Abdominal X-ray Flashcards
What are the main limitations of an abdominal x-ray?
Multiple structures have similar density and overlie each other
35x more radiation than a CXR = concerned over use in cancer patients, young patients and pregnant patients
Under what suspected diagnosis is an abdominal x-ray likely?
Obstruction
Perforation (also CXR)
Foreign body ingestion
Toxic megacolon
Intususspetion
Renal colic
What conditions should a AXR not be ordered?
Constipation
Haematemesis
Gallstones
Appendicitis
Diverticulitis
What structures appear high density on an AXR?
High density appear white - indicates calcification such as bones, gallstones, renal stones
Also metal = artificial joints, surgical clips and stents
Tubes = NG tubes, NJ tubes, catheter
What structures appear medium density on an AXR?
These appear grey
Soft tissue such as liver, spleen, kidneys and psoas muscles
What structures appear low density on an AXR?
Air - bowel gas
Fat - subcutaneous fat
These appear black
What features should be identifiable on this AXR?
This is a normal AXR
Bowel gas
Border of liver
Pelvis
Bladder
Bowel loops
Vertebrae
Psoas major muscle
What are some good ‘headings’ to use when interpreting an AXR?
Patient details
Image type and quality
Bowel
Solid organs
Calcification
Bones
Lines/tubes
What is the normal appearance of the small bowel on an AXR?
3cm or smaller in width
Central location
Valvulae conniventes - across width of bowel.
What is the normal appearance of the large bowel on an AXR?
6cm or smaller in width - up to 9cm allowed in the caecum
Peripheral location
Haustra
Faeces.
What is shown in this x-ray?
Abdominal x-ray
Centrally located
Dilated bowel loops >3cm
Valvule conniventes
Indicates a small bowel obstruction
What is shown in this AXR?
What is the likely cause of this pathology?
Dilated small bowel loops, centrally located >3cm and valvular conniventss
Suggests small bowel obstruction
Presence of surgical clip - past surgery - suggests adhesions is the most likely cause.
What is shown in this AXR?
Dilatd bowel loops >6cm
Located peripherally
Haustra (some present)
Suggests large bowel obstruction
What is a volvulus?
How does it tend to present?
Twisting of the bowel around its mesentry - typically occurs in the sigmoid colon and caecum
Results in large and sometimes small bowel obstruction
Presentes with abdominal pain, distention, constipation and vomiting
Requires urgent decompression
What are the key signs of a volvulus on a AXR?
Dilated bowel
Coffee-bean sign
Sigmoid - arises from LLq and extends to RUQ, loss of haustra
Caecum - arises from the RLQ and extends to the LUQ, haustra maintained
What are the key signs of a bowel perforation on an AXR?
Pneumoperitoneum - free air under the diaphragm on erect CXR
Riglers sign - both sides of the bowel wall becoming visible - suggests pneumoperitoneum - on supine AXR.
What features are shown in this AXR?
What pathology is it indicative of?
Lead pipe bowel - loss of normal haustral markings secondary to chronic colitis
Signs of Inflammatory bowel disease
What features are shown on this AXR?
what pathology is it indicative of?
Thumbprinting - mucosal thickening of the haustra due to inflammation and oedema causing them to appear like thumbprinting projecting into the lumen.
Indicative of an Inflammatory Bowel Disease
What is shown in this AXR?
Patient presents with signs of sepsis +/- shock
Extreme inflammation and distention of the colon
Rare but potentially life-threatening complication
What solid structures are indicated on this AXR?
What other structures might also be seen?
Lungs - inspect for pathology
(as seen above) Liver - as seen, large RUQ
Gallbladder - often not seen but check calcification (gallstones0 and cholecystectomy clips
Stomach - between LUQ and midline, variable gas content
(as seen above) Psoas muscles - bilater to the lumbar vertebrae and sacrum.
May see inferior poles of kidneys, right tends to be lower than left (as shown above)
What pathology is indicated in this AXR?
Bony mets
Can be an incidental finding
Change in opacity of the pelvic bones and femoral head/neck - not yet fractured
What pathology is shown in the AXR?
Renal stones
Calcification in the renal pelvis
Should follow along the tibs of the lumbar spin, over the sacroiliac joint, to ischial spine and medial to bladder to identity any more stones in the ureter.
Note AXR norm for monitoring not diagnosing stones
What pathology is shown in the AXR?
Calcification in the pancrease (L1 or transpyloric plane)
Indicate chronic pancreatitis.
Also dilated small bowel bloops - centrally - small bowel obstruction
What pathology is shown in this AXR?
Calcification in the RUQ and right flank
Indicative of gallstones in the common bile duct - may present with acute cholangitis.
Require confirmation with US or CT
What is shown on both of these images?
Foreign body ingestion
One shows magnets in the stomach and the other shows a golf tee in the ascending colon/caecum
What is shown in the AXR?
Ureteral stent
What is shown in the AXR?
Common bile duct stent (often done in case in inoperable neck of pancreas tumour)
84 male
Abdominal pain
Constipation and vomiting
What is the most likely diagnosis?
Peripherally located - bowel loop dilation >6cm - haustra - indicates a large bowel obstruction
55F
Abdominal pain
Constipation and vomiting
What is the most likely diagnosis?
Cecal volvulus
Coffee bean sign - RLQ to LUQ - dilated bowel loop - still some bowel marking remain
26M
With abdominal pain, diarrhoea and vomitting
What does the AXR indicate?
Normal
Question gastroenteritis
44M
Sudden onset abdominal pain
History of NSAID use
Erect CXR
What is the diagnosis?
Concerned over perforated bowel obstruction resulting in pneumoperitoneum (under right hemidiaphragm)
Dilated bowel under the left hemidiaphragm haustra present - question second obstruction
42 F
Bilateral flank pain
Haematuria
AXR
What is the likely diagnosis?
Renal stones - calcification bilaterally in the R/L hypochondriac regions and flank regions
19 F
Abdominal pain
Recent viral illness
AXR
What is the relevant diagnosis?
Massive splenomegaly - greyish appearance as mid density
Poor appearance of bowels due to overlying spleen
On the left hand side of the image.
87 F
Abdominal pain
Constipation
AXR
What is the likely diagnosis?
Sigmoid volvulus
Coffee bean sign - LLQ to URQ
Absence of haustra
Large dilated bowel loops
