This document provides information on abdominal x-ray images and findings. It discusses various conditions that can be seen on abdominal x-rays including bowel obstructions, necrotizing enterocolitis, intussusception, volvulus, malrotation, peritonitis, appendicitis, and meconium peritonitis. For each condition, it describes typical x-ray findings and includes example images demonstrating these findings.

1. 17th, August 2012
Dr Huong

2. Abdominal Xray images
Digestive bowel obstruction: duodenal Obst., small
and large bowel Obst.
Necrotizing Enterocolitis( NEC)
Intussusception
Volvulus and malrotation
Peritonitis: due to appendicitis, meconium
peritonitis, the others causes…

3. Pediatric abdo xray
Gas Distribution: There
are pockets of gas
scattered in several areas
of the abdomen. There is
gas in the small bowel,
colon, and rectum.
Bowel Dilatation: No
excessively dilated bowel.
Air-Fluid Levels: None.
Arrangement of Loops:
Large loops are not
present.
Impression: Within
normal limits.

4. Plain adult abdo Xray

6. Duodenal atresia/obstrution
Plain radiograph of the
abdomen: The arrows
point to the dilated
stomach and that part of
the duodenum which is
above the obstruction.
Other parts of abdomen
do not contain gas.

7. Duodenal atresia/obstruction: double
bubble sign

8. Duodenal obstruction

9. Duodenal obstruction:

10. Duodenal obstruction

11. Small bowel obstruction

12. Small bowel obstruction

13. Large bowel obstruction

14. Necrotizing Enterocolitis( NEC)
NEC is one of the most common acquired, life-threatening
gastrointestinal diseases in the newborn, affecting 1%–5%
of neonatal ICU admissions and up to 10% of neonates
under 1500 g
NEC most commonly manifests within the first or second
week of life
The symptoms referable to the gastrointestinal tract
include feeding intolerance, vomiting, diarrhea, and blood
in the stool
Physical signs include abdominal distention and, in more
advanced cases, palpable, distended bowel loops and
abdominal wall erythema and edema. Neonates with
severe disease may even present in shock

15. Necrotizing Enterocolitis
Plain abdominal radiography is the current modality
of choice for the evaluation of neonates suspected of
having NEC.
The timing of follow-up plain abdominal radiographs
depends on the severity of the NEC and may vary
from 6 to 24 hourly
plain abdominal radiography must include one image
obtained with a vertical beam with the patient supine
and a second image obtained with a horizontal beam

16. Necrotizing Enterocolitis
Radiographic findings:
Intramural gas
football sign( intra- peritoneal air)
Free Intraperitoneal Gas
Portal venous gas

17. Necrotizing Enterocolitis: intramural gas
Supine (a): The bowel is mildly dilated
with gas, mainly on the left side. The
bubbly pattern of gas seen mainly in the
right lower quadrant represents intramural
gas.
cross-table lateral (b): Free
intraperitoneal gas is present
anteriorly (arrows)

18. Intra- mural gas
generalized bowel dilatation
with gas, intramural gas
mainly in the large bowel,
and portal venous gas
There is a band of radiolucency or black band
(black arrow) and a band of soft-tissue opacity or
white band (white arrow) along the margin of the
involved loop. The black band represents the
intramural gas in the serosal layer of the bowel
wall, and the white band represents the submucosa
and mucosa, which is contrasted on one side by the
intramural gas and on the other side by the gas in
the lumen

19. Intra- mural gasThe intraluminal gas present is limited
almost entirely to the large bowel, and
there is no significant dilatation. There is
extensive intramural gas involving the
entire large bowel despite the benign
clinical course. There are well-developed
black and white bands
There is marked dilatation of bowel
with gas and fluid and extensive
intramural gas (arrows). The
intramural gas is seen as multiple
curvilinear black bands, and in some
areas white bands are also visible

20. Intra- mural gas
Differentiation of intraluminal gas from
intramural gas in the nondependent part of a
bowel loop: two hyperechoic foci are noted within
the wall (arrows), which represent intramural gas.
In the other loop, there is intraluminal gas
(arrowhead) floating on the intraluminal fluid
and causing a posterior artifact.
Multiple bowel loops are seen
surrounded by some free fluid.
There is extensive intramural
gas involving all of these loops

21. Necrotizing Enterocolitis: football sign?
In radiology, the football sign is a sign indicative of
air in the abdominal cavity seen on supine
radiographs of the abdomen. It appears as a large oval
radiolucency reminiscent of an American football.[1]
The football sign is most frequently seen in infants
with spontaneous or iatrogenic gastric perforation
causing pneumoperitoneum.

22. football sign

26. Necrotizing Enterocolitis: Free Intraperitoneal Gas
There is a small amount of
free intraperitoneal gas
anterior to the liver (arrows).
There are even smaller amounts of free
intraperitoneal gas anteriorly, which are seen as
subtle triangular areas of lucency between the
anterior abdominal wall and loops of bowel
(arrows) and as a linear area of lucency anterior to
the stomach (arrowhead).

27. Necrotizing Enterocolitis: portal venous gas
Supine abdominal radiograph shows a
small bubble of portal venous gas
projected over the liver (arrow)
Cross-table lateral radiograph obtained
immediately after a shows that portal venous gas
(arrow) may be depicted more extensively in the
liver on this view

28. Necrotizing Enterocolitis: portal
venous gas

31. Intussusception:
Target sign: Meniscus sign(crescent sign):

32. Intussusception

33. with air enema therapy

34. with barium enema therapy

35. Volvulus : 1.Gastric volvulus

36. Volvulus : Gastric volvulus

37. Malrotation

38. Caecal vovulus in adult

39. Caecal vovulus in adult

40. Sigmoid vovulus in adult

41. Sigmoid vovulus in adult
Bird of Prey Sign-tapered
barium column in sigmoid
volvulus

43. Peritonitis due to appendicitis
 Perforated appendicitis.
A, Soft-tissue mass effect
and presence of a
fecalith (arrow) in the
right lower quadrant
suggest perforated
appendicitis on plain
radiographs

44. appendicitis
Abdominal X-ray (AXR)
showing Appendicolith

45. Necrotic appendicitis in a
16-year-old boy. A large
soft-tissue mass is seen in
the right lower quadrant
representing fluid-
containing bowel loops. The
proximal small bowel is
slightly dilated with short
air-fluid levels (arrows) and
the large bowel is dilated
with long levels indicating a
dynamic (paralytic) ileus.

46. Meconium Peritonitis
Meconium peritonitis refers to a sterile chemical
peritonitis due to intra-uterine bowel perforation and
spillage of fetal meconium into the fetal peritoneal
cavity. It is a common cause of peritoneal calcification.
Plain film - abdominal radiograph
may show intra-abdominal (peritoneal) calcification (can
be curvilinear, linear or flocculant)
may show a mass containing calcification in the context of
a meconium pseudocyst
if the processus vaginalis is patent at the time of
perforation, calcification may also be seen in the scrotum.

47. Meconium Peritonitis

48. Meconium Peritonitis

49. Meconium Peritonitis

50. Meconium Peritonitis

51. Meconium Peritonitis

52. Meconium Peritonitis