Contrast Loculation Within The Pelvis

Lesser Sac Sign

Fig. 3-76. Lesser sac abscess secondary to duodenal ulcer.

(a) Right lateral decubitus plain film. There is a loculated gas-containing abscess (Ab) compressing the top of the fundus of the stomach (S). On a frontal projection, this might suggest a subphrenic collection within the greater peritoneal cavity. There are associated changes at the base of the left lung.

(b) Upper GI series. Lateral view shows extravasation into the lesser sac behind the stomach from a posterior ulcer of the duodenal bulb.

Fig. 3-76. Lesser sac abscess secondary to duodenal ulcer.

(a) Right lateral decubitus plain film. There is a loculated gas-containing abscess (Ab) compressing the top of the fundus of the stomach (S). On a frontal projection, this might suggest a subphrenic collection within the greater peritoneal cavity. There are associated changes at the base of the left lung.

(b) Upper GI series. Lateral view shows extravasation into the lesser sac behind the stomach from a posterior ulcer of the duodenal bulb.

Fig. 3-77. Pancreatic fluid within medial compartment of lesser sac.

In this patient with acute pancreatitis, there is fluid loculation within the right (medial) compartment of the lesser sac (RLS).

Fig. 3-77. Pancreatic fluid within medial compartment of lesser sac.

In this patient with acute pancreatitis, there is fluid loculation within the right (medial) compartment of the lesser sac (RLS).

Pancreas Lesser Sac

Fig. 3—78. Pancreatic pseudocyst within medial compartment of lesser sac.

The encapsulated collection has localized to the right medial compartment of the lesser sac (RLS).

(Courtesy of Richard Gore, M.D., Evanston Hospital, Evans-ton, IL.)

Lesser Sac Fluid

Fig. 3—79. Pancreatic pseudocyst within medial compartment of lesser sac.

The loculation severely compresses the papillary process of the caudate lobe in the superior recess (asterisk) and is limited toward the left of the inflammatory reaction at the plane of the gastropancreatic plica (arrow). (Courtesy of Yong Ho Auh, M.D., Asan Medical Center, Seoul, Korea.)

(a) Well-defined loculated gas collection superior to the stomach (S), identified by its rugal outlines. The collection is continuous with a circular lucency at its base (arrows). There are associated changes at the left lung base.

(b) GI series demonstrates extravasation from a large duodenal ulcer accounting for the circular lucency on the plain film, into the medial compartment of the lesser sac, demarcated inferiorly by the fold (arrowheads) raised by the left gastric artery.

(Courtesy of Al Berne, M.D., Crouse Hospital, Syracuse, NY.)

Frontal (a) and lateral (b) projections demonstrate a large retrogastric mass displacing the stomach anteriorly (arrows) and depressing the transverse colon (C). These changes localize the abscess behind the stomach and gastrocolic ligament and above the transverse mesocolon. The collection is compartmentalized within the lateral compartment of the omental bursa.

Frontal (a) and lateral (b) projections demonstrate a large retrogastric mass displacing the stomach anteriorly (arrows) and depressing the transverse colon (C). These changes localize the abscess behind the stomach and gastrocolic ligament and above the transverse mesocolon. The collection is compartmentalized within the lateral compartment of the omental bursa.

Transverse Pancreatic Artery

Fig. 3-82. Pancreatic pseudocysts compartmentalized by the left gastric artery.

CT scan at two different levels (a and b) demonstrates partition of pseudocysts obliterating the lesser sac by attachment (arrow) to the posterior wall of the contrast-filled stomach along the plane of the peritoneal fold of the left gastric artery.

Fig. 3-82. Pancreatic pseudocysts compartmentalized by the left gastric artery.

CT scan at two different levels (a and b) demonstrates partition of pseudocysts obliterating the lesser sac by attachment (arrow) to the posterior wall of the contrast-filled stomach along the plane of the peritoneal fold of the left gastric artery.

Gallbladder Lesser Sac

Fig. 3-83. Lesser sac abscess secondary to perforated gallbladder.

(a) Initial upper GI series shows a large retrogastric mass and left pulmonary basilar changes.

(b) Contrast injection through a paracolic drainage tube demonstrates that the catheter has inadvertently entered a site of gallbladder rupture.

