Radiology: Reporting an Abdominal Radiograph (AXR)
Abdominal radiographs (AXR) feature less often than CXRs in medical OSCEs, however it is wise to be able to present them fluently and to be aware of the most likely diagnoses. Remember, to assess for perforation of the abdominal viscera you need an erect CXR, not an AXR.
Start by commenting on the projection, the date and the patient details. The radiograph should image from the diaphragm to the hernia orifices, and both sides of the abdomen too.
This abdominal AP radiograph was taken on 1/1/15 and is of Mr. Smith. The radiograph images the whole abdomen satisfactorily.
Next, comment on the bowel gas pattern and any areas of calcification, for example, gallstones, renal calculi, or calcification of the abdominal aorta.
The bowel gas pattern is non-specific, and I can see faecal loading in the descending colon. The abdominal aorta is calcified.
Remember that the small bowel is located centrally, has a normal diameter of less than 3cm and has valvulae conniventes, which cross the diameter of the bowel. In contrast, the large bowel is located peripherally, and haustra are visible, which do not cross the diameter of the bowel. The maximum diameter for the colon and caecum is 6cm and 9cm respectively. Remember to comment on the bones and soft tissues!
I cannot see any abnormalities of the small or large bowel, and the soft tissues and bones look normal. In summary this AXR shows calcification of the aorta, suggestive of atherosclerotic disease. It is otherwise normal.
Look at some examples of presentations of classic AXR pathology in 'AXR examples'.
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