GS HO

X-RAY READING
Important Pointers
• Clear, concise history.
• Write down (your/team) clinical thoughts and questions.
• Give relevant information.
• Avoid Acronyms. They mean different things to different
disciplines. For e.g. – CCF (congestive cardiac failure)
(carotid-cavernous fistula).
• Be prepared to be called if your name is on the request
form.
Important Pointers
“Bad request” “ Good request”

• “Abdominal pain for • “ 23/female with right iliac

investigation” fossa pain for 1 day. ?
• “.” Tubo-ovarian abscess vs
appendicitis?
• “ ?CCF”
• “Motorcyclist involved in
• “RTA”
high speed collision. Flung
• “NKDA” and hit windscreen. GCS
• “Routine 3 on arrival. Hypotensive.”
• Alvarado score for
appendicitis cases
Topics
• Where is the air?
• Pneumoperitoneum
• Pneumothorax
• Pneumomediastinum
• Widened mediastinum
• Intestinal Obstruction
• Lines
• Cervical Spine Trauma
• Must know CT cases
PNEUMOPERITONEUM
Sliver of air below the diaphragm such that the
diaphragm is very well seen
Rigler’s sign

Free air results in air on both sides of bowel, making

the bowel wall obvious
Falciform ligament sign

Free air outlining the falciform ligament

Portovenous gas

Tree-branch like pattern of air seen over the liver

PNEUMOTHORAX
Border of the lung is seen, indicating air on both
sides (air-filled lung and air filled pleural cavity)
PNEUMOMEDIASTINU
M
Mediastinal-lung interface clearly seen due to air on
both sides (mediastinum, air filled lung)
WIDENED
MEDIASTINUM
Aortic aneurysm

Definition: mediastinum >8 cm in width. Suspect

mediastinal pathology, e.g. commonly aortic
aneurysm. Note the cut off of 8 cm is arbitrary and
experience is needed. Consult radiologist if unsure.
INTESTINAL
OBSTRUCTION
3-6-9 rule. Small bowel > 3cm, large bowel > 6 cm,
caecum > 9 cm
‘string of pearls’ sign indicating multiple air fluid levels Jejunal dilatation; also grossly dilated stomach
in obstructed fluid filled small bowel (green)
Sigmoid volvulus

‘coffee bean’ configuration of dilated sigmoid

IO due to gallstone

Small bowel obstruction due to large passed gall stone

LINES
Expected position: Feeding tube tip projected
over gastric bubble
Acceptable position: tip at cavoatrial junction
to proximal right atrium
ETT tube in right main bronchus
CERVICAL SPINE
INJURIES
Bilateral interfacetal dislocation
Flexion teardrop fracture
C2 body fracture
MUST SEE CT CASES
CBD stones with gross biliary dilatation

Marked biliary tree

dilatation Obstructing CBD calculi
Drainable hepatic abscess

Large irregular abscess (red arrow) with

adjacent hepatic hyperemia (green arrow;
left lobe enhances more than right lobe)
Acute appendicitis

Appendix is markedly dilated and thick

walled, with adjacent fat stranding
 Colonic CA with IO and perforation

Florid free intraperitoneal air, in keeping

with perforation

Colonic mass with upstream colonic

dilatation
THE END