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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