Health Questions and Answers

QUESTION: Which plain films are most useful?

ANSWER: Traditional teaching holds that plain abdominal films should include a supine view plus either an upright view or a left lateral decubitns view (if unable to stand) or all three. The supine view of the abdomen is the most informative and worthwhile abdominal film. The upright film is superior for visualizing air-fluid levels associated with ileus and obstruction and biliary air. If the patient is unable to stand, the left lateral decubitus (left side down) view may be substituted when looking for either obstruction or free air. The erect chest radiograph is most sensitive for detection of free intraperitoneal air and may show basal pneumonia, ruptured esophagus, elevated hemidiaphragm, air-fluid levels associated with subdiaphragmatic or hepatic abscess, pleural effusion, and pneumothorax. In the evaluation of patients with abdominal pain, the upright chest film, taken alone, has been shown to be more useful than films of the abdomen itself.

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