Fig. 3-83. Lesser sac abscess secondary to perforated gallbladder.

(a) Initial upper GI series shows a large retrogastric mass and left pulmonary basilar changes.

(b) Contrast injection through a paracolic drainage tube demonstrates that the catheter has inadvertently entered a site of gallbladder rupture.

Caudate Lobe Lesser Sack

Fig. 3-84. Lesser sac abscess with inferior extension between the layers of the greater omentum.

(a and b) Large gas-containing abscess (A) in the lesser sac secondary to acute pancreatitis displaces the stomach (ST) anteriorly. There is also extension into the mesentery and considerably into the anterior pararenal space (APS) on the left.

(c) Spread has occurred into the inferior recess of the lesser sac (ILS) between the anterior and posterior reflections of the greater omentum.

(Courtesy of David H. Stephens, M.D., Mayo Clinic, Rochester, MN.)

Fig. 3-84. Lesser sac abscess with inferior extension between the layers of the greater omentum.

(a and b) Large gas-containing abscess (A) in the lesser sac secondary to acute pancreatitis displaces the stomach (ST) anteriorly. There is also extension into the mesentery and considerably into the anterior pararenal space (APS) on the left.

(c) Spread has occurred into the inferior recess of the lesser sac (ILS) between the anterior and posterior reflections of the greater omentum.

(Courtesy of David H. Stephens, M.D., Mayo Clinic, Rochester, MN.)

Lessrer Amd Greater Sac

Fig. 3-85. Acute pancreatitis with development of lesser sac pseudocysts and extension into greater omentum.

(a) Loculated fluid collections have developed within the lesser sac (LS) separated by the peritoneal fold raised by the left gastric artery. Ascites and extrapancreatic effusion within the left anterior pararenal space are present. (b and c) Pancreatic pseudocyst extends within the inferior recess of the lesser sac (ILS) between the reflections of the greater omentum anterior to the transverse colon (TC) and into the pelvis.

(Courtesy of Michiel Feldberg, M.D., University of Utrecht, The Netherlands.)

Fig. 3-85. Acute pancreatitis with development of lesser sac pseudocysts and extension into greater omentum.

(a) Loculated fluid collections have developed within the lesser sac (LS) separated by the peritoneal fold raised by the left gastric artery. Ascites and extrapancreatic effusion within the left anterior pararenal space are present. (b and c) Pancreatic pseudocyst extends within the inferior recess of the lesser sac (ILS) between the reflections of the greater omentum anterior to the transverse colon (TC) and into the pelvis.

(Courtesy of Michiel Feldberg, M.D., University of Utrecht, The Netherlands.)

Peritoneal Reflection

Fig. 3-86. Left subphrenic abscess secondary to anterior perforation of a gastric ulcer. The abscess (A) is bordered by the falciform ligament (arrow), the anterior peritoneal reflection of the stomach (S), and the liver (L).

Gas is present around the pars transversus of the left portal vein. (Courtesy of Richard Gore, M.D., Evanston Hospital, Evans-ton, IL.)

Loculations Abscess

Fig. 3-87. Left perihepatic abscess.

The fluid collection has coalesced around the lateral segment of the left lobe of the liver (LL), encapsulated with rim enhancement anterior to the gastrohe-patic ligament. In contrast to the right gastrohepatic space, the left perihepatic space communicates freely around the lateral segment of the left lobe. LT = ligamen-tum teres; ST = stomach.

Fig. 3—88. Left subphrenic abscess.

Following left hemicolectomy for a gunshot wound, a huge abscess (A) has coalesced in the left subphrenic space. It displaces the fundus of the stomach (S) and the spleen (Sp) anteromedially. The abscess has a characteristic enhancing rim (arrowheads). (Courtesy ofJay Heiken, M.D., Mallinckrodt Institute of Radiology, St. Louis, MO.)

Left Subphrenic Abscess

phrenicocolic ligament had been excised previously, as is done in splenectomy and in surgical mobilization of the splenic flexure of the colon, infection may readily spread from the left paracolic gutter to the subphrenic space (Figs. 3-101 through 3-103).

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Responses

  • Aamu Vaara
    What is contrast loculation within the pelvis?
    2 years ago

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