Part 3.

0
Standardised Interpretation of Paediatric
AXR

Done in collaboration with: Authors:

The Northern School of Radiology, UK Dr. Alasdair Mackie MD
County Durham and Darlington NHS Dr. Abdelrahman Omer MD
Foundation Trust Dr. Ramdas Senasi MD
 Aim

Demonstrate a systematic approach in the

interpretation of paediatric Abdominal X-rays
using ABCDE method.
Test you skills
 The answer is
• Splenomegaly and right femoral head sclerotic
abnormality.

• How not to miss it

• Systematic approach
 Systematic approach
Technique
•A - Air
•B - Bones and Bowel
•C – Calcification and soft tissue.
•D - Diaphragm
•E - Extra body equipment
Child vs Adult
Anatomy
 Systematic approach

►Air:
►B • Extra-luminal air – always
►C pathological.
►D • Intra-luminal air – it depends on
the distribution
►E
 Gastric bubble

Small bowel gas distribution centrally Large bowel gas

peripheral
NO EXTRA)LUMINAL FREE GAS

Gas in the rectum

 Systematic approach

►A
►Bone and Bowel:
►C Bones: ribs, pelvis, femur,
►D spine.
►E Bowel: Thorough look at the
bowel dilatation from
stomach to rectum
 Spine

Ribs Thin bowel wall

Femur

Pelvic bones
 Systematic approach

►A
►B
►Calcifications and soft tissue
►D ►Easy to miss especially soft tissue
►E because of poor contrast difference
►E.g: Hepatosplenomegaly
 Abnormal calcifications

Liver
Left Kidney

Left psoas muscle line

 Systematic approach

►A
►B
►C
►Diaphragm: ►Should be clear and crisp.
►E ►Not to miss lung bases or
air under diaphragm
 Lungs bases

No air under diaphragm

 Systematic approach

►A
►B
►C
►D
►Extras: ►Check for lines and tubing
 Endotracheal tube

Nasogastric tube

Umbilical vein catheter

Umbilical artery catheter

Test you skills now!
 Summary
Demonstrated a systematic approach to paediatric
AXR using ABCDE.
• Thank you for your attention.

• Any questions?
 References
Images obtained from following resources;
https://www.pinterest.com/pin/24192781120473
4854/
http://www.pedrad.org/portals/5/events/2013/m
arkowitz-abdradiograph.pdf
Radiopaedia.org