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Basic Interpretation of Abdominal Radiographs (1)

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A radiograph of the kidneys, ureters, and bladder (KUB) demonstrates the: 1. Size 2. Shape 3. Position

Examination technique: Plain abdomen KUB

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What is normally visible 1. Spleen Y 2. Gallbladder N 3. Stomach Y with gas 4. Veins N 5. Arteries N if calcified 6. Small bowel N gas is pathological 7. Colon (gas) Y with gas 8. Bladder Y with urine 9. Pancreas N 10. Ureters N 11. Kidneys Y 12. Adrenal glands N 13. Flank stripes Y 14. Liver Y

Conditions

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Gas filled transverse colon demonstrating haustrations.

Entire colon, from cecum to sigmoid, filled with gas. Unless obstructed, distention of this degree should be relieved by flatulence

More Gas Patterns

Radiographic Anatomy of the plain film abdomen

A child’s stomach and colon filled with gas and feces, (speckled appearance). Note how the hepatic flexure and transverse colon define the liver

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Detail of liver in RUQ Detail of spleen in LUQ Radiographic Anatomy of the plain film abdomen

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The bladder is often seen, if contrasted by urine. Gas in the sigmoid colon may obscure it

Detail of flank stripe Detail of urine filled bladder Radiographic Anatomy of the plain film abdomen

Flank stripes are not always seen due to lack of contrast or clipping on larger persons. When visible, bowing of the stripes may be a sign of a mass.

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Subject contrast of the kidneys is enhanced by the perirenal fat capsule. They are best seen in the asthenic body habitus

Kidneys

Radiographic Anatomy of the plain film abdomen

Placement of Rt marker is less than desirable

= Psoas muscles 8

Calcifications can form in various tissues, and especially fluid filled organs where minerals consolidate. In the plain film abdomen those seen are: * gallstones (calcium not cholesterol) * Kidney stones * Bladder stones * arteriosclerosis (mostly of abdominal aorta)

Calcifications Radiographic Anatomy of the plain film abdomen

Large gallstone in RUQ If not in the RUQ, where else could it be?

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Plain Abdominal Radiographs • Intraperitoneal and extraperitoneal spaces • Abdominal organs • Abdominal calcifications • Bowel gas and fluid • Abnormal gas collections • Abdominal fluid • Abdominal masses and foreign bodies • Musculoskeletal structures & visible thorax

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Extraperitoneal lipomatosis

M/63. Palpable abdominal masss

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Extraperitoneal lipomatosis

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M/31. Plain abd (2015-09-29)

Obesity & hepatomegaly

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M/31. Abd CT (2015-09-29): Obesity & hepatomegaly Fatty metamorphosis of liver

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F/28. For physical exam. KUB (2015-02-17).

Splenomegaly

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M/51. Chief complaint: Palpable mass CXR (2015-04-30)

KUB (2015-04-30) Splenomegaly due to liver cirrhosis

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M/66. KUB

Splenomegaly

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F/52. KUB

Hepatomegaly

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M/33. Plain abdomen (2015-08-06).

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M/33. Abd CT (2015-08-07): Atrophy of both kidneys with caliceal calculi

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M/33. Abd CT (2015-08-07): Atrophy of both kidneys with caliceal calculi & post kidney transplantation

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M/80. KUB (2015-10-13). Abdominal distention and dysuria

Distended urinary bladder

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F/67, KUB

L-spine MRI: 1. An enlarged uterus 2. T12 & L3 recent

spinal compression fr

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KUB shows a bowing of the right psoas muscle, and increased opacity. The diagnosis was abdominal aortic aneurysm (AAA).

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Intra-abdominal calcifications

• Calculi • Vascular calcifications – arteries, veins • Post infectious or inflammatory

calcificatons • Dystrophic calcifications • Calcifications of neoplasm

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Acute calculous cholecystitis

M/73 Abdominal pain

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Gallbladder stone, M/58

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1. Acute calculous Cholecystitis 2. Bladder stones

M/73 Abdominal pain

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F/85. KUB (2012-11-28).

Porcelain gallbladder

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F/81.

Splenic arterial aneurysm

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M/72. Abdominal pain KUB (2013-02-11)

M/72. KUB 2013-03-28) Abdominal aortic aneurym, post stenting, Lt retroperitoneal abscess

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Chronic pancreatitis

Typical coarse calcifications at the pancreas on plain abdominal presentation

M/43 Abdominal pain

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F/47 CXR (2015-11-05) for physical exam

1. Cardiomegaly with left ventricular hypertrophy

2. A subsegmental atelectasis at left lower lung field.

3. Chronic pancreatitis with coarse calcifications

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M/57. Acute abdominal pain, KUB (2015-10-01)

Abnormal coarse calcifications at upper abdomen

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M/57. Acute abdominal pain 10 year ago ER Abdominal CT (2005-05-15): Chronic pancreatitis with relapse episode

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M/40. KUB (2015-09-28)

Bil renal calculi & Lt ureteral calculi

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Bilateral renal stones and ureteral stones. Bilateral enlarged kidneys (hydronephroses)

M/44

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F/83. Standing abdomen X-ray

Staghorn stones in both kidneys.

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M/44

Acute abdominal pain

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Lt UV junctional stone

M/44 Abdominal pain

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M/61. KUB

Calcified mesenteric lymph nodes

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M/61. KUB

Calcified left paraaortic lymph nodes

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Diverticulosis of descending & sigmoid colon

Barium retention or calcifications

F/88. KUB (2015-09-24)

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Thank you for your attentions!