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Dr.K.G.MoniGandhi

normal abdominal xay

Liver
The liver is a soft tissue organ located in the right upper quadrant. The liver usually displaces the bowel preventing itself from overlying bowel/bowel gas. There may be, however, an interposition of the colon between the liver and the right hemidiaphragm, called Chilaiditi's syndrome, that may mimick free intra-peritoneal air under the right hemidiaphragm. As a normal variant you may also find an extension of the right liver lobe down to the right flank or iliac fossa, resembling a shark's fin, which is also called Riedel's lobe.

Spleen
The spleen is a soft tissue organ located in the left upper quadrant. The size is usually comparable to the size of the patient's heart or fist and measures approximately three vertebrae in length diameter. It may be difficult to delineate this soft tissue organ due to overlying gas. In fact, mostly the spleen will not be visible at all. If splenic enlargement is greater than 15 cm displacement of adjacent organs may be caused.  Enlargement of the spleen can be in medial but also in latero-inferior direction.

Kidneys, Ureter and Bladder
Usually there is some overlying gas hindering the delineation of the kidneys in their entirety. In relation to the thoracic and lumbar spine, the bean-shaped kidneys extend from T12 on the left side down to L3 on the right side. The left kidney is located slightly higher as compared to the right kidney. The left kidney is also slightly bigger (approx. 1.5 cm longer) than the right kidney. The upper poles of both kidneys are closer to the spine than their lower poles (approximately 12 degree angle compared to the spine, supero-medially down to infero-laterally). The kidneys are relatively mobile. They can move down with inspiration, and drop several centimetres in the erect position.

Normally, the ureters cannot be delineated on a plain abdominal radiograph. But ureteric calculi may be visbile along the course of the ureters. Keep in mind that the ureters run along the transverse processes of the lumbar spine. 

If there is a full bladder it usually will be visible as a soft tissues density (water density equals soft-tissue density radiographically), and will be outlined by the perivesical fat. In particular in females a full bladder (up to 2 litres volume) may cause upwards displacement of the bowel loops, and may render the differentiation to a real tumour mass difficult. Therefore, if possible, the bladder should have been emptied before a plain abdominal film is taken.

Iliopsoas muscle
The psoas muscle originates from the lumbar spine and extends downwards and inferolaterally before finally inserting on the lesser trochanters of the femora. 
Obscuration of the psoas muscle may allude to a pathological retroperitoneal process, e.g. retroperitoneal fluids/ascites, retroperitoneal haemorrhage/haematoma, retroperitoneal abscess, retroperitoneal tumour. 

Bones 
Identify the diapgragm and the following bony structures on the same abdominal X-ray (Fig. 1a):
Ribs, thoracic vertebra 12, lumbar vertebrae 1 to 5, sacrum, coccyx, ilio-sacral joint, ilium, superior pubic ramus, hip joint and femoral head.

normal abdominal xay

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