Abdominal x rays made easy normal radiographs

Abdominal X Rays Made Easy Normal Radiographs-Free PDF

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Key to densities in AXRs,White calcified structures. Grey soft tissues,Darker grey fat,Intense white metallic objects. appearance of what looks like a soft tissue,mass in the region of the stomach is more. often than not actually a gastric pseudotu,mour This is a normal finding on the supine. film and represents gastric fluid lying within,the fundus fig 6.
The assessment of bones entails evaluat,ing the spine and pelvis for evidence of bony. pathology Osteoarthritis frequently affects,the vertebral bodies as well as the femoral. and the acetabular components of the hip, Figure 4 Haustra films Figure 5 Faecal mottling joint Paget s disease may also be identified. commonly along the iliopectineal lines of,the pelvis Your bone survey should also. Presenting the AXR Places to look for abnormal check for fractures especially subtle femoral. neck fractures in elderly people The spine, This is the supine abdominal radiograph extraluminal gas.
and pelvis are also common locations for, of a 42 year old women taken yesterday Under the diaphragm metastatic deposits In the spine this is classi. It is technically satisfactory The amount In the biliary system cally seen as the absent pedicle. and distribution of gas within the bowel Within the bowel wall. is normal There is no bowel dilatation, There is no evidence of extraluminal air Artefacts. Soft tissue outlines of the psoas muscles most commonly phleboliths Part 4 of this You should be able to identify man made. series is dedicated to calcification on AXR structures correctly These may be iatro. and kidneys are seen The kidneys are,genic put there by health professionals. normal in size and shape There are no accidental put there by the patient or. apparent bony lesions or abnormal calci other or projectional lying in front of or. fication Incidentally sterilisation clips behind the abdomen but spuriously pro. can be seen within the pelvis indicating jected within it on the AXR Examples of. previous gynaecological intervention iatrogenic structures would be surgical. clips an interuterine contraceptive device,renal or biliary stent an endoluminal aortic. been perforated This gas within the peri stent or inferior vena cava filter Accidental. toneal cavity is termed pneumoperitoneum findings include bullets or a per rectum. Gas in the right upper quadrant within object Projectional findings include pyjama. the biliary tree is a normal finding after buttons coins in pockets or body piercings. sphincterotomy or biliary surgery but it can see part 6 of the series. indicate the presence of a fistula between the Figure 6 Gastric pseudotumour. biliary tree and the gut Ian C Bickle final year medical student Queen s. Beware of gas in the portal vein as this University Belfast. medicine totalise co uk, can look very similar to biliary air Gas in the Soft tissues and bone.
portal vein is always pathological and fre A review of the soft tissues entails evaluating Barry Kelly consultant radiologist Royal Victoria. quently fatal It occurs in ischaemic states the outlines of the major abdominal organs Hospital Belfast. such as toxic megacolon and it may be Observing these structures is made easier by. accompanied by gas within the bowel wall the fatty rim properitoneal fat lines sur. intramural gas rounding them In fact the loss of these fat Next month Abnormal intraluminal gas. planes may indicate an ongoing pathological, process such as peritonitis Look at the size Review points. Calcification and position of the liver and spleen Look at. Calcium is visible in a variety of structures the position and size of the kidneys lateral to Technical specifics of the radiograph. both normal and abnormal and becomes the midline in the region of the T12 L2 verte Amount and distribution of gas. more common with advancing age How brae a useful way of identifying vertebrae Extraluminal gas. ever review the following areas in particu the lowest one to give off a rib is T12 and Calcification. lar for evidence of calcification cartilage of serves as a reference point The renal outline. Soft tissue outlines and bony struc, ribs blood vessels chiefly the aortoiliac and is usually three to three and a half vertebral. splanchnic arteries pancreas kidneys the bodies in length Also look for the clear out. right upper abdominal quadrant for gall line of the psoas muscle shadow s Finally Iatrogenic accidental and incidental. bladder calculi and the pelvis which may try to identify the outline of the bladder seen objects. contain a variety of calcified structures more clearly if full within the pelvis The. STUDENT BMJ VOLUME 10 April 2002 studentbmj com 103. Abdominal x rays made easy,abnormal intraluminal gas. Got a blockage in your learning Let Ian Bickle and Barry Kelly. help by explaining bowel obstruction and other causes of abnormal. intestinal gas in the second part of our series on abdominal. radiographs,On an abdominal radiograph as with all. plain film images four densities can be,seen white grey slightly darker grey and.
