What Does This Abdominal X-Ray Reveal About Extraluminal Gas?

[nokia8650]

I was struggling with the radiograph below;I am told that "the plain abdominal X-Ray shows the falciform ligament outlined by gas. This is the appearance of extraluminal gas."

http://img687.imageshack.us/img687/1634/c03axrperf.jpg

However I am unable to see this; is it possible for someone to please explain this to me?

Thanks very much.

 

[SW VandeCarr]

Is this your radiograph?

EDIT: If not, how did you obtain it?

 

[nokia8650]

It was amongst a number of radiographs accessible to us online for those at our college.

 

[SW VandeCarr]

It was amongst a number of radiographs accessible to us online for those at our college.

Well I went to the website Image Shack and it's open to all. I'm just concerned that private medical records are being hacked. (Actually the URL could be read "images hack".) Anyway posting a patient's radiograph on on an open internet site might be an issue. Are you a medical student?

In any case, do you know where the falciform ligament is? Do you know the significance of "extra luminal gas"? The finding is fairly obvious on this AP flat plate. An upright AP chest film would be the best to demonstrate this.

 

[nokia8650]

Yes, I am a first year medical student. No, I would certainly not be hacking patients records or anything! The url is for "image shack", a popular image hosting website.

Hmm yes I know the falciform ligament is the ligament attached the liver to the anterior abdominal wall and the diaphragm. I believe extra luminal gas is caused by gut rupture for instance. I just can't see this extra luminal gas nor the falciform ligament; I am very new to radiographs and don't really know what to be looking for!

Thanks

 

[SW VandeCarr]

Yes, I am a first year medical student. No, I would certainly not be hacking patients records or anything! The url is for "image shack", a popular image hosting website.

Hmm yes I know the falciform ligament is the ligament attached the liver to the anterior abdominal wall and the diaphragm. I believe extra luminal gas is caused by gut rupture for instance. I just can't see this extra luminal gas nor the falciform ligament; I am very new to radiographs and don't really know what to be looking for!

Thanks

I'm not saying you hacked into anything, nor am I saying this shouldn't be posted on a secure site for educational purposes. I just question whether it should be posted on PF which is an open site. In this case, there are no identifiers showing, but it's still a private record of a patient.

Identify the inferior margin of the liver and look at the adjacent tissue at the top of the image. See anything?

 

[nokia8650]

Hmm I see your point. I made sure no identifiers etc were present but I guess i won't do it again!

I see the inferior margin of the liver, but I am still unsure of where the falciform ligament is;is it the line which is crossing from the right over to the left in the midline at the top of the image?

Thanks so much!

 

[SW VandeCarr]

Hmm I see your point. I made sure no identifiers etc were present but I guess i won't do it again!

I see the inferior margin of the liver, but I am still unsure of where the falciform ligament is;is it the line which is crossing from the right over to the left in the midline at the top of the image?

Thanks so much!

Gas is radiolucent, meaning it shows dark on the radiograph. The liver is water density and shows lighter. Bone is (relatively) radio-opaque and shows lighter than water density. If you trace the liver margin medially and superiorly, you'll see a parallel dark streak which widens toward the top of the image. That shouldn't be there. That's gas.

It's not all that common to pick this up on an abdominal flat plate. The diagnosis is usually made from an upright chest film where extra-luminal gas shows clearly under the diaphragm. It would be interesting to see the companion chest film. I'm sure one was done, if not right away, then as soon as this film was evaluated.

 

[nokia8650]

ah okay; i see it now. Thanks so much. Yes, there was an accompanying chest radiograph which showed the gas clearly, but i couldn't see it in the abdomen which is why i only asked about this image. Thanks you!

 

[Moonbear]

Since the original question is answered, I will just address the secondary question raised by others. Films provided to medical students for their training are from patients (or other normal subjects) who have signed waivers permitting those radiographs to be used for educational purposes. All personally identifying information is removed, and it is then okay for the radiographs to be used publicly in an educational context, such as this. nokia8650 has done nothing wrong to share this information in the pursuit of further education.

I am familiar with this because I am in the process of obtaining photographs from a subject displaying a particular anatomical abnormalilty (with nothing in the photo that would reveal that person's identity), and will have that person sign a waiver before even using the material in my lectures.

 

[SW VandeCarr]

nokia8650 has done nothing wrong to share this information in the pursuit of further education.

Thanks for posting this Moonbear. I'm aware of problems with hacking into electronic medical records, so I wanted to confirm nokia8650 had proper access. I'm sorry if I might have seemed a bit harsh in my initial response, but the OP did not state he/she was a medical student until I asked him/her.

 

[Moonbear]

Thanks for posting this Moonbear. I'm aware of problems with hacking into electronic medical records, so I wanted to confirm nokia8650 had proper access. I'm sorry if I might have seemed a bit harsh in my initial response, but the OP did not state he was a medical student until I asked him.

No problem. It's a fair question when one doesn't state where they've obtained the information. I just wanted to make sure it was clear there aren't any ethical issues in sharing teaching materials.