A Address

A Adequacy

A Artefacts

A Air

B Bowel

B Bone

C Calcification

S Soft tissues and viscera

Checklist

Address

• Name and date of birth

Adequacy

• Lung bases to pubic bone

• Lateral edges of abdominal wall

Artefacts

• Intrauterine devices

• Surgical instruments

• Intrabdominal drainage tubes

• Stents (biliary tree/ureteric/aortic/colonic)

• Foreign objects: buttons, coins, body piercings

Air (extraluminal gas)

• Pneumoperitoneum: free air under the diaphragm; evidence of hollow viscus perforation

• Rigler ’ s sign

• Biliary tree (pneumobilia):

• normal after biliary surgery

• fistula between bowel and biliary tree

• biliary sepsis, e.g. cholangitis

• Bowel wall:

• bowel ischaemia or necrotising enterocolitis (pneumatosis coli/intestinalis)

• toxic megacolon

• Portal vein: the presence of gas in the portal vein indicates bowel ischaemia or mesenteric sepsis. Portal venous gas is unlike biliary tract gas in that it is more difficult to see on AXR and will branch out to the periphery of the liver. Biliary tract gas tends to be more central in position.

• Pseudopneumoperitoneum: intraluminal (usually colonic) gas in a loop of intestine interpositioned between liver and right hemi-diaphragm (Chiliaditi's sign).

Bowel (bowel gas pattern)

• Obstruction:

• distended bowel loops

• volvulus/closed loop obstruction

• Faeces and constipation:

• mottled appearance within lumen of the bowel

• Toxic megacolon

Bone

• Vertebrae: crush fractures, bamboo spine, Paget's disease, malignancy

• Hips: fractures, osteoarthritis

• Pelvis: fractures of pelvis, femoral heads and necks, metastases or primary malignancy, Paget's disease

Calcifications

• Kidneys and ureters: staghorn calculus, renal, ureteric and vesical stones

• Gallstones

• Appendicolith

• Aorta, iliacs and splanchnic vessels: atherosclerosis

• Pancreas: chronic calcific pancreatitis

• Fibroids

• Prostate

Soft tissues

• Liver contour

• Spleen contour

• Kidney contour (between T12 and L2)

• Psoas muscle shadows: if one is obliterated, it suggests retroperitoneal pathology (abscess, haemorrhage)

• Bladder: calcified or containing air (schistosomiasis, TB)

• Soft tissue: loss of peritoneal lines, surgical emphysema, bacterial infection with gas-forming organisms