Abdominal X Ray by DR Shervin Farahmand

SHFARAHMAND@SINA.TUMS.AC.
IR

Intussusseption

10/28/16
shfarahmand@sina.tums.ac.ir

pneumoperitoneum
Radiographupright chest or left lateral decubitus abdominal view ;

CT
(supine and upright); CT (IV contrast, oral

Radiographyabdomen
in ED
contrast not essential); Upper GI contrast

study
(enteroclysis)not
Small bowel obstruction
Large bowel obstruction (tumor or volvulus)
Radiography; CT (Contrast enema)
Intussusception (children)
Radiography; ultrasonography; Contrast or air enematherapeutic (reduces

the intussusception)
Appendicitis
CT, MRI (pregnancy); Ultrasonography (graded-compression technique)
Diverticulitis
CT
Ovarian cyst (bleed or torsion), pelvic abscess
Ultrasonography (transvaginal, including Doppler); CT (if enteric disorders are

also being considered)
Early pregnancy (ectopic)
Ultrasonography (transvaginal)
Colitis, enteritis
No imaging needed for infectious diarrhea; CT for Crohns disease or ischemic

colitis
Mesenteric ischemia
CT; angiography for acute arterial occlusion; Emergency surgery, if bowel

infarction and peritonitis; Radiographyintramural gas and hepatic portal
venous gas (rare)
Abdominal aortic aneurysm or dissection
Ultrasonographydetects aneurysm, not leakage; CTnoncontrast to detect

aneurysm leakage, IV contrast for dissection
Renal colic
CTnoncontrast to detect aneurysm leakage, IV contrast for dissection; Renal

colic Helical CT (noncontrast); radiography (to follow a known stone);
Ultrasonographyhydronephrosis, Contrast urography (if no CT)
Cholecystitis
Ultrasonography; CT; Radiography (gallstones, gallbladder gas);

Hepatobiliary scintigraphy (HIDA)
Pancreatitis
CTprognostic assessment in severe pancreatitis, complications (pseudocyst),

10/28/16
negative in mild pancreatitis
:Abdominal Series
Supine View
Upright Abdominal View

Decubitus
Left
Lateral

Upright Chest View
Lateral Chest View
10/28/16
5 :
.1
.2
) (
.3
.4
.5
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)(
%95 %5

: LUQ

.1
valvulae conniventes
.2
.3 )(Bent Finger
.4 Haustra
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:

:

)
(
10/28/16
5 :
: ) (
: ) > cm 3 3(
) < cm 3 < cm 8
(
.1
.2
.3
Sentinel Loop
)(
.4
Partial Obstruction
/ ) (Stepladder String of earl
.5
< cm 13- 11
10/28/16
Small Bowel Obstruction

9
10/28/16
1
10
A 50-year-old man complained of periumbilical and left
lower quadrant abdominal pain that began earlier in the

day. The pain was intermittent, crampy in character,
and accompanied by anorexia and vomiting. He had a
normal bowel movement the previous day. He had not
experienced similar pain in the past.
There was no history of prior abdominal surgery.
On examination:
the patient was afebrile and in moderate distress due to his

abdominal pain.
Bowel sounds were present, and the abdomen was mildly distended
with periumbilical tenderness, but no rebound tenderness.
10/28/16
11
10/28/16

12
) < (cm 3
(Partial or early or Possible SBO) .
Stack of Coins
mm15 <) Multiple differential air/fluid level (

Step ladder
Broad air/fluid levelTortoise - shell
String of pearls
) (:
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13
10/28/16
1
14
Left Incarcerated Inguinal

.H
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2
15
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3
16
10/28/16
CT Scan SBO
17
%50
CT Scan
:SBO
.1
.2
.3
.4
.5
) < (cm 2/5

