Abdominal x-ray densities

Last revised by Dr Jeremy Jones on 14 Aug 2021

Abdominal x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using ABDO X is a helpful and systematic method for abdominal x-ray review, where D refers to the assessment of dense structures such as the bones and areas of calcification.


  • introduction
    • several bony structures are visible on an abdominal x-ray and should be evaluated carefully
    • calcification may also be visible and may provide a clue as to the cause of the patient's symptoms and signs
  • procedure
    • evaluate all of the bones visible on the x-ray as you would on any other x-ray
      • look at the contours, density, trabecular pattern, areas of lysis or sclerosis
      • you may see the lower thoracic vertebral bodies, all of the lumbar vertebral bodies, sacrum, iliac blades, ischium, femoral heads and necks, and lowest ribs
      • Paget disease of the pelvis is frequently identified on abdominal x-rays
    • examine the renal shadows and paths of the ureters for small densities which indicate stones
    • gallstones are radiopaque in approximately 15-20% of cases
    • small pelvic calcifications are likely to be phleboliths
    • calcified lymph nodes are also sometimes identified
    • other calcifications include:

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Cases and figures

  • Case 1: calcified abdominal aortic aneurysm
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  • Case 2: encapsulating peritoneal sclerosis
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