Test yourself: Abdominal X-ray

Case Study 1.

A 17-year-old boy underwent laparoscopic appendectomy one week ago. Abdominal recovery is delayed. The patient has had no bowel movement over the past few days. Physical examination reveals distension and irritation in the entire abdomen.  Particularly the lower right quadrant is painful on palpation.  Sink-like sounds are audible on auscultation.  

An abdominal X-ray is made to look for evidence of an ileus (fig. 1).
Note: after the abdominal X-ray, ultrasound is performed. It reveals an abscess in the ileocecal region.  

Figure 1. Supine AP image (a) and left lateral image.

Findings?

Diagnosis?

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Case Study 2

A 20-year-old woman with no medical history presents to the Emergency Assistance department with colic-like bouts of pain in the right flank.
Renal ultrasound reveals a slightly dilated pyelocaliceal system of the right kidney. Also the proximal part of the right ureter is slightly dilated.
No obvious concrements are visible in the right kidney. Tracing the proximal ureter is difficult because of the overprojecting intestinal loops.  

You decide to make an abdominal X ray to see if there is nephrolithiasis/urolithiasis (fig.  2).

Figure 2. Supine AP image (a) with an additional detail image of the upper abdomen (b).

Findings?

Diagnosis?

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Case Study 3

A 67-year-old man with acute abdominal pain is referred by his GP for emergency examination at the Emergency Assistance department with suspected gastric perforation. 
Patient is adipous and in much pain. The entire abdomen is irritated and painful.

History: diverticulosis, hypertension, H. pylori infection, total hip prosthesis left

An abdominal X-ray is made immediately after arrival to confirm or exclude free air (fig. 3). The patient is very restless and afraid. Unfortunately, only a supine AP image could be made. 

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Figure 3. Supine AP image.

Findings?

Diagnosis?

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