Transitional zone
Small Bowel Feces

.6
10/28/16

CT

18
10/28/16
Large Bowel Obstruction

19
10/28/16
3
20
An 83-year-old man was brought to the ED by ambulance for
progressive shortness of breath of one day duration. On arrival, he

was in severe respiratory distress and was unable to provide a
detailed medical history.
On examination:
Vital signs: BP: 150/80 mm Hg PR: 120/min, irregular RR: 36/min;
pulse oximetry SO2 78% on room air.
There was poor air movement bilaterally. His abdomen was distended,
tympanitic to percussion, and non-tender. Bowel sounds were quiet,
but present. The patient stated that he had been constipated for six
days, but had a bowel movement the previous day.
On 100% oxygen by face mask, the pulse oximetry SO2 was 92%.
ABG: pH 7.20, PCO2 59 mm Hg, 79 mm Hg, PO2 79 mm Hg
The patient was intubated.
10/28/16
3
21
10/28/16
22
) (

cm10 .

.

Soft Tissue Strip
10/28/16
Coffee Bean
23
Whirl Sign
Beards Beak
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Large Bowel Obstruction (LBO)

24
Sigmoid volvulus
Coffee beana doubled-back
and dilated bowel segment
Extends from left lower
quadrant to right upper
quadrant
Proximal large bowel dilated
Cecal volvulus
Single dilated segment (kidneyshaped) in mid or upper
abdomen
Distal large bowel collapsed,
unless concomitant colonic
ileus
Small bowel often dilated
(effectively obstructed at
terminal ileum)
Large bowel obstruction
distal
Diffuse distention of large bowel

and often small bowel
Cecum disproportionately
distended (75% of cases)
Rectum not distended
Ileuspseudo-
obstruction
Diffuse distention of colon and

often small bowel
Rectum distended on CT or
prone rectal view (air filled)
Toxic megacolon
Distended colon with focal
bowel wall edema (nodularity)
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Sigmoid Volvulus
25
Coffee beana doubled-
back and dilated bowel

segment
Extends from left lower
quadrant to right upper
quadrant
Proximal large bowel
dilated
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Cecal Volvulus
26
Single dilated segment
(kidney-shaped) in mid
or upper abdomen
Distal large bowel
collapsed, unless
concomitant colonic ileus
Small bowel often dilated
(effectively obstructed at
terminal ileum)
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Distal LBO
27
Diffuse distention of large
bowel and often small

bowel
Cecum disproportionately
distended (75% of cases)
Rectum not distended
10/28/16
Adynamic Ileus (Pseudo obstruction)

28
Diffuse small and large
bowel dilation
Without underlying
cause; Ogilvie syndrome
10/28/16
Toxic Megacolon
29
Colonic distention
(Megacolon) with clinical

sign of systemic toxicity
Ulcerative Colitis
Infections colitis +
Antiparalitic
Clostridium D.
Amibiasis
Shigellosis
Distended colon
Loss of haustral marking
Focal bowel wall edema
(nodularity)
10/28/16
4
30
A 51-year-old man presented to the ED with progressive
abdominal pain of one day's duration. He had not eaten all

day and had vomited twice. There was no associated diarrhea
or melena.
He had a history of alcoholic hepatitis, COPD, and surgical
repair of a colonic-bladder fistula 10 years earlier. He had
mild constipation and abdominal discomfort for the past few
months.
On examination, the patient was in moderate distress due to
abdominal pain. Vital signs: BP: 130/70 mm Hg; PR:
118/min; RR: 24/min; temperature 100.8 F (rectal). His
abdomen was distended but soft, with mild diffuse tenderness
and no rebound tenderness. His stool was negative for occult
blood. He was anicteric.
10/28/16
4
31
10/28/16

32
80%
%60)
(
pneumatosis cystoides
intestinalis
Perforated peptic ulcer (usually

duodenal)
Gastric ulcer perforation (benign or
malignant)
Large bowel obstruction causing
cecal perforation
Cecal or sigmoid volvulus
Perforated appendicitis or
diverticulitis (infrequent)
Colonoscopy and biopsy
Residual postoperative gas
Ruptured pneumatosis cystoides
intestinalis
Extension from pneumomediastinum
10/28/16

