Interpreting Abdominal X-ray

January 28, 2018 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
By Yasser Al-Obudi (5th year Medical Student)
Patient identifiers

Date & time of film

Indication & previous imaging

Quality: Projection (usually AP supine), Exposure (full width, diaphragm to pelvis), Penetration (Lumber Vertebrae visible)

Obvious abnormalities, foreign bodies & artefacts (e.g. drains)

Reviews small bowel: valvulae conniventes (traverse full width)

Reviews large bowel: haustra (thicker & partial width)

Checks sizes: small bowel (less than 3cm), large bowel (less than 6cm) & caecum (less than 9cm)

Comments on faeces visibility

Looks for signs of perforation: air under diagram and Rigler's double wall sign

Reviews lung bases, stomach

Reviews hepatobiliary structures & spleen (commenting on size)

Reviews aorta (less than 3cm is normal) and kidney & bladder areas

Reviews bones for fractures/deformities

Consider the following questions:

When would you order an erect film?
When bowel preforation is suspected evidenced by free abdominal gas (e.g. air under diaphragm)

What are the features of inflammatory bowel disease?
  • Leadpipe appearance (featureless colon i.e. no haustra)
  • Thumbprinting (mucosal thickening due to inflammation)
  • Toxic megacolon (dilated colon presenting with abdominal pain & sepsis)
What are the features of volvulus?
  • Twisting of bowel resulting in bowel obstruction
  • Sigmoid volvulus: characteristic "coffee bean" sign