Preface vii Acknowledgements viii Learning objectives checklist ix Part 1 About X - rays 1 What are X-rays? 1 How are X-rays produced? 1 How do X-rays make an image? 2 How are X-ray images (radiographs) stored? 3 Radiation hazards 3 The Ionising Radiation (Medical Exposure) Regulations 3 In women of reproductive age 3 Indications for an abdominal X-ray 4 Abdominal X-ray views 5 AP Supine abdominal X-ray 5 Other views 5 Radiograph quality 6 Inclusion 6 Exposure 6 Normal anatomy on an abdominal X-ray 8 Right and left (Figure 7) 8 Quadrants and regions (Figure 8) 8 Abdominal viscera 1 (Figure 9) 8 Abdominal viscera 2 (Figure 10) 9 Skeletal structures (Figure 11) 10 Pelvis (Figure 12) 10 Lung bases (may be visualised at the top of the abdomen) (Figure 13) 11 Bowel 1 (Figure 14) 11 Bowel 2 (Figure 15) 12 Presenting an abdominal radiograph 14 Be systematic! 14 Part 2 Overview of the ABCDE of abdominal radiographs 15 A - Air in the wrong place 16 Pneumoperitoneum (gas in the peritoneal cavity) 21 Pneumoretroperitoneum (gas in the retroperitoneal space) 26 Pneumobilia (gas in the biliary tree) 28 Portal venous gas (gas in the portal vein) 29 B - Bowel 17 Dilated small bowel 30 Dilated large bowel 34 Volvulus 37 Dilated stomach 40 Hernia 41 Bowel wall inflammation 43 Faecal loading 48 Faecal impaction 49 C - Calcification 18 Gallstones in the gallbladder (cholelithiasis) 50 Renal stones (urolithiasis) 53 Bladder stones 56 Nephrocalcinosis 57 Pancreatic calcification 58 Adrenal calcification 59 Abdominal aortic aneurysm (AAA) calcification 60 Fetus 62 Calcified structures of little clinical significance 63 Calcified costal cartilage 63 Phleboliths ('vein stones') 63 Calcified mesenteric lymph nodes 64 Calcified uterine fibroids 65 Prostate calcification 65 Abdominal aortic calcification (normal calibre) 66 Splenic artery calcification 66 D - Disability (bones and solid organs) 19 Pelvic fractures - 3 Polo rings test 67 Sclerotic and lucent bone lesions 68 Spine pathology 69 Solid organ enlargement 71 E - Everything else 20 Medical and surgical objects (iatrogenic) 73 Surgical clips/staples/sutures 73 Urinary catheter 75 Supra-pubic catheter 75 Nasogastric (NG) and nasojejunal (NJ) tubes 76 Flatus tube 77 Surgical drain 78 Nephrostomy catheter 78 Peritoneal dialysis (PD) catheter 79 Gastric band device 79 Percutaneous endoscopic gastrostomy (PEG)/radiologically inserted gastrostomy (RIG) 80 Stoma bag 80 Stents 81 Inferior vena cava (IVC) filter 84 Intra-uterine device (IUD) 85 Pessary 85 Foreign bodies 86 Retained surgical swab 86 Swallowed objects 87 Objects inserted per-rectum (PR) 88 Clothing artefact 90 Piercings 90 Body packer 91 Lung bases 93 Self-assessment questions 94 Self-assessment answers 99 Glossary 107 Index 112.