Abdominal Xrays in Children

Dr. Savvas Andronikou

Red Cross Childrens Hospital

Assessment:

STONES: any calcified / ossified things

BONES: foccal or diffuse including fracture
MASSES: seen as bowel displacement
GASSES: within the bowel, outside the bowel [intra or

retro-peritoneal], in the wall of the bowel or in weird

places such as the scrotum, liver, calyces or gall bladder
NB a chest x-ray should be part opf the initial series as a
high proportion of abdominal pain and other symptoms
are due to lower lobe lung parenchymal disease

Normal: supine ,erect and prone

Use for gas
distribution as base
linen and general
assesment. Must
see pubis on film.

Must see
diaphragms on film.
Use to see free air
and air-fluid levels

Most institutions dont

supply this. It excludes
obstruction by showing
gas in the rectum [the
least dependent area]

Stones
Calculi
Meconium
Neoplasms
Faecolith/appendicolith

Appendicitis
RIF calculus is almost
diagnostic but cannot
always be distinguished
from ureteric or ovarian
calculus / calcification

CALCIFICATION

Renal calculi

Meconium
peritonitis:
can occur
over 24hrs

Calcified mass
in the liver.

Calcifications
within the colon
in a patient with
PICCA

Bones
Congenital
Generalised
Focal

Vertebral anomaly
[hemivertebra] in a
patient with
VACTREL and an
bowel atresia

Bones: with gasses

Sacral hypogenesis in a patient with a high
anorectal malformation: distal obstruction.

Bones:AML

Hepatomegally and metaphyseal lucent bands are

diagnostic of leukaemia

Gasses

Free air
Intraluminal gas: obstruction
Gas in weird places: scrotum, liver , GB
No gas: gassless abdomen
Gas above the diaphragm

Free air

Distal obstruction

Distal obstruction:
ileal atresia

Proximal obstruction
:Sinlge, double, triple bubble

Hypertrophic Pyloric
Obstruction

No gas: HPO and OA

Malrotation

Gas in weird places:

Inguinal hernia

Gas in funny places:NEC

Gas in the chest:

Bochdalek hernia

Massess

Renal / retroperitoneal
Hepatosplenomegally
Intussusception
Appendix mass
TB
Hydatid
Neoplasm
Worm bolus

Bowel displacement: mass

Renal:
Hydronephrosis,
Polycystic disease

Hepatospleno
megally

Intussusception

Appendix
mass

TB

Hydatid

Worm Bolus