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  1. Radiographic sign of acute pancreatitis
    A large number of radiographic features have been described in acute pancreatitis, but these are uncommon and non-specific hence not of much significance, these include:
    1. QSentinel loop sign (single dilated small bowel loop), optimally demonstrated in left lateral decubitus view
    2. QRenal halo sign (the left kidney has surrounding halo due to edema and is displaced down)
    3. QColonic ‘cut-off’ sign (dilated transverse colon becomes abruptly gasless in the region of splenic flexure)
    4. QGasless abdomen due to vomiting

QThe pseudocyst is the most common cystic lesion of the pancreas, accounting for about 90% of all cystic lesions in the pancreas.

  1. QCT Features of acute pancreatitis:
    1. Edematous pancreas
    2. Peripancretic stranding of fat
    3. Area (s) of necrosis
  2. Carcinoma Head Of Pancreas Include:
    1. Hypotonic duodenogram, ultrasound (transabdominal, endoscopic and laparoscopic), CT, MRI and ERCP may, under different circumstances, each have a role in the diagnosis of ductal adenocarcinoma (commonest type of pancreatic neoplasmQ).
    2. QCarcinoma of the head of pancreas frequently causes changes in the duodenal loop (reversed '3' sign of Frostburg) as seen on the duodenogram.
    3. QCECT is the most effective technique for the diagnosis and staging of potential theoretical advantages over CT and promising results are now emerging.
    4. ERCP demonstrates a structure and obstruction of pancreatic and common bile ducts and even directly visualizes duodenum and ampulla of Vater and also allows cytological sampling.
  1. Periampullary carcinoma
    1. QDouble duct sign is dilatation of CBD and pancreatic duct (the CBD is dilated till the terminal end and the main pancreatic duct is also dilated).
      It can be seen in:
      1. Ampullary tumor (Most common)
      2. Other Periampullary tumors
      3. Store impacted in ampulla of vertex
      4. Papillary stenosis.
    2. Pancreatic Injury
      1. QThe pancreatic neck and body are the most common portions of this organ to be injured in blunt trauma.
        QCECT is best for its diagnosis.

Plain radiography
This plays little part in investigation now, although calcification in the spleen may suggest an old infarct or hydatid disease. Multiple areas of calcification would suggest splenic tuberculosis.
Ultrasonography of the spleen is of value in deter­mining its size and consistency, and whether or not cysts are present. It can be used for diagnosis of a ruptured spleen. However, in this case a computerised tomography (CT) scan is more usually undertaken to exclude other intra-abdominalproblems. Similarly, a spiral CT scan with contrast enhance­ment will be preferable in the diagnosis of splenomegaly to determine both the extent of the disease and the associated problems such as the extent of lymphadenopathy.
Radioisotope scans
Technetium-99m (99mTc)-labelled colloid can provide information about the position and size of the spleen and, with appropriately labelled red cells, the life and place of their destruction can he determined.
  1. Quick specifics – GIT

Pyloric obstruction

Single bubble sign

Ladds bands

Annular pancreas

Duodenal atresia, obstruction

Double bubble sign

Acute pancreatitis

Renal halo sign

Gasless abdomen sign

Colon cut-off sign

Sentinel loop sign

Chronic pancreatitis

Beaded appearance

String of pearls sign

Chain of lakes appearance

Rat tail stricture of CBD

Carcinoma pancreas

Double duct sign

Scrambled egg appearance

Inverted 3 sign

Rose thorning of 2nd part of duodenum

Widened duodenal C loop

Achalasia cardia

Bird beak sign on barium swallow

Hurst phenomenon

Diffuse esophageal spasm

Cork screw appearance on barium swallow


On barium meal:

a. Beak sign                    

b. Double track Sign

c. Tram track sign            

d. Shoulder sign

e. String sign                 

f. Diamond sign

g. Twinning recess         

h. Pyloric teat

i. Teat sign                    

j. Mushroom sign

k. Caterpillar sign

Gall stone with gas

Seagull sign

Mercedes benz sign

Crow feet sign

Ulcerative colitis

Lead pipe appearance

Chron’s disease

String of Cantor

Bulls eye lesion

Target lesion

Ischemic colitis

Thumb printing sign


a. Pincer sign                         

b. Claw sign

c. Target sign                        

d. Meniscus sign

e. Coiled spring appearance  

f. Crescent in doughnut sign

g. Pseudokidney sign             

h. Sandwich sign

i. Hay fork sign                      

j. Hamburger sign

k. Doughnut sign                  

l. Signa de dance

m. Dance sign

Midgut volvulus

Whirlpool sign

Sigmoid volvulus

a. Coffee bean sign             

b. Bent tyre tube sign

c. Liver overlap sign          

d. Pelvis overlap sign

e. Left flank overlap sign

Diverticulitis of colon

Saw tooth appearance on barium enema

Ca Colon

Napkins sign

Benign gastic ulcer

Hamptons line

Malignant gastric ulcer

Carmens meniscus sign

Kirkland complex

Ileal atresia

Apple peal appearance

Ileo-cecal tuberculosis

a. Fleishner sign            

b. Inverted umbrella defect

c. Steirlin sign               

d. Amputed cecum

e. Goose neck deformity


Liver edge sign

Falciform ligament sign

Gall bladder sign

Diaphragmatic muscle slip sign / Leaping dolphin sign

Luscent liver sign

Anterosuperior bubble sign

Doge’s cap sign

Riglers double wall sign

American footballs sign

Cupola’s sign

Triangle sign

Visible transverse mesocolon sign.

