Recognizing normal abdomen: conventional radiographs

Question 1

What should you consider when unable to visualize one or both psoas muscles?

Answer 1

Retroperitoneal disease. However, if the patient is very skinny this may be another possibility as there must be adequate extraperitoneal fat surrounding them.

Question 2

4 things to look for when looking at an abdominal radiograph.

Answer 2

First, look at overall gas pattern. Second, check for extraluminal air. Third, look for abnormal abdominal calcifications. Fourth, look for soft tissue masses.

Question 3

What is wrong with this patient?

Answer 3

Aerophagia 2/2 fecal obstruction (what the arrow is pointing to) causing massive obstruction – > intraluminal air in both small and large bowel.

Question 4

Which area of abdomen should you NOT normally see air-fluid level on radiograph?

Question 5

Most common location of gas in large bowel

Answer 5

Rectosigmoid

Question 6

ID abnormality.

Answer 6

Hepatomegaly – liver extends all the way down to the iliac crest! Could be a riedel lobe. Fairly common incidental finding in females.

Question 7

ID pathology.

Answer 7

Note displacement of bowel loops from RUQ down to iliac crest and across midline 2/2 HEPATOMEGALY.

Question 8

ID pathology.

Answer 8

Splenomegaly. If the spleen projects well below 12th posterior rib or displaces stomach bubble toward or acrosss midline, the spleen is probably enlarged. This example is very dramatic. This pt has sickle cell anemia.

Question 9

Why would you get a chest xray for an abdominal complaint?

Answer 9

Looking for pathology (anatomically close to the abdomen) that could be causing abdominal pain, such as: free air under diaphragm, pleural effusions, pneumonia at bases.