ABDOMINAL X-RAYS

Prepared by:
Dr FIZZAH ARIF.
Abdominal x-ray-
approach
 Abdominal organs
 Bowel gas pattern
 3/6/9 rule
 Fluid levels
 Peritoneum
 Calcification/artifacts/ lines
 Bones and joints
Normal AXR
Liver Gas in
stomach Splenic flexure
11th rib T12

Psoas margin
Left kidney

Hepatic flexure
Transverse colon

Iliac crest
Gas in sigmoid
Sacrum

Gas in caecum
SI joint

Bladder
Femoral head
Gas pattern
What is normal?
 Stomach
 Almost always air in stomach
 Small bowel
 Usually small amount of air in
2 or 3 loops
 Large bowel
 Almost always air in rectum
and sigmoid
 Varying amount of gas in rest of large bowel
 Normal fluid levels
 Stomach
 Always (upright, decub)

 Small bowel
 Two or three levels
acceptable (upright, decub)

 Large bowel
 None normally
 small vs large
bowel

Small bowel
Central
Valvulae conniventes
extend across lumen and
are spaced closer together
Large bowel
Peripheral (except RUQ occupied by liver)
Haustral markings don’t extend from wall to wall
3, 6, 9 RULE

Maximum Normal Diameter of

bowel
Small bowel 3cm
Large bowel 6cm
Caecum 9cm
SBO Erect SBO Supine

Air fluid levels

Step ladder appearance
String of pearls sign
LARGE BOWEL OBSTRUCTION
Large bowel obstruction
Calcified gallstones
Apple core sign
 Thestricture
demonstrates
shouldered margins and
resembles the core of
an apple that has been
partially eaten. The
most common cause is
an annular carcinoma of
the colon.
 Double Bubble Sign

Duodenal Atresia
VOLVULUS:
Coffee Bean Sign
Sigmoid volvulus
Barium study:

BIRD-BEAK Deformity: Caecal volvulus

Intussusception

Crescent
Sign/claw sign
Claw sign
Localized ileus
Key features
Generalised adynamic ileus
ISCHEMIC COLITIS:
Thumbprinting
IMPORTANT RADIOLOGICAL
SIGNS ON AXR.
Colon cut off sign
Lead pipe
colon
 Ulcerative colitis
Upright film best

 The patient should be positioned sitting upright

for 10-20 minutes prior to acquiring the erect
chest X-ray image.

 This allows any free intra-abdominal gas to rise

up, forming a crescent beneath the diaphragm.
It is said that as little as 1ml of gas can be
detected in this way.
Crescent Sign
Free air under the diaphragm
Continuous diaphragm sign
Chilaiditis sign
Rigler’s Sign
Football Sign

Paediatric
Pneumoretroperitoneum

 If you are not confident

that the appearance is
pneumoretroperitoneu
m, you can try an erect
and decubitus view to
see if the gas moves. If
the gas is seen to
move, it's not in the
retroperitoneum.
Pneumatosis intestinalis
 Intramural air, best
appreciated in
profile
Air in the biliary tree
 One or two tube-like branching lucencies in the RUQ,
confirm to location of major bile ducts
CALCIFICATIONS
Linear/Track

 Calcification in walls of tubular structures

 Arteries
 Fallopian tubes
 Vas deferens
 Ureter

Aortoiliac calcification
 Calcified
Calcified
fibroids
enteric
lymph nodes

Calcified
pancreas
Presenting an abdominal x-ray

Having a structured approach to summarising your findings

is key to ensuring you communicate the salient points.  

“This is a supine AP abdominal radiograph of Jayne Lister, date of

birth 11/4/1970.  The film is of good quality with appropriate
exposure. No prior imaging is available for comparison. Both the
small and large bowel appear within normal limits.  Other abdominal
viscera appear normal within the limits of this projection. No obvious
bony pathology is identified. No abnormal calcification is seen. In
summary this is a normal plain radiograph of the abdomen.”
Thank You………