracture description and classification, bone tumors and arthritis patterns.
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- What radiographic finding helps distinguish mechanical small bowel obstruction from adynamic ileus?
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A distinct transition point between dilated and decompressed bowel, present in obstruction but absent in ileus.- What is the 'string of pearls' sign on an abdominal radiograph?
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Small gas bubbles trapped between valvulae conniventes in fluid-filled, obstructed small bowel loops on an upright or decubitus view.- What is the most common cause of small bowel obstruction in adults with a history of abdominal surgery?
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Postsurgical adhesions.- What CT finding suggests a closed-loop small bowel obstruction?
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A U-shaped or C-shaped dilated loop of bowel with mesenteric vessels converging radially toward a single point of torsion.- What CT findings suggest bowel ischemia complicating a small bowel obstruction?
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Bowel wall thickening with decreased or absent mural enhancement, pneumatosis, or mesenteric/portal venous gas.- What is the classic finding of pneumoperitoneum on an upright chest or abdominal radiograph?
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A crescent-shaped lucency of free air beneath the diaphragm.- What is Rigler's sign (double wall sign)?
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Visualization of both the inner and outer walls of a bowel loop, caused by free intraperitoneal air outlining the bowel wall.- Which patient position is most sensitive for detecting small amounts of free intraperitoneal air on radiograph?
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Left lateral decubitus, which lets air rise and collect over the liver.- What is the falciform ligament sign of pneumoperitoneum?
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Free air outlining the falciform ligament as a visible linear density on a supine abdominal radiograph.- What is the most sensitive imaging modality for detecting small volumes of free intraperitoneal air?
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CT of the abdomen and pelvis.- What outer appendiceal diameter is generally used as a threshold suggesting appendicitis on CT or ultrasound?
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Greater than 6 mm.- What ultrasound finding supports a diagnosis of acute appendicitis?
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A noncompressible, dilated, blind-ending tubular structure in the right lower quadrant.- What does periappendiceal fat stranding on CT indicate?
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Inflammation extending into the adjacent mesenteric fat, supporting appendicitis.- What is an appendicolith, and why does it matter clinically?
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A calcified fecalith within the appendiceal lumen; it increases the risk of luminal obstruction and perforation.- What CT findings suggest a perforated appendix?
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Extraluminal air, a periappendiceal abscess, or loss of the normal appendiceal wall with adjacent fluid collection.
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