Radiology - Abdominal X-rays
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þ CHILAIDITI SYNDROME

        Associated with transverse colon volvulus

þ Abdominal X-rays are pretty much useless:

I recently reviewed the literature on this subject so as to counter the head
radiology tech's attempt to eliminate the upright chest from the "abdo
series". My intuitive feeling was that, while the abdo series was an
incredibly useless and over-ordered test, it WAS useful to pick up intestinal
occlusion and perforation. Since the latter manifests as free air under the
diaphragm, it was illogical to stop doing upright chests.

The literature fully supports this. In fact, a couple of PROSPECTIVE trials
have validated the use of precise criteria to decide who needs an abdo xray.
Use of these criteria DECREASE the ordering of abdo xrays by 30-40%, with NO
loss of sensitivity in picking up pathology. These criteria can be recalled by
the mnemonic "ABDO XR"

A - Age over 50
B - Bowel sounds diminished
D - Distension (objective, not subjective)
O - Obstipation or constipation
X - previous surgery (a bit of a stretch - the "X" conjures up scars)
R - Ralfing (vomiting)

Only one of these criteria is necessary to qualify for an abdo series. While
not specifically addressed in the literature, it was obvious to me as I read
through the articles that the supine abdomen view yielded virtually no added
information. I would therefore encourage you to use these criteria to select
patients for abdominal xray evaluation. If the radiology department wants to
save even more money, get them to stop doing supine abdomens.

Regards,

Ray Wiss


Eur J Surg 1998 Oct;164(10):777-84
Prospective study which validated the "ABDO XR" criteria

J Accid Emerg Med 1996 Nov;136);390-1
Prospective study showing abdo xr useless in ureteral colic

Pediatr Emerg Care 1991 Oct;7(5);281-5
J Emerg Med 1990 May-Jun;8(3);271-5
J R Coll Surg Edinb 1998 Aug;(4);267-70
Retrospective studies showing the same thing

þ Normal Variants
 - Chilaliti's Syndrome (per Dr. Shindei at Mercy): interposition of the large
   bowel in front of (or more rarely on top of) the liver, sometimes mimicing
   free air.


   Chilaiditi's syndrome

   Also known as:
   Chilaiditi's anomaly

   Associated persons:
   Demetrius Chilaiditi

   Description:
   Interposition of a portion of the colon or, less frequently, the small
   intestine between liver and right diaphragm when the patient is upright,
   associated with abdominal pain, nocturnal vomiting, anorexia, and
   distension with loss of liver dullness. Rare condition caused by congenital
   anomalies of the calciform ligament of the diaphragm sometimes observed in
   roentgenologic clinics. More often in adult males; rarely seen in children.
   The only specific symptom is a feeling of pressure on the upper part of the
   belly, which resides when lying down.