Abdominal X-Ray PDF

Abdominal X-Ray Dr. Heba Abou El Atta. MD. EDiR Introduction Most of abdominal imaging involves mainly Ultrasound, CT, MRI. Radiographs are often used as a quick first step to help decide what type of imaging is needed. Main Indications of abdominal X Ray (AXR):- Nor...

Abdominal X-Ray Dr. Heba Abou El Atta. MD. EDiR Introduction Most of abdominal imaging involves mainly Ultrasound, CT, MRI. Radiographs are often used as a quick first step to help decide what type of imaging is needed. Main Indications of abdominal X Ray (AXR):- Normal Abdominal X-Ray (AXR) Stomach Barium Meal: stomach & Duodenum Barium Meal Follow Through(BMFT)  Small Intestine Mucosa of jejunum Mucosa of Ileum Barium Meal Follow Through(BMFT) Small Intestine Large Intestine (colon)  Large Bowel Rectum On Barium Enema  Normal stool in the colon It appears as small bubbles of gas within density in the colon giving mottled appearance. Difference Between Small & Large Bowel  Measurements to remember Rule 3-6-9 Small Intestine < 3cm. Large Intestine < 6cm. Cecum < 9cm.  Abdominal X-Ray approach Bowel gas pattern. A: Air Free air. B: Bowel Solid organs. C: Calcification Soft tissue masses. D: Densities (lines, FB) O: Organs Bones. E: Everything else Calcifications. (lung, Bone, soft tissues) Lung gases.  Acute Abdomen X- Ray series 1. Abdominal supine AP 2. Chest PA  Left lateral decubitus Used for evaluation of air-fluid level. Used for evaluation of free air which will arise to right side. Obtained with the patient is lying on his left side  When intestinal obstruction is suspected.. Questions to be answered ? 1. Is there obstruction? 2. What is the level of obstruction? 3. What is the cause of obstruction? Gas Gas in the bowel lumen Gas In the bowel lumen  Intestinal Obstruction Supine Upright Large Bowel Obstruction Anteroposterior supine abdominal radiograph in a 67-year-old man with LBO shows dilated ascending, transverse, and descending colon. A transition point is identified from an obstructing colon carcinoma (arrow). Small bowel obstruction Coffee bean sign Toxic megacolon Gas outside bowel lumen Gas outside the lumen (extra-luminal)  Pneumoperitoneum Causes include: Peptic ulcer disease Bowel ischemia (any cause) Appendicitis Colitis Diverticulitis Penetrating abdominal trauma Foreign body ingestion Endoscopic complication Immediate post surgery (normal) Gas in the wall of hollow viscus Emphysematous cystitis Emphysematous cholycystitis  Splenic tip Major Organs RT Kidney LT Kidney Liver edge Urinary Bladder Hepatomegaly Splenomegaly Abnormal high Densities  Urolithiasis Majority of kidney stones are radio-opaque. Can be present in: ✓Renal pelvis ✓Ureter ✓Bladder ✓Urethra Left ureteral stone Left renal staghorn stone Urolithiasis Phleboliths on X-Ray  Gall stones Minority of gall stones are radiopaque (i.e. seen on X ray). They are present in: Gall bladder Cystic duct Common bile duct Bowel  Pancreatic calcification Causes include : Chronic pancreatitis Cystic fibrosis Pancreatic cancer Senile Calcified uterine fibroid Ureteral(JJ ) stent Spinal Hardware (plate & screw) Hip Prosthesis  Intra-uterine Device (IUD) IUD in Place Migrated IUD in the abdominal cavity Ingested batteries Drug Mule: Cocaine  Diffuse sclerotic metastasis Bone Case Of the Day Thank You