Abdominal X Ray
Abdominal X Ray
Abdominal X Ray
BY ABDULLAH ASA’AD
ABDOMINAL X‐RAY
• INCLUSION:
• THE ENTIRE ANATOMY SHOULD BE INCLUDED FROM
THE HEMI‐DIAPHRAGMS TO THE SYMPHYSIS PUBIS.
Air in stomach
ABDOMINAL X‐RAY
ANATOMY
2. KIDNEY AND URETER AND
BLADDER.
1. R KIDNEY 2. L KIDNEY
3. SITE OF R URETER 4. SITE OF
L URETER (NOT NORMALLY
VISUALIZED )
5. BLADDER
6. AIR IN RECTUM
7. +8 SITE OF ADRENAL GLAND
(NOT NORMALLY VISUALIZED)
9. SITE OF GALL BLADDER (NOT
NORMALLY VISUALIZED).
• IN THESE PIC WE SEE NORMAL
VISUALIZED ORGANS & BONES IN AXR.
ABDOMINAL X‐RAY
ANATOMY
3. SOLID ORGANS
1. LIVER
2. SPLEEN
3. PANCREAS ( NORMAL
WE CAN’T SEE IT)
Air in stomach
ABDOMINAL X‐RAY
ANATOMY
1. BOWEL
• THE ROLE OF BOWEL IN AXR NOTHING FIXED !!
1. STOMACH
2. CAECUM
3. ASCENDING COLON
4. HEPATIC FLEXURE
5. TRANSVERSE COLON
6. SPLENIC FLEXURE
7. DESCENDING COLON
8. SIGMOID COLON
• NOW GO TO MORE EX. OF BOWEL IN AXR AND
SOME CHARACTER OF LARGE AND SMALL BOWEL
Normal bowel
ABDOMINAL X‐RAY
ANATOMY
Normal bowel
ABDOMINAL X‐RAY
ANATOMY
LARGE BOWEL
1. SITE PERIPHERALLY.
2. THE COLONIC WALL IS LINED BY HAUSTRA
3. UP TO 6 CM IN DIAMETER.
4. CONTAINS GAS AND FAECES.
MAIN CAUSES :
1. PERFORATED PEPTIC ULCER
2. PERFORATED APPENDIX/BOWEL
DIVERTICULUM We find it at RT. Side because the left is obscured by the stomach
3. POST‐SURGERY
4. TRAUMA
diaphragm
The normal is no air
(black ) under it )
PNEUMOPERITONEUM
FREE GAS IN THE PERITONEAL CAVITY
diaphragm
The normal is no air
(black ) under it )
PNEUMORETROPERITONEUM
GAS IN THE RETROPERITONEAL SPACE
• RETROPERITONEAL CONTAINS THE KIDNEYS, URETERS, ADRENAL GLANDS, AORTA, INFERIOR
VENA CAVA (IVC), MOST OF THE PANCREAS DUODENUM, THE ASCENDING AND DESCENDING
COLON.
• THE CAUSES :
1. BOWEL PERFORATION :
• POSTERIOR DUODENAL PERFORATION
• ASCENDING OR DESCENDING COLON PERFORATION
• RECTAL PERFORATION
2. POST‐SURGICAL (E.G. RESIDUAL AIR FROM
UROLOGICAL/ADRENAL/SPINAL SURGERY)
PNEUMORETROPERITONEUM
GAS IN THE RETROPERITONEAL SPACE
• THE KEY TO IDENTIFYING A PNEUMORETROPERITONEUM IS TO LOOK FOR GAS
(BLACKNESS) SURROUNDING ALL OR PART OF THE KIDNEYS.
Kidney
DILATED SMALL BOWEL
SMALL BOWEL OBSTRUCTION
• DISTENSION OF THE SMALL BOWEL IS A SIGN OF MECHANICAL OBSTRUCTION OR ILEUS. IN A
NORMAL INDIVIDUAL THE SMALL BOWEL IS NOT VISUALIZED BECAUSE IT IS COLLAPSED OR
CONTAINS FLUID.
