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Indications and Normal Findings of Abdominal X-Ray

Indications for Abdominal X-Ray

• Before i.v. urography (plain film)
• Abdominal pain or acute abdomen,
• Gastrointestinal obstruction, suspected bowel perforation
• Nephrolithiasis
• Search for foreign bodies

Abdominal X-ray has clear disadvantages in sensitivity and specificity compared to an abdominal CT in almost all issues.

Abdominal x-rax (KUB): with right-sided kidney stone amd placed DJ ureteral stent. With kind permission, Dr. R. Gumpinger, Kempten.

Examination Technique

For urological questions, imaging is done in anteroposterior (AP) projection, which leads to a better representation of the retroperitoneal structures (KUB = X-ray of kidneys, ureters, and bladder). In the case of an acute abdomen or gastrointestinal obstruction, the posterior-anterior projection is chosen for better imaging of the intraperitoneal organs.

Coverage on the X-ray should include the 11th thoracic vertebrae and diaphragm cranially. Caudally, the lower margin of the symphysis should be visible. Two images may be necessary for large patients. Depending on the question and prior findings, the target area of the image can be reduced (for example, half-sided KUB after stone therapy).

Normal Findings

In good examination conditions, the kidneys are visible. The length is usually 11–12 cm, and the width is around 5 cm. The upper pole of the left kidney is at the upper edge of the 12th thoracic vertebra, the lower pole ends at the middle of 3rd lumbar vertebra. The right kidney is shifted about 1.5 cm to the pelvis.

Deviations from the typical renal shape may be caused by renal cysts, renal infarctions, kidney tumors, abscess, or congenital malformations. Calcifications in projection on the urinary tract are not only caused by urinary calculi; consider also lymph node calcifications, phleboliths, arteriosclerosis, chronic pancreatitis, intestinal contents, or foreign bodies.

The spine, ribs and pelvis should be carefully evaluated (fractures? cortex interruptions? ossal lesions?). Urological tumors often cause skeletal metastases. The psoas shadow should be symmetrical, a lost or asymmetric psoas shadow may be caused by retroperitoneal bleeding, tumor or aortic aneurysm. Assess the intestinal gas distribution for signs of obstruction.

References

  Deutsche Version: Röntgen des Abdomens