The imaging spectrum of the abdominal wall lesions

44 Pages·2010·2.65 MB·English

The imaging spectrum of the abdominal wall lesions
Poster No.: C-1671
Congress: ECR 2010
Type: Educational Exhibit
Topic: GI Tract
Authors: 1 2 2 1 2
Y.-W. Kim , J. H. Yoon , S. S. Cha ; Yangsan/KR, Busan/KR
Keywords: Abdominal wall, abdominl wall. disease, abdominal wall, mass
DOI: 10.1594/ecr2010/C-1671
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Page 1 of 44
Learning objectives
• To describe the normal anatomy and constituents of the abdominal wall.
• To list a broad spectrum of lesions that affects the abdominal wall.
• To illustrate a characteristic imaging findings of lesions that occur in the
abdominal wall
Background
The muscles and fascial layers of the abdominal wall support and protect intraperitoneal
contents and abdominal structures are extended to the retroperitoneal space. Various
conditions are involved in the abdominal wall. Abdominal wall lesions can be classified
as nontumorous or tumorous. Nontumorous lesions include congenital lesion (urachal
abnormalities), abdominal wall hernia, inflammation and, infection (abscess,parasitic
infestation), vascular lesions (varix, venous thrombophlebitis), miscellanous conditions
(edema, RT change, hematoma, subcutaneous emphysema). Various types of benign
and malignant neoplasms can be found involving the abdominal wall either arising
primarily from wall structures or secondarily extending into the sinus from the adjacent
organs or retroperitoneum.Tumors involving the abdominal wall can be classified
according to their origins into three subgroups:(a) primary tumors of mesenchymal origin,
(b) retroperitoneal tumors that extend to the abdominal wall (c)hematogenous spread.
Imaging findings OR Procedure details
Normal anatomy of abdominal wall
Page 2 of 44
Fig.: normal anatomy of abdominal wall
References: Y.-W. Kim; Diagnostic Radiology, Pusan National univeristy, College of
Medicine, Yangsan, KOREA, Republic of
Superficial to deep dissection of the anterior abdominal wall
* Superior aspect of arcuate line
: the rectus abdominis muscle is surrounded by three flank muscle
(transverse muscle, internal and external oblique muscle)
* Inferior aspect of arcuate line
: the aponeurosis of the internal oblique muscle and the transversus abdominis
muscle no longer contribute to the posterior aspect of the rectus sheath, the rectus
invested posteriorly only by the thin transversalis fascia from the arcuate line to
the pubic symphysis
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Fig.: nomal anatomy schema and normal CT image of abdominal wall
References: Y.-W. Kim; Diagnostic Radiology, Pusan National univeristy, College of
Medicine, Yangsan, KOREA, Republic of
Pathologic condition of abdominal wall
Page 4 of 44
Fig.: pathologic conditions of abdominal wall
References: Y.-W. Kim; Diagnostic Radiology, Pusan National univeristy,
College of Medicine, Yangsan, KOREA, Republic of
Non-tumorous lesion
Congenital lesion (urachal abnormalities)
1. Patent urachus (50%)
: Urine leakage during the neonatal period.
2. Umbilical-urachal sinus (15%)
: Blind dilatation of the urachus at the umbilical end.
Periodic discharge.
Thickened tubular structure along the midline below the umbilicus.
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3. Vesicourachal diverticulum (3-5%)
: Urachus communicate only with the bladder dome.
Mildline cystic lesion just above the anterosuperior aspect of the bladder.
4. Urachal cyst (30%)
: Fluid-filled cavity in the midline lower abdominal wall.
Fig.: The scheama of Urachal lesions
References: Y.-W. Kim; Diagnostic Radiology, Pusan National univeristy, College of
Medicine, Yangsan, KOREA, Republic of
Non-tumorous lesion
Abdominal wall hernia
Abdominal wall hernias are a frequent imaging finding in the abdomen,
approximately 1.5% of the population.
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Most abdominal wall hernias are asymptomatic.
Content
: variety of intraperitoneal structure, including fat, omentum, bowel.
Complication
: incarceration, obstruction, strangulation, ischemia, infarction.
Type
1) Ventral hernia
- midline defect
- lateral defect
- Spigelian hernia(semilunar)
2) Lumbar hernia
3) Incisional hernia
4) Groin hernia
Page 7 of 44
Fig.: The types of abdominal hernia
References: CIBA TEXT
1. Ventral hernia
All hernias in the anterior and lateral abdominal wall.
1) Midline defects
* Umbilical hernias (M/C) Fig 1
: small, particularly common in women.
high prevalence of incarceration and strangulation.
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* Paraumbilical hernias
: large abdominal defects through the linea alba.
diastasis of the rectus abdominis muscles.
* Epigastric hernias Fig 2
: uncommon.
though the linea alba between the umbilicus and the xyphoid process.
* Hypogastric hernias
: though the linea alba below the umbilicus.
2) Paramedian or lateral defects
: less common.
typically, omentum and short segments of bowel protrusion.
high prevalence of incarceration.
3) Spigelian hernia (lateral ventral or semilunar hernia) Fig 3
- Rare, 1-2% of all hernia.
- Intermittent lower abdominal pain.
- Internal obstruction.
- Hernia in anterolateral aspect of the lower abdomen.
: along the semilunar line formed by fibrous union of the rectus sheath
with the aponeurosis of the transversus abdominalis & oblique
abdominal muscles.
- Congenital weakness in the posterior layer of transversalis fascia
or surgical incision.
2. Lumbar hernia
- Defects in the lumbar muscles or the posterior fascia,
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below the 12th rib and above the iliac crest.
- After surgery (flank incisions in kidney surgery) or trauma.
- Superior (Grynflett-Lesshaft) lumbar triangle (m/c)
: anteriorly by the internal oblique muscle.
superiorly by the 12th rib.
posteriorly by the erector spinal muscle.
- Inferior (petit) lumbar triangle Fig 4
: anteriorly by the external oblique muscle.
inferiory by the iliac crest.
posteriory by the latissimus dorsi muscle.
Fig.: Lumbar hernia
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