• MECHANICAL OBSTRUCTION AND ILEUS APPEAR IDENTICAL :
1. DILATION >3 CM (THE HEIGHT OF AN ADULT VERTEBRAL BODY IS APPROXIMATELY 4 CM
,COMPARE TO IT )
2. CENTRAL LOCATION.
3. VALVULAE CONNIVENTES ; THEY ARE THIN, CLOSELY SPACED AND CLASSICALLY SEEN AS A
CONTINUOUS THIN LINE ACROSS THE ENTIRE WIDTH OF THE BOWEL.
EX. FROM LECTURES, BOOKS, GOOGLE AND PAST JASMINE NOTE
• SO
• SMALL BOWEL
OBSTRUCTION
EX. FROM LECTURES, BOOKS, GOOGLE AND PAST JASMINE NOTE
Small Bowel Obstruction
• SO
• LARGE BOWEL
OBSTRUCTION
EX. FROM LECTURES, BOOKS, GOOGLE AND PAST JASMINE NOTE
haustra
• LARGE BOWEL
OBSTRUCTION
dilated bowel
EX. FROM LECTURES, BOOKS, GOOGLE AND PAST JASMINE NOTE
• LARGE BOWEL
OBSTRUCTION
haustra
dilated bowel
VOLVULUS
TWISTING OF THE BOWEL
• A VOLVULUS IS THE TWISTING OF THE BOWEL ON ITS MESENTERY. IT CAUSES PARTIAL OR
COMPLETE BOWEL OBSTRUCTION.
• 2 TYPES 1. SIGMOID , 2. CECAL .
A. RADIOLOGICAL SIGNS OF A SIGMOID VOLVULUS:
1. COFFEE BEAN SIGN: THE SHAPE OF THE DISTENDED GAS FILLED ‘CLOSED LOOP’ OF COLON
LOOKS LIKE A LARGE COFFEE BEAN.
2. GENERAL LACK OF HAUSTRA: OFTEN THE BOWEL IS SO DISTENDED THAT HAUSTRA FLATTEN
OUT
3. DISTENSION OF THE ASCENDING, TRANSVERSE AND DESCENDING COLON
B. Radiological signs of a caecal volvulus:
1. Comma shaped: The shape of the distended gas filled ‘closed loop’ of colon often looks like a
large comma
2. Haustra often visible
3. Collapse of the ascending, transverse and descending colon: The colon distal to the obstruction
(volvulus) is often collapsed.
VOLVULUS
TWISTING OF THE BOWEL
cecal sigmoid
EX. FROM LECTURES, BOOKS, GOOGLE AND PAST JASMINE NOTE
sigmoid volvulus
Coffee bean sign
general lack of haustra
EX. FROM LECTURES, BOOKS, GOOGLE AND PAST JASMINE NOTE
Caecal volvulus
Comma , not like coffee .
In RT. Pic haustra clearly
seen
Other part of colon
collapse.
INFLAMMATORY BOWEL DISEASE
IMPOSSIBLE TO DIFFERENTIATE BETWEEN THE DIFFERENT CAUSES
OF COLITIS USING A PLAIN ABDOMINAL RADIOGRAPH
• BOWEL WALL INFLAMMATION CAN OCCUR ANYWHERE ALONG THE
BOWEL, BUT IS MOST COMMONLY SEEN IN THE LARGE BOWEL.
• RADIOLOGICAL SIGNS OF WALL INFLAMMATION :
BOWEL WALL THICKENING : DUE TO MUCOSAL OEDEMA.
1. THUMB PRINTING (‘THUMB‐SHAPED’) : HAUSTRA THICKENING TO GO
LIKE THUMB.
2. FEATURELESS BOWEL ( PIPE – SHAPED ) : WHEN THICKENING WALL
LOST ALL FUTURE OF COLON .
THUMP SHAPED
FATHERLESS
EX. FROM LECTURES, BOOKS, GOOGLE AND PAST JASMINE NOTE
SITE !
SKIP LESIONS
RECTUM VS ILEUS
TOXIC MEGACOLON
Toxic Megacolon
DIVERTICULOSIS
• POLYPS LIKE
LARGE BOWEL
LIKE POLYP
كمشة صور مشكلة
• CENTRALLY
• DILATED =
VERTEBRA .
• VALVULAE
CONNIVENTES
• SMALL BOWEL
OBSTRUCTION
sigmoid volvulus
Liver enlargement
Urine catheter
Nasogastric tube
nasojejunal tube
Gastric band
device
النهاية