PLAIN ABDOMINAL RADIOGRAPH

TRI LESTARI, dr.Sp.Rad

 PROCEDURES

u Basmallah
u General patient information
Patient details, date and time, marker, previous imaging examination
u Assess image quality
Projection, position, exposure
u Assess structures in the abdomen à ABDOX
Air : intraluminal (normal), extraluminal (intraperitoneal, retroperitoneal, pneumatosis intestinalis, pneumobilia, etc)
Bowel : position, size, wall thickness
Dense structures, calcification and bones
Object : soft tissue organs (liver, kidney, spleen, bladder, psoas muscle)
External objects and artefacts
u Conclussion
u Hamdallah
 AP Erect
ASSESS IMAGE QUALITY
(PROJECTION & POSITION)

Left lateral decubitus (LLD)

AP Supine-KUB (standard)
ASSESS IMAGE
QUALITY
(EXPOSURE)

AP-supine
ASSESS IMAGE
QUALITY
(EXPOSURE)

AP-erect
 ASSESS STRUCTURE
OF THE abdomen
(A-B-D-O-X)
AIR : intraluminal

Ø Stomach : almost always air in the stomach (red arrow)

Ø Small intestine : usually a small amount of air in about
two or three loops (yellow arrow)
Ø Large intestine : almost always air in the sigmoid and
rectum (green arrow)
ASSESS STRUCTURE OF THE abdomen (A-B-D-O-X)
AIR : extraluminal-intraperitoneal (free air)

Air beneath diaphragm Visualization of both side of the bowel wall (Riggler sign) Visualization of falciform ligament (Silver sign)
ASSESS STRUCTURE OF THE abdomen
(A-B-D-O-X)
AIR : extraluminal-intraperitoneal (free air)

Air underneath of the central tendon Large amount of air in the center of the Triangular collection of gas in the Morison
of diafragma (Cupola sign) abdomen over fluid collection (football sign) pouch (Doge’s cap sign)
ASSESS STRUCTURE OF THE abdomen (A-B-D-O-X)
AIR : extraluminal

Air in biliary system (pneumobilia)

Pneumatosis seen in profile. Close-up of the right lower
quadrant in an infant demonstrates a thin curvilinear
lucency that parallels the lumen of the adjacent bowel
(solid yellow arrows), an appearance characteristic of gas
in the bowel wall seen in profile.
Pneumatosis intestinalis seen en face. Close-up of
the right lower quadrant in another infant shows
multiple faint, mottled lucencies in the right lower
quadrant (yellow circle),
ASSESS STRUCTURE OF THE
abdomen (A-B-D-O-X)
AIR : retroperitoneal

Unlike the collections of free intraperitoneal air that outline

loops of bowel and usually move freely in the abdomen,
extraperitoneal air can be recognized by certain other
characteristics:
• Streaky, linear appearance outlining extraperitoneal
structures
• A mottled, blotchy appearance (anterior pararenal
space, especially)
• Relatively fixed position, moving little if at all with
changes in patient positioning
Extraperitoneal air may outline extraperitoneal structures:
• Psoas muscles
• Kidneys, ureters, or urinary bladder
• Aorta or inferior vena cava
• Inferior border of the diaphragm by collecting in the
subphrenic tissues
 ASSESS STRUCTURE OF THE
abdomen (A-B-D-O-X)
BOWEL : position, size, wall thickness
Normal small bowel valvulae. Markings
representing the valvulae typically do
extend across the lumen of the small bowel
to extend from one wall to the other. In
addition, the valvulae are spaced much
closer together than the haustra of the
large bowel, even when the small bowel is
dilated.
Position : The large bowel usually occupies the periphery of the abdomen (solid
black arrows). The small bowel is located more centrally (yellow circle).
Normal large bowel haustral markings. Most
haustral markings in the colon do not traverse
the entire lumen to extend from one wall to
the opposite wall (solid white arrows). This is
unlike the appearance of the valvulae
conniventes in the small bowel. The haustral
markings are also spaced more widely apart
than the valvulae of the small bowel
 ASSESS STRUCTURE OF THE abdomen (A-B-D-O-X)
Dense Structure, calcification, bones

Amorphous or popcorn
Type of calcification based calcification (solid red
on morphology : arrow) visible in the pelvis,
suggests formation in a solid
organ or tumor (Calcified
Ø Rimlike : formed in uterine leiomyoma (fibroid).
hollow viscus

Ø Linear or trackline :
formed in wall of
tubular structure

Ø Lamellar or laminar :
formed in stone

Ø Amorphous, cloudlike,
popcorn : formed in
solid organ or tumor Rimlike calcification (solid
blue arrow) in calcified Lamellated calcification
gallbladder wall present in the right
Linear or tracklike calcification upper quadrant in
present (solid green arrows) in gallbladder stone (solid
calcified arterial wall yellow arrow)
 ASSESS STRUCTURE OF THE abdomen (A-B-D-O-X)
Dense Structure, calcification, bones

Calcification based on location :

Right Upper Quadrant :

Gallstones, Renal calculus

Right Midabdomen or Right

Lower Quadrant Ureteral
calculi, Appendicolith

Left Upper Quadrant : Renal

calculus

Central Abdomen Pancreas

(chronic pancreatitis),
Atherosclerotic abdominal aorta

Pelvis : Phleboliths (low in

pelvis), Uterine fibroids Renal calculus Chronic pancreatitis
(popcorn appearance), Bladder
stone, Iliac or femoral vessels Phlebolith
ASSESS STRUCTURE OF THE
abdomen (A-B-D-O-X)
Organ (soft tissue)

Liver
Kidney
Spleen
Psoas muscles
ASSESS STRUCTURE OF THE abdomen (A-B-D-O-X)
External Objects and Artifacts

Nasogastaric tube are widebore tubes marked with a radiopaque

stripe that “breaks” in the position of the side hole, usually about 10
cm from the tip (solid red arrow). The tip and all side holes of the
tube should extend about 10 cm into the stomach beyond the
esophagogastric (EG) junction to prevent aspiration from
administration of the feeding into esophagus
THANK YOU