Abdominal X-Ray Interpretation

Bowel Gas Pattern

• There is a non-obstructive bowel gas pattern. Gas is distributed in a normal physiological distribution across the colon and scattered small bowel.
• The cecum and ascending colon in the right lower/mid-abdomen show gas and fecal mottling - a normal finding.
• Gas is also noted in the left upper quadrant, likely splenic flexure/descending colon.
• No abnormally distended small bowel loops (cut-off: >3 cm). No colonic dilatation suggesting megacolon or toxic megacolon.

Free Air (Pneumoperitoneum)

• No subdiaphragmatic free air is identified.
• No Rigler's sign (double-wall sign) seen.
• Note: This is a supine view - an upright chest X-ray or left lateral decubitus film is more sensitive for detecting free air if clinically suspected.

Air-Fluid Levels

• Cannot be assessed reliably on a supine film. Upright or decubitus views would be needed.

Calcifications / Foreign Bodies

• Three small circular radiopaque densities are present - one in the upper midline and one each in the right and left upper quadrants. These are ECG electrode leads (artefacts, not pathological).
• No gallstones, renal calculi, appendicolith, or vascular calcification identified.

Solid Organs & Soft Tissues

• Liver and splenic shadows appear grossly normal in size - no obvious hepatosplenomegaly.
• Psoas muscle margins are partially obscured by overlying bowel gas but appear symmetric where visible.
• No large soft tissue mass identified.

Bony Structures

• Lumbar spine alignment is normal.
• Mild lower lumbar disc space narrowing, consistent with degenerative disc disease (incidental finding).
• Pelvis, sacroiliac joints, and visualized femoral heads appear intact without fracture, dislocation, or aggressive bone lesion.
• Lower ribs are symmetric with no acute rib fractures.

Summary / Clinical Impression

Grossly unremarkable supine abdominal X-ray. No evidence of mechanical bowel obstruction, paralytic ileus, visceral perforation (pneumoperitoneum), or significant organomegaly. ECG electrode artefacts are present. Incidental mild lumbar degenerative changes noted.

• Upright chest X-ray or left lateral decubitus view - if free air or air-fluid levels are clinically suspected
• Ultrasound abdomen - for better soft tissue/organ assessment (gallstones, renal pathology)
• CT abdomen/pelvis - if occult pathology remains a concern despite normal plain film