Visible small bowel mesentary sign

Pneumo-omentum / Pneumo-mesocolon

Urachus sign

Medial / Lateral umbilical fold sign

Inverted V sign


Coeliac sprue

Moulage sign

Small bowel obstruction

String of beads sign

Stepladder appearance

Concertina effect

Candy-cone appearance

Snake head appearance on barium study

Acute appendicitis

Arrowhead sign

Rovsings sign

Diverticulitis of colon

Bowlers hat sign


Straight line sign

Adenomyomatosis of gall bladder

Comet-tail sign on USG

Caroli’s disease

Central dot sign

Biliary atresia

Triangular cord sign

Esophageal candisiasis

Shaggy esophagus

Pseudomembranous colitis

Accordion sign

Emphysematous cholecystitis

Champagne sig

Pneumatoses cystoides coli

Cluster of grapes sign

Midgut volvulus

Corkscrew sign

Diaphragmatic rupture

Dependant viscera sign

Mesenteric panniculitis

Fat ring sign

Extraperitoneal bladder rupture

Molar tooth sign

Graft versur host disease

Ribbon bowel appearance on barium

Small bowel volvulus

Spokewheel sign

Peritoneal carcinomatosis

Straight line sign on PET

Extra Edge

  1. Defecography (a dynamic barium enema including lateral views obtained during barium expulsion) reveals "soft abnormalities" in many patients; the most relevant findings are the measured changes in rectoanal angle, anatomic defects of the rectum, and enteroceles or rectoceles.
  2. More commonly, outlet obstruction results from a nonrelaxing puborectalis muscle, which impedes rectal emptying, rather than from defects identified by defecography.

A balloon expulsion test is an important screening test for anorectal dysfunction. If positive, an anatomic evaluation of the rectum or anal sphincters and an assessment of pelvic floor relaxation are the tools for evaluating patients in whom obstructed defecation is suspected.
Gardner’s syndrome

  1. Multiple osteomas:
    1. Benign osseous excrescences
    2. Appear around puberty
    3. Are found on vault, mandible and in facial sinuses
    4. Facial deformities present
    5. Facial osteomas are larger and much more common than those elsewhere
  2. Dental lesions:
    1. Compound odontomes and unerupted supernumerary teeth are found in up to 50% of patients
  3. Skin lesions:
    1. Epidermoid inclusion cysts (in 50% cases)
    2. Lipomas
    3. Fibromas
    4. Dermoid (prone to recur after surgery, especially in the abdomen)
  4. Polyposis coli
    1. Multiple adenomatous polyps arise around puberty in colon and rectum and occasionally in the small bowel.
    2. In view of their almost inevitable malignant transformation, treatment is usually prophylactic colectomy.
Somatostatin receptor scintigraphy
  1. Pets and carcinoid tumors frequently overexpress high-affinity somatostatin receptors in both their primary and their metastatic tumors. Of the five types of somatostatin receptors (sst1-5), radiolabeled octreotide binds with high affinity to sst 2 and sst5, lower for sst3, and has a very low affinity for sst1 and sst4.
  2. Nearly all carcinoid tumors and pets express sst2, and many also have the other four sst subtypes. Interaction with these receptors can be used to localize nets using [111in-dtpa-d-phe1]octreotide and radionuclide scanning (SRS) as well as for treatment of the hormone excess state with octreotide or lanreotide.
  3. Because of its sensitivity and ability to localize tumor throughout the body at one time, srs is now the initial imaging modality of choice for localizing both primary nets and metastases.
Protein-losing enteropathy ( PLE ) can be diagnosed scintigraphically using 99mTc- human senjm albumin (HSA) scans.
  1. The need for measurement of fecal radioactivity over 3–4 days has also been a drawback with some of the methods in which these materials are used.
  2. Imaging with other radioisotope-labeled materials such as 111In chloride (5) and 111In transferrin (6–8) has been reported, but 99mTc is more widely available and is simple to use. 99mTc dextran, however, can occasionally produce an anaphylactic reaction.
  3. A variety of adverse reactions,  have been reported with 99mTc HSA, including nausea, vomiting, erythema, flushing, hypotension, dyspnea, tachycardia, dizziness, and abdominal pain.

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