AXRs Flashcards
What pathology most likely causes this AXR? [1]
Describe why [2]
UC: Toxic megacolon
- Large bowel obstruction; loss of haustra
Patient with severe abdominal pain. What does the image show?
Ascites
Lead pipe colon
Normal gas pattern
Rigler’s/ double wall sign
Thumbprinting
Patient with severe abdominal pain. What does the image show?
Rigler’s/ double wall sign
Free gas (pneumoperitoneum) can be seen on both sides of the bowel wall. This is Rigler’s sign or the double wall sign.
Whenever sharp points or triangles of low density are seen adjacent to loops of bowel, pneumoperitoneum should be suspected.
Note: In patients with an acute abdomen an erect chest X-ray is more sensitive for small volumes of free gas.
Patient with severe abdominal pain. What does the image show?
What is the likely pathology?
Ascites
Lead pipe colon
Normal gas pattern
Rigler’s/ double wall sign
Thumbprinting
Patient with severe abdominal pain. What does the image show?
Ascites
Lead pipe colon
Normal gas pattern
Rigler’s/ double wall sign
Thumbprinting
Inflammation of the bowel wall leads to thickening of the haustral folds. This results in the radiological sign of thumbprinting, a characteristic finding in patients with active ulcerative colitis.
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is the cause of the abnormal calcification?
Staghorn renal calculus
24-year-old patient with suspected appendicitis. What does the image show?
Caecal volvulus
Normal appearances
Pneumoperitoneum
Small bowel obstruction
Toxic megacolon
24-year-old patient with suspected appendicitis. What does the image show?
Small bowel obstruction
Dilated loops of bowel with valvulae conniventes – lines crossing the full width of the bowel – indicates small bowel obstruction.
Patient with severe abdominal pain. What is the cause of pain demonstrated on this abdominal X-ray?
Caecal volvulus
Normal appearances
Pneumoperitoneum
Small bowel obstruction
Toxic megacolon
Patient with severe abdominal pain. What is the cause of pain demonstrated on this abdominal X-ray?
Caecal volvulus
Normal appearances
Pneumoperitoneum
Small bowel obstruction
Toxic megacolon
What is the artifact shown in this image?
Biliary stent
Colonic stent
External tubing
Percutaneous nephrostomy tube
Ureteric stent
What is the artifact shown in this image?
Biliary stent
Colonic stent
External tubing
Percutaneous nephrostomy tube
Ureteric stent
Patient with abdominal pain and vomiting. What is the radiological diagnosis?
Caecal volvulus
Large bowel obstruction
Small bowel obstruction
Bowel perforation
Normal
Patient with abdominal pain and vomiting. What is the radiological diagnosis?
Caecal volvulus
Large bowel obstruction
Small bowel obstruction
Bowel perforation
Normal
What is the radiological diagnosis?
Sigmoid volvulus
Normal
Ascites
Small bowel obstruction
Pneumoperitoneum
What is the radiological diagnosis?
Sigmoid volvulus
Normal
Ascites
Small bowel obstruction
Pneumoperitoneum
What is the cause of the abnormal calcification in this image?
Calcified gallstones
Calcified mesenteric lymph nodes
Pancreatic calcification
Malignant calcification
Calcified uterine fibroid
What is the cause of the abnormal calcification in this image?
Calcified gallstones
Calcified mesenteric lymph nodes
Pancreatic calcification
Malignant calcification
Calcified uterine fibroid
Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis?
Caecal volvulus
Sigmoid volvulus
Small bowel obstruction
Perforation
Normal
Patient with abdominal pain, vomiting, and constipation. What is the radiological diagnosis?
Caecal volvulus
Sigmoid volvulus
Small bowel obstruction
Perforation
Normal
What is the cause of the area of increased density in the pelvis?
Calcified pelvic kidney
Calcified abdominal lymph node
Calcified uterine fibroid
Ingested barium
Calcified adrenal gland
What is the cause of the area of increased density in the pelvis?
