Tuesday, October 21, 2008

"Whirl Sign"




A woman came in to clinical that presented with severe abdominal pain. She was 43 years old and was 5 years post gastric bypass. Her exam was an abdomen for stone protocol. Her exam was negative for stone but showed a mid-gut volvulus, inflamed bowl, and possible ischemia. The patient’s exam also showed a “whirl sign” that is a characteristic of a gastrointestinal volvulus. The “whirl sign” is a loop of bowl that presents in a whirl or swirl pattern on CT abdominal imaging. A “whirl sign” is usually associated with rotation of the superior mesenteric vein around the superior mesenteric artery or any mesenteric rotation or looping. The radiologist then ordered a dual phase contrast study of the abdomen and pelvis. The “whirl sign” with a gastrointestinal volvulus is a possible side effect of gastric bypass surgery. This problem can present itself 3-5 years post-surgery in some cases.

Wednesday, October 8, 2008

CT Spine Work


I have been very busy with spine work. I have several spine patients everyday. This can range from routine spine, post-myelogram spine, SI joint injections, or spine imaging for a pars defect. Each one of these exams have completely different protocols. It has been hard keeping all of these protocols straight, but I'm working on it. Most of the pars defect patients that I have seen have been teenagers. Most of them are athletes and have a sports-related injury. A pars defect is easiest for me to see on sagittal reformats.