Abdominal X-Ray

Liza de la Cruz, M.D.

3 Most Common Views:

1. Supine 2. Erect 3. Left lateral decubitus

4 Quadrants

Less gas Valvulae coniventes

Not > width of pinky finger haustra

Approach AXR
Champagne - gas bubbles Free ABDO Free Fluid Air Bowel Wall Thickening Densities Organ

Specific Problems
I. Free fluid
Colon & flank fat stripe < width of pinky finger
Fluid in paracolic gutter opacification Bowel float & collects at the center of the abdomen

II. Air out of bowel lumen

A. Intraperitoneal air No air outside of the bowel in the peritoneal cavity

Bowel Perforation Location

@ Duodenum 2 to PUD @ Colon 2 to diverticulitis, colon CA or obstruction

 Look for air under the diaphragm

R flank or R iliac bone

Chilaiditi's syndrome - large bowel is interposed between the liver and the diaphragm

Rigler's sign - air inside and outside the bowel enables one to see both the outer and inner aspects of the bowel abdominal surgery 10 days

B. Retroperitoneal air
retroperitoneal structures Outlines: kidneys and the iliopsoas muscle

C. Branching air in the liver homogeneous fluid density pneumobilia or in the portal venous system.

D. Abscess Collected in areas that does not correlate with the N location of bowel

E. Pneumatosis air in the bowel wall linear black streaks in bowel wall Bowel perforation, gangrene, bowel ischemia or infarct

III. Air in the bowel lumen (dilated bowel) Critical bowel diameter greater than: 3 cm for the small bowel 6 cm for the large bowel (except cecum) 9 can for the cecum Air fluid level - straight horizontal line with air above and fluid below

A. Ileus
loops of bowel become paralyzed bowel dilation of d/t gas collection
Localized - near an inflammatory process Generalized - drugs, surgery or pain

Gallstone Ileus

Post-op Ileus

B. Bowel obstruction The bowel proximal to the obstruction dilates and more distal bowel collapses. Complete vs Partial Bowel CA, adhesions

Air fluid levels

C. Volvulus the bowel twists on itself, thereby causing obstruction a. Sigmoid volvulus coffee bean or an inverted U remainder of the colon is usually dilated
b. Cecal volvulus RLQ bubble in the middle of the abdomen associated with SB dilatation

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IV. Densities 1. Bones

2. Appendicolith small calcification is seen in the RLQ (10%) focal small bowel ileus 3. Stones
4. Pancreatic calcifications across the midline in the area of the pancreas chronic pancreatitis

5. Abdominal aortic aneurysm (AAA) bilateral curvilinear calcifications adjacent to the lumbar spine Distance is > 3 cm abdominal aortic aneurysm

V. Organs fat in the abdomen allows visualization of their outline

Bibliography
Ouellette, Hugue, & Tetreault, Patrice. (2002). Clinical radiology made ridiculously simple. Miami, Fl: Medmaster.