Radiology gallery 4

	This 89 year old lady presented with a four day history of absolute constipation and abdominal distension. Examination showed a grossly distended non-tender abdomen. This plain abdominal X-ray shows the typical features of a sigmoid volvulus. Sigmoidoscopic examination showed an empty rectum. At about 25 cm a large amount of faecal fluid and gas was encountered with relief of her symptoms. A rectal tube was left in-situ for 24 hours and the patient made an uncomplicated recovery.
	This 76 year old man had a previous history of a bladder transitional cell carcinoma. He presented with a further episode of frank haematuria. A check cystoscopy showed no bladder tumour but blood was seen coming from the left ureteric orifice. A retrograde ureterogram was performed. This showed a filling defect with the superior pole calyx of the left kidney very suggestive of a further transitional cell carcinoma.
	This 85 year old lady presented with a two months history of progressive painless obstructive jaundice. Biochemical assessment showed obstructive features. An ultrasound scan showed dilated common and intrahepatic ducts. The head of the pancreas was not well seen. This image is from a contrast enhanced abdominal CT shows a 4 cm partially enhancing mass in the head of the pancreas. The features are those of a carcinoma of the head of the pancreas.
	This 70 year old man presented with postprandial abdominal discomfort and bloating. He had no significant past history and examination was unremarkable. An upper gastrointestinal endoscopy was normal. This investigation was then performed. It is a barium meal and follow through study. It shows large diverticulae of the proximal small bowel with partial intestinal obstruction. The diagnosis is that of jejunal diverticulosis. He underwent resection and primary anastomosis of the affected segment and six weeks after his operation he was symptom free. Jejunal diverticulosis occasionally presents as an emergency with perforation, obstruction or gastrointestinal haemorrhage.