In this era of high-technology multisectional imaging, the plain film of the abdomen might be considered passe. After all, its diagnostic capabilities seem limited when compared with ultrasonography, computed tomography, and magnetic resonance imaging. Most plain film signs were recognized more than two decades ago and have become established verities, perhaps too encased in tradition to warrant further evaluation, revision, or extension. Surprisingly, the lessening of academic interest about the fascinations of the plain abdominal film has not been matched by a corresponding decline in its clinical uses and usefulness. Even today, it remains one of the most frequently requested imaging examinations, performed much more often than body CT. It is my contention that there is still much we can learn from it if we only pause to look more closely and base our interpretations on a correlation of clinical and radiologic jindings. This brief update will focus on three diagnostic situations in which the plain film examination of the abdomen can provide crucial insights.
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