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What dows this xray shows

Reading File
analyse_media
This is a plain supine AP abdominal film (KUB), labelled "Abdomen KUB", dated 2018, with a "R" marker. I can't give you one definitive diagnosis from a phone photo of the film. Here is what I can see and how sure I am of each point.
Fairly clear
  • Gas in the right lower abdomen: There are several rounded, gas-filled loops in the right iliac fossa and right flank. This is most likely the caecum and ascending colon. They look a little prominent, but the loops are not clearly dilated beyond normal limits (caecum under 9 cm, small bowel under 3 cm).
  • Scattered gas and faecal mottling: There are small gas pockets and mottled stool in the left flank, the pelvis and the lower abdomen. This is a non-specific bowel gas pattern.
  • Spine: The vertebral column is visible with a mild curve. The lower thoracic and upper lumbar segments look slightly shifted and tilted. Some of this may come from patient positioning or rotation. I can't judge whether it is true scoliosis.
Visible, but I'm not sure what they are
  • Ring-shaped opacity: There is a small, sharply defined ring-like opacity in the left upper abdomen, lateral to the spine. It could be an external object such as a button, ring, or clothing or ECG artefact. It could also be an ingested foreign body, which would be a typical "What does it demonstrate?" answer. I can't tell whether it lies inside or outside the patient.
  • Thin linear and bead-like opacities: These lie along the edges of the film. They look like tubing, a lead or a drain outside the body. They are probably artefacts.
  • Small bright density in the left upper abdomen: There is a small bright, irregular density near the left side of the upper lumbar spine. It could be a calcification, a renal or ureteric stone, or residual contrast. The photo isn't clear enough to say.
Limitations
  • The film is photographed on a light box and is overexposed, with hazy soft tissue. The psoas outlines, renal outlines and any subtle calcification are hard to assess.
  • I can't see free air under the diaphragm on this film. Free air needs an erect chest or erect abdominal film.
What I'd look for to answer the question
  1. Is the ring-shaped density a foreign body? Check whether it is intra-abdominal on a lateral view or a repeat film.
  2. Is there a radio-opaque calculus along the renal or ureteric tract, or any other calcification?
  3. Is there a dilated bowel pattern?
If you tell me the clinical context (for example the patient's symptoms, or which topic this question is from), I can narrow it down. A sharper, straight-on scan of the film would also help.
This is for study purposes only. A radiologist or treating clinician should interpret the actual film.

Suspected diagnosis

My best guess is a radio-opaque foreign body in the left upper abdomen (the ring-shaped density), on a KUB with a non-specific bowel gas pattern. I'm not confident, because this is a photo of a film and I can't confirm the object is inside the patient.
Ranked suspicions
  1. Radio-opaque foreign body (ingested ring, coin or button-type object).
    • The small, sharply defined, ring-shaped density lies lateral to the spine in the left upper abdomen.
    • It stands out against the bowel gas and soft tissue, which is what a metallic or dense object looks like.
    • A repeat film or a lateral view would show whether it is intra-abdominal. It could also be a clothing or ECG artefact.
  2. Urinary tract calculus (left renal or upper ureteric).
    • A small bright, irregular density lies near the left upper lumbar spine, in the renal and ureteric area.
    • A KUB is the usual film for looking for this, but the exposure here is too poor to be sure.
    • If this is the intended answer, you would confirm it with a non-contrast CT KUB or ultrasound.
  3. Non-specific or early obstructive bowel gas pattern.
    • Gas-filled loops are prominent in the right iliac fossa and flank, with some mottled stool.
    • I can't see clearly dilated loops, air-fluid levels, or a coffee-bean sigmoid loop. I wouldn't diagnose obstruction or volvulus from this film.
What I don't see
  • There is no obvious free air or pneumoperitoneum, but this film is supine and can't exclude it.
  • There is no clear sign of volvulus.
  • The mild spinal curve is probably positional.
If this is from a spotter or viva set, the expected answer is likely whichever object or calcification the examiner pointed at. The wording "What does it demonstrate?" fits a foreign body or a radio-opaque calculus. Tell me the source or the clinical history, such as pain, vomiting, haematuria, or a known ingestion, and I can narrow it down. A clearer, straight-on image would also help.
This is for study purposes only. A radiologist should review the original film.
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