Abdominal Radiography

Dr. Alberto Guerrero

 Abdominal Radiography

• Step 1
• Position the radiograph correctly on the view box, with the film R
(right side) marker opposite to the viewer’s left side and the patient’s
head toward the top of the film
• On the anterior-posterior (AP) radiography, there should be a sign
indicating an upright view, usually an arrow near the R or L marker
pointing toward the patient head
• Decubitus radiographs should be clearly labeled as such and should
note which side is up.
 Abdominal Radiography
• Step 2
• The Practitioner should glace at the entire radiograph in a relax
manner to allow an obvious abnormality to jump out at you
• When you discover an abnormality, do not terminate your
subsequent
 Abdominal Radiography
• Step 3
• Evaluate the radiograph systematically
• First:
• Locate the water density liver and spleen silhouettes
• A clue to locating the liver and spleen edges is the presence of bowel
gas in the right and left upper abdominal quadrants
• Bowel gas permits an indirect estimates of the location of the hepatic
and splenic border, because it is located at the lower edges of the
liver and spleen
 Abdominal Radiography
• Normal Abdominal Radiograph Labeled Abdominal Radiograph
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When the liver shadow extends to the iliac crest, usually enlarged

Hepatomegaly Spleen
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• Second:
• In a normal radiograph, psoas muscle margins are usually visible
• A nonvisible psoas margin should alert you to a possible abnormality
 Abdominal Radiography
• Third:
• Let your eyes drift towards the renal shallows, evaluate their size, shape,
and position
• Renal shadows are visible because they are water density structures
(gray) surrounded by variable amounts of fat (black)
• Identifying renal outlines
• Locate the upper and lower renal poles, as well as their medial and
lateral bodies
• If the renal long axis is not parallel with the psoas muscle , you need to
rule out a mass
 Abdominal Radiography
Abdominal radiography key on Gallbladder, Pancreas (Male)
L-Liver
S-Spleen
RK-Right kidney
LK-Left kidney
P-Pancreas
B- Bladder
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Abdominal radiography of the kidney and Psoas muscle
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• Kidney Radiograph
• Normal Nephrolithiasis Kidney Failure
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Pancreas calcifications
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Normal colon Radiography

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• Kidney Stone Gallstone
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Abdominal Calcifications
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Fourth:
Evaluate gas patterns
Fifth:
Evaluate the Bones beginning with the visible ribs and spine
Study the pedicles of the dorsal and lumbar spine, proceeding from
head to toe
Missing pedicles indicates destructive process
 Abdominal Radiography
• Normal Lumbar Spine Metastasis of the lumbar spine
• Psoas muscle Pedicles
 Abdominal Radiography
• Evaluating the Interstitial Air OR Gas Pattern
• Interstitial Gas (black) provides a natural contrast media that can be useful for
detecting abdominal disease
• When evaluating the intestinal gas patterns, you should ask yourself several
important questions
• It is normal to have some air in the abdomen
• Is the bowel pattern normal?
• If no;
• Is there too much or too little air?’
• IS the air in the wrong place
 Abdominal Radiography
Normal Abdominal intestinal gas pattern
 Abdominal Radiography
• Too Much Bowel Gas
• Differential Diagnosis
• Adynamic ileus and bowel obstruction
• A systematic approach must be used to arrive to a correct answer
• In Adynamic ileus (also called paralytic ileus or just ileus) there is too
much bowel gas in the entire GI tract including the small and large
intestine
Adynamic Ileus-Major Causes
Intraabdominal Extra-abdominals
Postoperative or posttraumatic Septicemia
Post inflammatory: pancreatitis, enteritis, Metabolic disease: hyperkalemia, uremia
colitis
Pain related: renal colic, epidural disease Medications (specially narcotic)
Prolong bedrest
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• If you identify a comparable amount of gas in the small and large
intestine and in the rectum, this generally indicates a Adynamic ileus
• Air in the rectum may be a key differential point

• Normal gas pattern. Adynamic ileus

Air in the rectum
 Abdominal Radiography
• In intestinal obstruction there is usually air-filled dilated intestine
proximate to the point of obstruction
• In both ileus and obstruction , often the dilated small and large
intestine has air-fluid levels noted on upright and decubitus
radiographs

• Small Bowel Obstruction

 Abdominal Radiography
SBO vs Ileus
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• In both ileus and obstruction, often the dilated small and large bowel
containing too much air will have air fluid levels noted on upright and
decubitus radiograph
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Abdominal Radiography
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• If you believe that the patient has a small bowel obstruction, you
need to determine the location of the obstruction
• Is the obstruction in the small or large intestine?
• In small bowel obstruction, there are loops of dilated small bowel
proximal to the obstruction site and little or no gas in the colon or
the rectum.
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• Small Bowel Obstruction
• The large intestine is not visualized only the dilated small intestine
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• Sometimes, it is difficult to differentiate dilated small or large bowel
• One way is to identify the valvulae conniventes and colon haustra.
• Valvulae conniventes
• Are regular spaced, thin mucosal layer folds that extends across the entire
small bowel lumen
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• Colon haustra
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• Valvulae conniventes are regularly spaced, thin mucosal folds that
extends across the entire small bowl lumen
• On the other hand, the colon can usually be identified by the
somewhat irregularly spaced transverse bands, called colon septa or
haustral folds that do not extend completely across the colon lumen
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 Abdominal C X R
• Sigmoid volvulus
• This condition is found in the elderly and constipated patient
• The sigmoid colon twist partially or completely
• Barium enema is the confirmatory test
• Condition that causes too little gas in the colon
• Enlarged abdominal organ
• Hepatomegally Splenomegaly Cholelithiasis
 Abdominal Radiography
• Intraabdominal Tumors
• Large calcified intra-abdominal mass
• Wilms tumor
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Fluid filled intestine
Ascitis
Plain abdominal supine radiography shows abdominal distension with
widening of both paracolic gutters (arrow) suggesting ascites
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• Pneumoperitoneum