AXR Interpretation
AXR Interpretation
Abdominal X-Ray Views
1) AP supine
2) AP erect
3) Lateral decubitus
4) Supine lateral
5) KUB
Indications for Abdominal X-ray: gases, masses, bones and stones
Bowel obstruction: 50% sensitive
Perf: USS higher sensitivity
KUB: 80-90% sensitive for radiolucent stone >3mm
FB: 90% sensitive
Radioopaque Toxicology
Iron, KCl, mercury, barium
Interpretation
Name and SOB
Date of film
Projection
Posture
Adequacy of exposure
Gases: look for normal or abnormal intraluminal and extraluminal gas distribution
Small bowel: intraluminal gas usually minimal, centrally located
2.5 – 3.5cm
valvulae conniventes (stretch all the way)
Large bowel: gas and faeces; in periphery
3 – 5cm
haustra (part way)
Abnormalities: dilated (obstruction, ileus, inflammation)
>5 A-F levels on erect (>2.5cm length) (obstruction, ileus,
ischaemia and gastroenteritis)
intramural gas (ischaemic colitis)
intraperitoneal gas (perf, penetrating abdo injury)
Rigler’s sign (double wall sign)
Extraperitoneal gas (in ST’s, retroperitoneal structures)
[pic]
In localized ileus, isolated distended loops = sentinel loops
RLQ = appendicitis
RUQ = cholecystitis
LUQ = pancreatitis, ulcer
LLQ = diverticulitis
Central = ulcer, ureteral calculus
In generalized ileus; long A-F levels
SBO cause: adhesions, hernia, volvulus, gallstone ileus, intussuseption
LBO cause: tumour, volvulus, hernia, diverticultis, intussuseption
If incompetent ileocaecal valve, large bowel decompresses into small bowel,
and may look like SBO
Signs of intraperitoneal gas: >20% with perf have no free air on X-ray
Present in >20%:
[pic] [pic] [pic]
1. Ant sup oval sign: oval, round / pear-shaped bubble projected over liver
2. Hyperlucent liver sign: blacker free gas ant to liver replaces brightness of hepatic shadow
3. Subphrenic radiolucency of gas under diaphragm
4. Rigler sign (double wall sign, bas-relief sign): both sides of bowel wall seen
Present in 10-20%:
[pic] [pic] [pic]
[pic] [pic]
1. Falciform ligament sign: linear denisity just to R of midline in upper abdo
2. Cupola sign: arcuate lucency overlying lower thoracic spine
3. Football sign: large oval readiolucency produces sharp interface with parietal peritoneum
4. Hepatic edge sign: cigar-shaped collection of free gas in subhepatic space, long axis following liver edge
5. Triangle sign: triangular lucency between 3 adjoining bowel loops or 1 bowel loops and parietal peritoneum
6. Inverted V sign: caused by lateral umbilical ligaments, seen over pelvis
7. Fissue for ligament teres sign
Present in ................
................
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