black representing bone soft tissue fat,and air Metallic objects are seen as intense. bright white The abdominal radiograph is,a representation of the abdominal viscera. and bowel the presence of gas in most,instances is normal Several medical and. surgical conditions however are recognis,able by an abnormal amount distribution. or location of air on the radiograph Abnor,mal gas can be a intraluminal in the stom.
ach duodenum and intestine or b,extraluminal that is elsewhere. Large bowel obstruction and,paralytic ileus,Most intraluminal gas is in the large intes. tine which has the greatest luminal diame, ter of the intestinal tract A diameter of Fig 1 Large bowel obstruction Fig 2 Paralytic ileus. more than 5 cm suggests a large bowel, obstruction and would be considered abnor the small bowel These can both be seen on fluid levels a stepladder appearance fig 4. mal except in the caecum As the intestine plain radiograph 1 Secondly large bowel is. is a large long tube any obstruction either found at the radiograph s periphery as. from within or by external compression opposed to the small bowel loops which Volvulus. prevents the passage of faecal material and take up central positions This has been A volvulus is the twisting of bowel about its. gas Consequently both will build up proxi referred to as a picture frame of large mesentery causing intestinal obstruction. mal to the obstruction causing dilation bowel and the picture of small bowel The two most common sites are the sigmoid. Unless the ileocaecal valve is incompetent within the frame and the caecum With a sigmoid volvulus an. this gas faecal material mix will be contained extremely dilated loop of sigmoid bowel. entirely within the large bowel With time forms two large compartments which look. the passage of a motion will empty any faecal Small bowel obstruction like a coffee bean hence the name of the. material and gas distal to the blockage This In small bowel obstruction dilated small sign This single loop usually fills most of the. gives the appearance of a cut off point on bowel loops are seen centrally on the radi lower abdominal radiograph On erect. the radiograph fig 1 This is an important ograph The valvulae conniventes should abdominal radiographs a fluid level may be. sign to appreciate as it is indicative of a be visible across the whole width of this noted. mechanical large bowel obstruction dilated bowel The dilated bowel diameter. The large bowel can also dilate with para is greater than 3 cm but usually less than 5 Comparison of large and small bowel. lytic ileus In this condition the bowel is ady cm There are likely to be several dilated obstruction features. namic not undergoing normal peristalsis bowel loops The number of small bowel. This allows gas which everyone swallows loops gives an indication of the level at Feature Obstruction. normally to accumulate in the bowel but which the obstruction within the small Small Large. importantly this air is contained within both bowel has occurred the higher the bowel bowel. the small and large bowel fig 2 There is also obstruction the fewer the number of Bowel diameter cm 3 and 5 5. no evidence of a cut off as it is bowel peri loops seen Unlike large bowel obstruction Position of loops Central Peripheral. stalsis not obstruction that is the problem table no gas should be seen within the Number of loops Many Few. Two other pertinent radiological signs large bowel fig 3 Fluid levels Many short Few long. help confirm that it is the large bowel that is So far we have considered supine abdom on erect film. obstructed Firstly large bowel has distinct inal radiographs An erect film may show Bowel markings Valvaulae Haustra. transverse bands termed haustra These do further evidence of small bowel obstruction all the way across partially across. not cross the full diameter of the bowel fluid levels indicating an air fluid interface Large bowel gas No Yes. unlike the transverse valvulae conniventes of An erect film tends to show multiple small. 140 STUDENT BMJ VOLUME 10 May 2002 studentbmj com,Fig 3 Small bowel obstruction supine.
