Radiology gallery 10

	This male infant with Down's syndrome was born at 34 weeks gestation. He developed profuse non-bile stained vomiting within the first 48 hours of life. A nasogastric tube was inserted and this plain abdominal x-ray shows the 'double-bubble' appearance of duodenal atresia. After fluid resuscitation he underwent a laparotomy and duodenoduodenostomy. He made an uncomplicated recovery from his surgery. Duodenal atresia occurs in 1:10,000 live births. It can often be diagnosed prenatally in the presence of polyhydramnios. 40% of atresias are pre-ampullary and the vomitus is not bile-stained. 65% of infants have another associated major congenital anomaly and 30% have Down's syndrome.
	This 45-year old lady presented with intermittent episodes of right upper quadrant abdominal pain. Each episode lasted 2-3 hours, was associated with nausea and occasional vomiting. She was never jaundiced. Abdominal examination was unremarkable. Her liver function tests were normal. The clinical picture was that of biliary colic. This abdominal ultrasound scan was organised by her general practitioner. It shows a solitary calculus within the fundus of the gallbladder. The common bile duct was of normal diameter. She proceeded to an uncomplicated laparoscopic cholecystectomy.
	This 60-year old man presented with painful swelling of his left submandibular gland immediately prior to eating. The swelling subsided with the release of a foul tasting discharge into his mouth. Examination between episodes showed minimal swelling of his submandibular gland, but the gland increased significantly in size when offered food. This plain x-ray shows a large calculus within the submandibular duct. The stone was easily palpable in the floor of the mouth and was surgically extracted from the duct. Overall, 80% of salivary gland calculi occur in the submandibular duct and 80% are radio-opaque. If there is any diagnostic doubt a sialogram should be performed.
	This 83-year old lady presented with a five day history of colicky central abdominal pain, bile-stained vomiting and increasing abdominal distension. She had not undergone any previous abdominal surgery and had no significant past medical history. Examination showed her to be clinically anaemic. Her abdomen was distended and palpation suggested a mass in her right iliac fossa. She had high-pitched bowel sounds. Her haemoglobin was 8 g/dl. This plain abdominal x-ray shows dilated small with the valvulae coniventes easily visible. There is no evidence of colonic dilatation. The clinical and radiological features are of small bowel obstruction probably due to a caecal carcinoma. After 24 hours resuscitation she proceeded to a laparotomy, without further radiological investigation, at which the diagnosis was confirmed and and uncomplicated right hemicolectomy was performed. Within the UK, in the absence of previous surgery, an obstructing carcinoma is the commonest cause of small bowel obstruction.