[résolu][Radio-Diagnostic] CGIHD !

• 
  Disruption of wall of hollow viscus
  
  
  
  • 
    Blunt or penetrating trauma
    
  • 
    Perforating foreign body
    
  • 
    Iatrogenic perforation
    
    
    
    • 
      Laparoscopy / laparotomy
      
      
      
      • 
        Absorbed in <7 days depending on initial amount of air introduced and body habitus
        
      
      
    • 
      Leaking surgical anastomosis
      
    • 
      Endoscopic perforation
      
    • 
      Diagnostic pneumoperitoneum
      
    
    
  • 
    Diseases of GI tract
    
    
    
    • 
      Perforated gastric or duodenal ulcer
      
    • 
      Ingested foreign-body perforation
      
    • 
      Diverticulitis (though abscess is usually walled-off)
      
    • 
      Necrotizing enterocolitis with perforation
      
    • 
      Inflammatory bowel disease (e.g. toxic megacolon)
      
    • 
      Perforated
      appendix rarely causes a large amount of free air because appendiceal
      obstruction leaves only a few cc’s of air in appendix if it perforates
      
    • 
      Obstruction from neoplasm, imperforate anus, Hirschsprung’s disease, meconium ileus
      
    
    
  
  
• 
  Through peritoneal surface
  
  
  
  • 
    Abdominal needle biopsy or catheter placement
    
  • 
    Mistaken thoracentesis or chest tube placement
    
  • 
    Endoscopic biopsy
    
  
  
• 
  Extension from:
  
  
  
  • 
    Dissection from pneumomediastinum
    
  • 
    Bronchopleural fistula
    
  • 
    Rupture of urinary bladder
    
  • 
    Penetrating abdominal injury
    
  
  
• 
  Intraperitoneal
  
  
  
  • 
    Gas forming peritonitis
    
  • 
    Rupture of abscess
    
  
  

• 
  Best seen with horizontal x-ray beam
  
  
  
  • 
    Upright chest which includes diaphragm, or
    
  • 
    Upright abdomen which includes diaphragm, or
    
  • 
    Left lateral decubitus view of the abdomen [Vous devez être inscrit et connecté pour voir cette image]
    
    
    
    • 
      Patient lies with left side down, right side up
      
    • 
      Air is seen over the liver
      
    
    
  
  
• Three major findings
  

• 
  Free air beneath diaphragm (crescent sign)
  
• 
  Visualization of both sides of the bowel wall
  
  
  
  • 
    "Rigler’s sign"
    
    
    
    • 
      Normally,
      only the inside of the bowel (the lumen) is visible unless free air
      outlines the outer surface of the wall
      
    
    
  
  
• 
  Visualization of the falciform ligament
  










• 
  Long
  vertical line to the right of midline extending from ligamentum teres
  notch to umbilicus; most common structure outlined
  
• 
  "Football
  sign" = large pneumoperitoneum outlining entire abdominal cavity with
  “laces” representing falciform ligament
  




• 
  RUQ gas (best place to look for small collections)
  
  
  
  • 
    Single large area of hyperlucency over the liver
    
  • 
    Oblique linear area of hyperlucency outlining the posteroinferior margin of liver
    
  • 
    Triangular area of free air trapped below central tendon of diaphragm
    
  
  

samsung_25 a écrit:donc pas de perforation !
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