In caecal volvulus the caecum is displaced,to the upper left abdominal quadrant from. its normal location the right lower quad,rant This leaves the area empty so the term. empty caecum is used The volvulus usually,consists of a single loop again showing a. fluid level on an erect radiograph Distal to,the volvulus the large bowel is empty. Toxic megacolon acute,pancreatitis duodenal,obstruction and meteorism.
Toxic megacolon seen in inflammatory,bowel disease especially ulcerative colitis. has an associated risk of bowel perforation,It is seen as grossly dilated large bowel typ. ically the transverse colon with thumb,printing evident fig 5. In acute pancreatitis a small sentinel loop, a collection of intraluminal gas of bowel Fig 4 Small bowel obstruction erect. may be seen the inflamed pancreas,paralysing the adjacent bowel making it ady.
namic Duodenal obstruction congenital or,acquired gives the appearance of two gas. bubbles one in the duodenum and the nor,mal gastric air bubble this is termed the. double bubble sign,Meteorism excessive swallowed air is. particularly common in crying children,and hyperventilating adults Although. there are prominent bowel loops there is,no cut off point the bowel has been.
likened to crazy paving fig 6,Ian C Bickle final year medical student Queen s. University Belfast,medicine totalise co uk,Barry Kelly consultant radiologist Royal Victoria. Hospital Belfast,Next month Abnormal extraluminal gas. 1 Bickle IC Kelly B Abdominal x rays made easy nor. mal radiographs studentBMJ 2002 10 102 3 April,Fig 5 Toxic megacolon Fig 6 Meteorism. STUDENT BMJ VOLUME 10 May 2002 studentbmj com 141,Abdominal x rays made easy.
abnormal extraluminal gas, This month in the third part of Extraluminal gas is gas outside the sealed. our series on abdominal gastrointestinal tract,radiographs Ian Bickle and. Barry Kelly look at identifying Pneumoperitoneum,A most important and potentially devastat. abnormal extraluminal gas on ing finding is that of free intraperitoneal. plain abdominal films gas which is known as pneumoperitoneum. Emergency surgical intervention is likely to,be necessary as pneumoperitoneum usu. ally indicates a perforated viscus The sup,plementary plain radiograph should be an.
Conditions causing extraluminal,air Fig 2 A subtle pneumoperitoneum. Perforated abdominal viscus, Abscesses subphrenic and other hemidiaphragms As you may recall from. Biliary fistula the first part of the series normal radi. Cholangitis ographs a gastric air gas bubble is usu. Pneumatosis coli ally seen in the left hypochondrium on the. erect film This can make distinguishing,Necrotising enterocolitis. free air on this side problematic For this, Portal pyaemia reason identification of free gas on the. right side is more straightforward The air is,trapped between the underside of the.
erect chest radiograph that visualises gas diaphragm and the upper surface of the. collecting beneath the diaphragm Depend liver fig 1 A small volume of gas has a. ing on the volume of gas in the peritoneum crescentic appearance. it may be apparent under one or both Should a supine abdominal radiograph. be the only film available if for example,the patient is too ill to undergo an erect. chest radiograph there are radiological,Rigler s sign. Fig 1 Gross pneumoperitoneum with free air under both hemidiaphragms In addition Fig 3 Falciform ligament left and Rigler s. there is a large dark egg shape projected through the heart This is a large fixed hiatus sign right dark triangles outlined by the. hernia an incidental finding but one which shows an abnormal air collection bowel wall serosa. 180 STUDENT BMJ VOLUME 10 JUNE 2002 studentbmj com. las are less common but may develop with a,gallstone ileus Fistulation between the gall. bladder and adjacent bowel allows a route,for gas into the biliary system The final. aetiology is cholangitis If the biliary ducts,are infected with gas forming organisms.
gas will be produced and contained in the,ducts effectively creating a negative con. trast to the surrounding soft tissue of the,Miscellaneous causes. Abdominal x rays made easy normal radiographs Figure 1 Normal film Figure 2 Rectal gas film Figure 3 Valvulae conniventes Understanding x ray films is something that all clinical students should get to grips with Starting out as a doctor you will not need to be an expert but you will need to know the basics Ian Bickle

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