33
Upright chest radiograph

Left lateral decubitus
abdominal radiograph
Lateral chest radiograph
PneumogastrogramNG
air insufflation
Supine abdominal
radiograph (massive free
air)
CT
Ultrasonography
10/28/16

34
10/28/16

35
10/28/16
5
36
A 2-year-old girl presented to the ED with
intermittent abdominal pain that began 18 hours

earlier. The previous evening, she had an episode
of abdominal pain accompanied by a large bowel
movement. During the night and following day,
she had several bouts of abdominal pain. Her
oral intake was poor and she vomited after
eating. Late that afternoon, her mother brought
her to the ED. The child had been in good
health. At age 4 months, she was brought to
the ED for abdominal pain, which resolved over
several hours. A medical evaluation at that time
was normal.
In the ED, her vital signs were: PR:114/min, RR:
24 min, and temperature 100.1F (rectal). The
child appeared well. Her abdomen was soft and
non-distended. There was minimal right lower
quadrant tenderness with no rebound tenderness
or palpable mass. Stool was guiac negative. The
child would not eat or drink and was admitted to
the hospital for observation.
10/28/16
Intussusception
37
Soft tissue mass

(absence of gas) on the
right side of the
abdomen
2. Crescent sign (the visible
head of the
intussusceptum)
3. Target sign
4. Small bowel obstruction
with dilated loops of airfilled bowel
1.
10/28/16

38
10/28/16

39
10/28/16
40
10/28/16

Abdominal X Ray by DR Shervin Farahmand

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SHFARAHMAND@SINA.TUMS.AC.

Radiographupright chest or left lateral decubitus abdominal view ;

(supine and upright); CT (IV contrast, oral

contrast not essential); Upper GI contrast

Small bowel obstruction

Large bowel obstruction (tumor or volvulus)

Radiography; CT (Contrast enema)

Radiography; ultrasonography; Contrast or air enematherapeutic (reduces

CT, MRI (pregnancy); Ultrasonography (graded-compression technique)

Ovarian cyst (bleed or torsion), pelvic abscess

Ultrasonography (transvaginal, including Doppler); CT (if enteric disorders are

Early pregnancy (ectopic)

No imaging needed for infectious diarrhea; CT for Crohns disease or ischemic

CT; angiography for acute arterial occlusion; Emergency surgery, if bowel

Abdominal aortic aneurysm or dissection

Ultrasonographydetects aneurysm, not leakage; CTnoncontrast to detect

CTnoncontrast to detect aneurysm leakage, IV contrast for dissection; Renal

Ultrasonography; CT; Radiography (gallstones, gallbladder gas);

CTprognostic assessment in severe pancreatitis, complications (pseudocyst),

Upright Abdominal View

Upright Chest View

Lateral Chest View

Small Bowel Obstruction

A 50-year-old man complained of periumbilical and left

lower quadrant abdominal pain that began earlier in the

the patient was afebrile and in moderate distress due to his

mm15 <) Multiple differential air/fluid level (

Left Incarcerated Inguinal

) < (cm 2/5

Large Bowel Obstruction

An 83-year-old man was brought to the ED by ambulance for

progressive shortness of breath of one day duration. On arrival, he

Large Bowel Obstruction (LBO)

Large bowel obstruction

Diffuse distention of large bowel

Diffuse distention of colon and

Coffee beana doubled-

back and dilated bowel

Single dilated segment

Diffuse distention of large

bowel and often small

Adynamic Ileus (Pseudo obstruction)

Diffuse small and large

(Megacolon) with clinical

A 51-year-old man presented to the ED with progressive

abdominal pain of one day's duration. He had not eaten all

Perforated peptic ulcer (usually

Upright chest radiograph

intermittent abdominal pain that began 18 hours

Soft tissue mass

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