Approach to plain abdominal
radiograph reporting
Mike Sinkala (Student)
(Lead MSK, Chest and Abdominal Reporting Radiographer)
Indications
Abdominal Radiograph
Assessment of an abdominal radiograph
• Look for air in wrong places
• Pneumoperitoneum
• Rigler’s sign
• Gas outlining the liver
• Falciform ligament
• Retroperitoneum
• Outlining the kidney
• Look at the liver
• Pneumobilia
• Gas in the portal vein
Rigler’s (double wall) sign:
• Gas outlining the liver: • Falciform ligament sign:
• Pneumoretroperitoneum • Pneumobilia
Air in the portal
vein
Pyelonephritis
Causes for retroperitoneum
• Bowel perforation:
• Duodenal perforation
• Ascending or descending colon perforation
• Rectal perforation
• Post surgical intervention
Bowel
• Look for dilated small and large bowel
• Look for a volvulus
• Look for a distended stomach
• Look for a hernia
• Look for evidence of bowel wall thickening
Dilated small bowel
Gall stone ileus
• Pneumobilia
• Small bowel obstruction
• Gallstone
Large bowel dilatation
• Causes of large bowel obstruction
• Colorectal carcinoma
• Diverticular stricture
• Faecal impaction
• Volvulus
Large bowel dilatation
Volvulus
Twisting of the bowel on its mesentery.
Types
• Sigmoid volvulus
• Caecal volvulus
• May result in:
• Bowel obstruction
• Bowel ischemia
Sigmoid volvulus
Caecal
volvulus
Dilated stomach
• Causes:
• Bowel obstruction
• Aerophagia
Hernia
Bowel wall inflammation
• Causes:
• Inflammatory bowel disease
• Ischaemic bowel
• Infection
• Radiological signs
• Bowel wall thickening
• Thumbprinting
• Featureless bowel
• Loss of formed faecal matter in the left-hand side of the colon
Bowel inflammation
Toxic Megacolon
Things to look for:
• Large bowel dilatation
• Inflammatory pseudo-polyps
• Thumbprinting and mucosa oedema
• Transverse colon affected usually
Faecal loading Faecal impaction
Characteristics:
• Rounded masses
• Mottled texture
Calcification
• Look for clinically significant calcified structures
• Look for a foetus (females)
• Look for clinically insignificant calcified structures
Calcification
left staghorn calculusleft staghorn calculus
Urinary bladder calculus
Cholelithiasis Left staghorn calculus
Calcifications
Adrenal calcification
Nephrocalcinosis Pancreatic calcification
Disability (Bones and solid organs)
• Look at the bony skeleton for fractures and
sclerotic/lytic bone lesions
• Check the spine
• Look for solid organ enlargement
Bones
Bones
Solid organs
Thank you
