Do you have a systematic approach to interpret abdominal radiographs? Let’s learn to read one like a radiologist. For abdominal radiographs, you can use the mnemonic tube to help you remember the approach. T for lines and tubes, O to evaluate the bowel gas pattern for obstruction, O again to look at the solid organs, and finally B for the bones.

First, find all the patient’s lines and tubes, like this patient’s enteric tube in the stomach and their rectal temperature probe. Ensure everything is correctly positioned. Next, evaluate the bowel gas pattern. But how can we tell which is the colon and which is the small bowel? One way is by location.

Remember that the colon surrounds the abdomen on the outside. The small intestine is more in the middle. A second way is by wall markings. Remember that the colon has these classic haustral markings, and they only indent the edge of the colon wall. Compare that to the small bowel, which typically looks more like amorphic blobs, or, when dilated, has markings that stretch all the way across the diameter, called valvulae conniventes.

Next, evaluate the solid organ shadows. Look for calcifications, or foreign bodies, or disrupted fat planes around the major organ shadows. Sometimes, a large abdominal mass can push aside the normally evenly distributed loops of bowel and colon, cueing you in that there’s a big mass there. Finally, look at the bones for fractures, or aggressive lesions, or degenerative changes.

Normally, we can see the lower ribs, the spine, and the pelvis. Let’s review our approach to reading abdominal radiographs using our mnemonic T for lines and tubes, O looking for obstruction, O again for the organs, and finally B for bones. Now you can read an abdominal radiograph like a radiologist.

Full Byte

Approach to reading an abdominal radiograph

Tags: ,