Identifying abdominal emergencies on radiographs and sonograms (part 1) (Proceedings)

GI issues are a common occurrence in the ER and assessment of these cases typically involves imaging, radiographs and/or ultrasound. While obtaining abdominal radiographs is a common and somewhat uncomplicated occurrence, interpretation of abdominal radiographs is anything but. Of all the imaging modalities, radiographs are the most ubiquitous and most difficult to interpret. Radiographs have poor contrast and spatial resolution when compared to ultrasound and CT but there are certain subtle radiographic principals, or roentgen findings, that should not be missed in an ER situation. The most common important and often challenging findings are ascites, free abdominal air and an obstructive GI pattern.

Subtle findings on plain radiographs can sometimes be enhanced using position radiography and contrast imaging (both positive and negative). Radiographs are typically more rewarding than ultrasound when gastric foreign bodies or free abdominal air is present. Other emergent cases may benefit more from an abdominal ultrasound. Ultrasound is extremely useful in cases of scant or mild ascites or suspected abdominal masses since ultrasound can be used for both imaging and sample collection.

For suspected intestinal pathology there was a paradigm shift in the late 1990's and early 2000's. Prior to that time radiographs were the choice for assessing bowel. However as imagers became more familiar with sonography the benefits of intestinal ultrasound became clear and abdominal ultrasound began to choice for bowel assessment. Less gastric lumen evaluation, ultrasound is excellent at GI imaging. Assessing bowel wall thickness, segmental dilation and mesenteric echogenicity are just a few of ultrasound's capabilities.

Future ER imaging will likely include Computed Tomography or CT. CT is ideal for abdominal ER imaging due to its fast scan speed and image reconstruction, high spatial and contrast resolution and contrast capabilities. Contrast imaging is useful in GI, urinary and vascular assessment.

The remainder of this talk will focus on GI case presentation.