Abdominal x-ray review: organs

Last revised by Vikas Shah on 23 Mar 2023

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 O refers to the assessment of the intra-abdominal organs and soft tissues.


  • introduction
    • abdominal radiographs are a blunt instrument for the evaluation of the abdominal organs due to the lack of soft tissue contrast resolution
    • the outline of the organs is visible due to the difference in density between the organ and the adjacent intra-abdominal fat
    • although not the reason for acquiring the radiograph, organomegaly may be seen
    • the soft tissues outside of the abdominal cavity, such as the lung bases and the inguinal regions, should also be carefully evaluated as they may contain abnormal findings that could explain abdominal symptoms
  • procedure
    • look for the outline of the liver, kidneys and spleen in the upper abdomen
    • liver
      • right upper quadrant
      • extends to the hemidiaphragm and past the midline
      • hepatomegaly is inferred when there is extension of the right lobe inferior to the lower pole of the right kidney
    • spleen
      • left upper quadrant
      • extends to the hemidiaphragm
      • splenomegaly is a subjective radiograph finding as there are no reliable objective criteria
    • psoas muscle
      • symmetrical triangles either side of the lumbar spine
      • narrowest near the diaphragm, widest at the pelvis
    • kidneys
      • sit on the psoas muscles
      • often just see the rounded lower pole
      • renomegaly is subjective radiograph finding as there are no reliable objective criteria
    • lung bases
      • pulmonary vessels in the bases projected over upper abdomen
      • signs of airspace opacification; pneumonia may present with abdominal pain
    • look for bowel gas in the inguinal regions as a sign of a hernia causing bowel obstruction

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Cases and figures

  • Figure 1: annotated abdominal radiograph
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  • Case 1: abdominal aortic aneurysm
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  • Case 2: enlarged bladder
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  • Case 3: splenomegaly
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