Interpretation of Radiological Examination

Abstract

An orderly approach should be taken to interpreting radiological studies to ensure that any significant pathology is detected. The following is suggested, particularly for neophytes:

• 1. Examine the “four corners of the film” (i.e., costodiaphragmatic angles, supra- and infradiaphragmatic spaces bilaterally). Special attention should be given to the lung bases and hip regions, and in particular to gas shadows that may project below the iliopectineal line. These may simply represent air in the bowel of individuals with a pendulous abdomen, or air in a herniated bowel (e.g., inguinal hernia, which can be discovered by observing air projecting below the iliopectineal line, usually on one side).

• 2. Evaluate the bony structures (lower thoracic and lumbosacral spine, lower ribs, iliac bones, and proximal femora). Relevant or unsuspected pathology of the spine may be the cause of the patient’s symptoms. Occasionally, one may observe destructive lesions of the bony skeleton which will reinforce a preliminary diagnosis of abdominal or extraabdominal malignancy (e.g., a patient with hepatomegaly or some abdominal mass with signs of bony metastasis).

• 3. Examine the flanks, paying special attention to the fat-muscle interfaces, and look for possible extraluminal air collections.

• 4. Examine the organs of the alimentary tract, starting with the hollow viscera, a) Focus on the esophagogastric region and then study the stomach, the duodenum, and the small and large bowel sequentially. Rule out intraluminal masses (e.g., cancer of the stomach revealed by an abnormal segment of the stomach where air has been replaced by a mass). Pay attention to the air-containing bowel and evaluate the distribution of air as well as the caliber and contours of the bowel. Occasionally, different forms of colitis or even cancer of the colon can be diagnosed by observing an alteration in the bowel contour. Then, look for the presence of air in the wall of the bowel and extraluminally.