Purpose
Chest radiograph is most commonly performed primary radiological examination in most diseases [1].
Many referring physicians and medical practitioners prefer patients to undergo radiological examinations for diagnosis related to chest complications or metastatic disease progression or in painful conditions.
It has been observed that certain patients often diagnosed with bowel complications are observed incidentally on chest x-ray (CXR) which is mostly ignored by the interpreters.
Stomach gas is normally seen at the left lower corner of chest radiograph [2].
But free air under diaphragm and...
Methods and Materials
A single centred retrospective cohort study of a sample of 2296 patients with chest radiograph examination was selected from digital radiography system.
Patients’ data was selected from hospital information system (HIS) and radiology information system (RIS),
six months data of examined patients from February to July was considered for this study.
The data of suspected patients for bowel abnormality were also taken as that had been performed with same modality.
All patients were included irrespective of their age or sex.
The soft copy radiographs were...
Results
Atotal of eighty nine (3.87%) patients had bowel complication noted on CXR with CI of 95%.
Fig.7 summarises,
Fifty nine (66.02%) patients were confirmed to have large bowel complications either obstruction either due to volvulus; intussusception or severe constipation,
while sixteen (18%) had small bowel complications either obstruction due to volvulus,
intussusception or perforation and seven (7.86 %) had pneumoperitoneum including two (2.24%) patients with case of stomach distinction and four (4.44%) were with chiladiti’s sign under diaphragm due to swollen transverse colon.
One (1.12%)...
Conclusion
Numbers of patients have been reported with bowel complications upon CXR while some had abdominal radiograph performed.
Radiographers identifying patients with stomach,
diaphragm,
small and large bowel complications as seen incidentally on chest radiograph must report to the radiologist or referring physician so that early diagnosis can be made to achieve better emergency patient management.
However,
the AXR must be justified to avoid unnecessary exposure.
Further studies are required for improving patient services.
References
Gatt M E,
Spectre G,
Paltiel O,
Hiller N,
Stalnikowicz R.
Chest radiographs in the emergency department: is the radiologist really necessary? Postgrad Med J.
2003;79(930):214-217.
Loh KY,
Kew ST.
A man with an acute abdomen.
Malaysian Family Physician.
2008;3(2):109-110.
Whittaker C,
Goh V.
Imaging for Common Complications.
In: Hoskin PJ,
Goh V,
editors. Radiotherapy in Practice: Imaging. New York: Oxford University Press Inc.,
2010; p.
289-306.
Personal Information
Rahman Ud Din
Radiology Department,
Shaukat Khanum Memorial Cancer Hospital and Research Centre,
Lahore,
Pakistan