The Abdominal XRay

1
The Abdominal X-Ray
2
Contents

• Normal Anatomy
• Types of Projection
• Assessing the Film
• Technical Qualities
• Gas containing structures
• Solid Organs
• Bones
• Soft Tissues
• Presenting the film

3
Anatomy on the Abdominal X-Ray
4
Abdominal X-Rays
AXR-4

• AXR-3

5
What to Examine

• Gas pattern
• Extraluminal air
• Soft tissue masses
• Calcifications

6
Normal Gas Pattern

• Stomach
• Always
• Small Bowel
• Two or three loops of non-distended bowel
• Normal diameter 2.5 cm 1 US quarter
• Large Bowel
• In rectum or sigmoid almost always

7
Gas in stomach
Gas in a few loops of small bowel
Gas in rectum or sigmoid
Normal Gas Pattern
8
Normal Fluid Levels

• Stomach
• Always (except supine film)
• Small Bowel
• Two or three levels possible
• Large Bowel
• None normally

9
Always air/fluid level in stomach
A few air/fluid levels in small bowel
Erect Abdomen
10
Large vs. Small Bowel

• Large Bowel
• Peripheral
• Haustral markings don't extend from wall to wall
• Small Bowel
• Central
• Valvulae extend across lumen
• Maximum diameter of 2"

11
Complete AbdomenObstruction Series

• Supine
• Prone or lateral rectum
• Erect or left decubitus
• Chest - erect or supine

12
Complete AbdomenSupine

• Looking for
• Scout film for gas pattern
• Calcifications
• Soft tissue masses
• Substitute none

13
Complete AbdomenProne

• Looking for
• Gas in rectum/sigmoid
• Gas in ascending and descending colon
• Substitute lateral rectum

14
Complete AbdomenErect

• Looking for
• Free air
• Air-fluid levels
• Substitute left lateral decubitus

15
Complete AbdomenErect Chest

• Looking for
• Free air
• Pneumonia at bases
• Pleural effusions
• Substitute supine chest

16
Extraluminal AirFree Intraperitoneal Air
17
Signs of Free Air

• Air beneath diaphragm
• Both sides of bowel wall
• Falciform ligament sign

18
Crescent sign
Free Intraperitoneal Air
19
Air on both sides of bowel wall Riglers Sign
Free Intraperitoneal Air
20
Falciform Ligament Sign
Football sign
Free Intraperitoneal Air
21
Free AirCauses

• Rupture of a hollow viscus
• Perforated ulcer
• Perforated diverticulitis
• Perforated carcinoma
• Trauma or instrumentation
• Post-op 57 days
• NOT perforated appendix

22
Air in Lesser Sac
23
Extraperitoneal Air
24
AbdominalCalcifications
25
Abdominal CalcificationsPatterns

• Rimlike
• Linear or track-like
• Lamellar
• Cloudlike

26
Rimlike Calcification

• Wall of a hollow viscus
• Cysts
• Renal cyst
• Aneurysms
• Aortic aneurysm
• Saccular organs e.g. GB
• Porcelain Gallbladder

27
Renal Cyst
Gallbladder Wall
28
Linear or Track-like

• Walls of a tube
• Ureters
• Arterial walls

29
Atherosclerosis
Calcification Vas Deferens
30
Lamellar or Laminar

• Formed in lumen of a hollow viscus
• Renal stones
• Gallstones
• Bladder stones

31
Stone in Ureterocoele
Staghorn Calculi
32
Cloudlike, Amorphous, Popcorn

• Formed in a solid organ or tumor
• Leiomyomas of uterus
• Ovarian cystadenomas

33
Nephrocalcinosis
Myomatous Uterus
34
What to Examine

• Gas pattern
• Extraluminal air
• Soft tissue masses
• Calcifications