Calcified pelvic kidney
Calcified abdominal lymph node
Calcified uterine fibroid
Ingested barium
Calcified adrenal gland
History of abdominal surgery 7 years ago. Presented with a 24 hour history of severe abdominal pain and vomiting. What is the radiological diagnosis?
Small bowel obstruction
Post-operative ileus
Normal
Perforation
Sigmoid volvulus
History of abdominal surgery 7 years ago. Presented with a 24 hour history of severe abdominal pain and vomiting. What is the radiological diagnosis?
Small bowel obstruction
Post-operative ileus
Normal
Perforation
Sigmoid volvulus
If you saw these X-ray appearances in the setting of acute abdominal pain, what would be the most appropriate course of action?
Place an abdominal drain
Request abdominal ultrasound
Request abdominal MRI
Resuscitate the patient and inform the surgeons
Take a break
If you saw these X-ray appearances in the setting of acute abdominal pain, what would be the most appropriate course of action?
Place an abdominal drain
Request abdominal ultrasound
Request abdominal MRI
Resuscitate the patient and inform the surgeons
Take a break
A large volume of free gas is present under the diaphragm. In the context of acute abdominal pain this finding indicates perforation. Emergency resuscitation and informing the surgeons would be the most appropriate action.
Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances?
Pneumoperitoneum
Ascites
Psoas abscess
Small bowel obstruction
Normal
Patient with abdominal pain and vomiting. Which answer best describes the X-ray appearances?
Pneumoperitoneum
Ascites
Psoas abscess
Small bowel obstruction
Normal
Patient with abdominal pain and absolute constipation. Which answer best describes the X-ray appearances?
Large bowel obstruction
Sigmoid volvulus
Caecal volvulus
Perforation
Small bowel obstruction
Patient with abdominal pain and absolute constipation. Which answer best describes the X-ray appearances?
Large bowel obstruction
Sigmoid volvulus
Caecal volvulus
Perforation
Small bowel obstruction
Describe what Rigler’s double wall sign appears like [1]
What does this indicate?
Normally only the inner wall of the bowel is visible
If there is pneumoperitoneum both sides of the bowel wall may be visible
What may a liver edge silhouette indicate on an AXR? [1]
When perforation of a duodenal ulcer occurs, and
results in a pneumoperitoneum:
Gas collects in Morison’s pouch (the hepato-renal space), and rise on the supine film to the anterior abdominal wall outlining the edge of the liver
diagnostic of duodenal
perforation.
What pathology is indicated in this AXR? [1]
False Rigler’s/double wall sign
* Be careful not to mistake the gas within two adjacent bowel segments for Rigler’s sign.
* Gas seen on both sides of the bowel wall is contained within adjacent bowel
* There are no black triangles or sharp angles on the outside of the bowel wall
Describe what is seen in this AXR [3]
Small bowel obstruction - features
Centrally located multiple dilated loops of gas filled bowel (arrowheads)
Valvulae conniventes (arrow) are visible - confirming this is small bowel
Describe what is depicted in this AXR [1]
Large bowel obstruction
- Here the colon is dilated down to the level of the distal descending colon. There is the impression of soft tissue density at the level of obstruction (X). No gas is seen within the sigmoid colon.
- Obstruction is not absolute in this patient as a small volume of gas has reached the rectum (arrow).
- An obstructing colon carcinoma was confirmed on CT and at surgery.
Which of the following is a caecal and sigmoid volvulus? [2]
What sign does this AXR show? [1]
What pathology does this indicate? [1]
Mucosal thickening - ‘thumbprinting’
This patient presented with an exacerbation of symptoms of ulcerative colitis.
What sign does this AXR show? [1]
What pathology does this indicate? [1]
Lead pipe colon
This patient with ulcerative colitis has a featureless segment of transverse colon with loss of the normal haustral markings.
