Abdominal X-ray - System and anatomy
Calcification and artifact

Key points

  • Added densities may be due to artifact or calcified soft tissue
  • Calcification of soft tissues is not always clinically significant
  • Differentiating pathological from inconsequential calcification is not always straightforward

Densities that cannot be explained by anatomical structures are often seen on abdominal X-rays. These may be artifactual, for example due to medical devices, or due to soft tissue calcification.

This calcification may not be pathological, but differentiating significant calcification from that which can be ignored is not always straightforward. The clinical features must be considered whenever abnormal calcification is suspected. Other investigations may be required.

Navel jewellery artifact

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Navel jewellery artifact

  • Ideally all jewellery that overlies anatomically important structures should be removed prior to acquiring an X-ray

Vascular calcification and ring pessary

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Vascular calcification and ring pessary

  • If seen, vascular (aorto-iliac) calcification implies a more generalised atherosclerosis.
  • Note the ring pessary in this elderly patient.

Calcified structures

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Calcified structures

  • There are multiple incidental and asymptomatic calcified structures seen on this X-ray. The patient is recovering from an appendicectomy (note surgical clips).
  • Gallstones are seen only if calcified (20% are calcified). Although they may cause symptoms they are usually asymptomatic. If gallstone disease is suspected ultrasound examination is a more appropriate investigation.
  • Costochondral calcification, calcified mesenteric lymph nodes, and phleboliths (calcified pelvic veins) are rarely clinically significant. Occasionally additional investigations are required to differentiate them from pathological calcium. For example phleboliths may be mistaken for ureteric calculi. Other investigations such as intravenous urogram (IVU) or CT-KUB (CT Kidneys-Ureters_bladder) should only be performed if there are typical clinical features of ureteric calculi.

Residual contrast

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Residual contrast

  • The large areas of very high density seen in the descending colon and rectum are caused by residual contrast material in this patient who had a Barium enema 10 days previously.
  • Also note costochondral calcification, and phleboliths.
  • Do not mistake the tips of the transverse processes for ureteric calculi.