Plain abdominal radiograph

Knowledge of the many variations in both the distribution and quantity of intestinal air in infants is useful in the interpretation of pathologic findings. In a healthy neonate, air can usually be identified in the stomach within minutes after birth, and reaches the proximal portion of the small bowel during the first 6 h of life. By 6-12 h the entire small bowel usually contains air, and after 12-24 h normal neonates show rectosigmoid air in a plain abdominal radiograph. 

Fig. l.la,b. Pyloric atresia. Anteroposterior (a) and lateral (b) plain abdominal radiograph in a newborn infant that shows distension of the stomach (st) and absence of air in the small howel and colon, resulting in the characteristic single bubble image... 

Severe congenital stenosis of the small bowel is usually accompanied by vomiting and abdominal distension, identical in severity to that seen in atresia. In less severe cases, these symptoms may be mild or even delayed for several days or weeks. Plain abdominal radiographs reveal dilatation of bowel loops proximal to the stenosis and normal or decreased quantity of air in the small bowel distal to the stenosis (McAlister et al. 1996). 

Fig. 1.35a,b. Necrotizing enterocolitis, a Photograph of a 3-week-old premature neonate showing important abdominal distension, b Plain abdominal radiograph shows diffuse nonspecific gaseous distension of the bowel loops... 

Plain abdominal radiographs have been used as the first imaging technique in suspected appendicitis. However, its diagnostic accuracy is limited. 

The diagnosis of bowel obstruction is established on clinical grounds and usually confirmed with plain abdominal radiographs. Plain radiographs usually show distended bowel loops with air-fluid levels (Fig. 1.66). In inguinal incarcerated hernia, plain film will also show thickening of the... 

Fig. 3.10. Plain abdominal radiograph reveals a markedly distended stomach and hyperperistalsis. (Courtesy of Dr. Carlo Buonomo, Boston, MA, USA)...

A diagnosis of intussusception is preferentiallymade by ultrasound. The plain abdominal radiograph has been shown to be of only limited value, and may be omitted safely in the vast majority of children suspected of having an intussusception, provided sonography is available. 

Fig. 2.15. Total migration of a stent. This covered Gianturco stent was placed across a malignant stricture one day previously. This plain abdominal radiograph shows complete migration of the stent into the stomach. The stent produced no symptoms and was left in place. A new stent was inserted across the stricture, which did not migrate...

Nephrolithiasis and/or nephrocalcinosis may be additional findings on sonography and can be confirmed on plain abdominal radiograph. Renal or urinary tract stones are found in uropathies caused by recurrent urinary infections and urine stasis. Nephrocalcinosis may be the consequence of acid-base disturbance and hypercalciuria in congenital tubulopathies. The presence of nephrocalcinosis and nephrolithiasis favors primary hyperoxaluria type 1 (PH 1) as diagnosis. This autosomal recessive inherited disease is caused by a deficiency of the liver-specific peroxisomal enzyme alanine-gly-... 

PD complications can be divided into acute or chronic and infectious or noninfectious. Imaging with ultrasound, CT, and eventually MRI can contribute significantly to appropriate treatment of many situations (Taylor 2002). Acute catheter dysfunction may be caused by malposition and can be seen on a plain abdominal radiograph. Development of inguinal hernias is caused by the permanently increased intra-abdominal pressure, and herniotomy is frequently needed. Acute respiratory distress should raise suspicion of hydrothorax caused by thoracic leakage of peritoneal fluid (Rose and Conley 1989). A chest X-ray can show this complication (Fig. 21.3). Infections of the exit site, the subcutaneous tunnel, and peritonitis are the most common infectious complications. Proper treatment with intraperitoneal antibiotics is mandatory. The incidence of peritonitis is estimated to be one infection per 13 treatment months. Recurrent peritonitis may lead to catheter removal. Tunnel infections typically show pericatheter fluid collection, and US is important for early detection and follow-... 

A plain abdominal radiograph demonstrates a mottled pattern in the stomach which can be diffi-... 

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