This ‘lead pipe’ appearance is associated with longstanding ulcerative colitis.
What sign does this AXR show? [1]
What pathology does this indicate? [1]
Toxic megacolon
The colon is very dilated in this patient with acute abdominal pain, sepsis, and a known history of ulcerative colitis. The clinical features and X-ray appearances are consistent with toxic megacolon.
Where is the ureteric stone in this AXR? [1]
What is depicted here? [1]
State a cause of this [1]
Bladder stones form in the bladder as a result of urinary stasis, e.g. bladder outflow obstruction (enlarged prostate) or in patients with a neurogenic bladder (loss of bladder function due to spinal cord injury/disease)
What is depicted in this AXR? [1]
What does this indicate? [1]
Vascular calcification
There is striking calcification of the aorta and iliac vessels
This is a sign of generalised atherosclerosis elsewhere in the body
What is depicted in this AXR? [1]
What does this indicate? [1]
Abdominal aortic aneurysm - AAA
There is calcification of the dilated aortic wall
Frequently only one side of the aneurysm is visible - as in this image - the other being projected over the spine
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is the cause of the abnormal calcification?
Adrenal calcification
Appendicolith
Gallstones
Pancreatic calcification
Staghorn renal calculus
What is depicted in this AXR? [1]
What does this indicate? [1]
Appendicolith
Appendicoliths are highly predictive of appendicitis in patients presenting with right iliac fossa pain
Appendicoliths are calcific masses in the appendix, formed as a result of the aggregation of faecal particulates and inorganic salts within the lumen of the appendix
What is the artifact shown in this image?
What pathology does it reduce the risk of?
Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter
Inferior vena cava (IVC) filter
An IVC filter may be used to reduce the risk of large pulmonary emboli
What is the artifact shown in this image?
What pathology does it reduce the risk of?
Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter
Colonic stent
Large bowel obstruction can be treated with placement of a metallic colonic stent
This is often used as a temporary measure allowing a patient to recover from the effects of obstruction prior to definitive colonic resection
What is the artifact shown in this image?
Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter
Pig-tail (JJ) stent
A ureteric stent has been placed to relieve ureteric obstruction
The catheter has loops (pig-tails) at both ends which hold it in place
What is the artifact shown in this image?
Naso-jejunal tube
Colonic stent
Pig-tail (JJ) stent
Percutaneous nephrostomy tube
Inferior vena cava (IVC) filter
Naso-jejunal tube
Placed for the purpose of enteral feeding
The tube passes through the stomach and forms a C-shape as it navigates the 4 parts of the duodenum (D1-4)
The tube tip lies beyond the duodenojejunal flexure which lies on the left
What is depicted in this AXR? [1]
What does this indicate? [1]
Ascites
There is generalised hazy density of the entire abdomen
In the presence of ascites gas within bowel is located centrally
This abdominal X-ray demonstrates multiple dilated loops of bowel with clear valvulae connivente markings. The large bowel is collapsed. This indicated small bowel obstruction.
This abdominal X-ray shows multiple loops of dilated bowel with a loss of bowel markings **indicating large bowel obstruction. **
Sigmoid volvulus
Caecum volvulus
This abdominal X-ray shows the ‘coffee bean’ sign, a loop of large bowel dilatation rising from the pelvis indicating sigmoid volvulus.
What is the name of the sign depicted here? [1]
What pathology does it suggest? [1]
This abdominal X-ray of a child shows the presence of ‘Rigler sign’ (double wall sign): indicating gas within the abdomen due to a pneumoperitoneum.
What is the name and suggestion of this sign? [2]
This barium study shows an apple core lesion of the caecum strongly suggestive of adenocarcinoma.
What infection is a likely cause of this pathology? [1]
On this plain radiograph of the kidneys, ureters and bladder (‘KUB’), a large staghorn calculus can be seen in the left kidney.
Proteus infection is often implicated and management can be difficult.
