Interpret the single‑view abdominal radiograph of a patient presenting with pain who has right femur intertrochanteric fracture fixation hardware.

Interpretation of Single-View Abdominal Radiograph

This abdominal radiograph shows no acute abdominal pathology requiring immediate intervention, but the bilateral radiodense foci in the lumbar regions measuring 10-14 mm are highly suspicious for kidney stones and warrant urgent follow-up imaging with CT to confirm nephrolithiasis and guide management. 1

Key Findings and Clinical Significance

Non-Acute Bowel Gas Pattern

• The nonobstructive, nonspecific bowel gas pattern with gas-distended ileal and colonic loops without obstruction or significant fecal load indicates no acute surgical abdomen 1
• Conventional abdominal radiography has limited diagnostic value for nonspecific abdominal pain, with studies showing 98% of radiographs are negative or show findings unrelated to the acute problem in patients with diffuse, nonspecific pain 2, 3
• The absence of free air, bowel obstruction, or other acute findings makes emergent surgical intervention unnecessary 1

Radiodense Foci - Suspected Nephrolithiasis

• The bilateral 10-14 mm radiodense foci in the lumbar regions are the most clinically significant finding and require immediate follow-up with CT imaging 1
• Conventional radiography has good accuracy for detecting urinary tract calculi, making this one of the few appropriate indications for plain abdominal films 1
• CT is the definitive imaging modality for suspected nephrolithiasis and should be obtained promptly to confirm the diagnosis, assess for obstruction, and guide treatment decisions 1
• Stones of this size (10-14 mm) are unlikely to pass spontaneously and may require urologic intervention 1

Orthopedic Hardware

• The internal fixation hardware traversing a healing right intertrochanteric femur fracture is an incidental finding unrelated to the current abdominal pain presentation 4, 5
• This hardware appears appropriately positioned and the fracture is described as healing, requiring no acute orthopedic intervention 4

Recommended Next Steps

Immediate Management

• Obtain non-contrast CT of the abdomen and pelvis to definitively evaluate for nephrolithiasis, assess stone burden, and identify any associated hydronephrosis or complications 1
• CT has significantly higher sensitivity and specificity than plain radiography for urinary tract pathology 6
• Urinalysis should be performed if not already done to assess for hematuria, which would further support the diagnosis of nephrolithiasis 2

Clinical Pitfall to Avoid

• Do not dismiss the radiodense foci as insignificant or delay CT imaging—bilateral kidney stones of this size can cause significant morbidity including obstruction, infection, and renal damage if not promptly evaluated and treated 1
• Do not rely solely on this single-view abdominal radiograph for definitive diagnosis, as it contributes to patient treatment in only a small percentage of cases (4%) without follow-up imaging 3