. Roentgen interpretation; a manual for students and practitioners . Fig. 164.—The indefinite ring-like shadow between the eleventli and twelfthvertebrae is that of a single large gall-stone. it varies greatly in size and position; it may be found an\^vherefrom the costal margin to the crest of the ilium. Gall-stones maybe recognized if they contain a sufficient amount of calcium salts,which unfortunately is true in only 20 to 30 per cent, of the appear as single or multiple shadows which may be thetypical faint ring, a dense homogeneous mass, or a mottled area 188 GASTRO-INTESTINAL
. Roentgen interpretation; a manual for students and practitioners . Fig. 164.—The indefinite ring-like shadow between the eleventli and twelfthvertebrae is that of a single large gall-stone. it varies greatly in size and position; it may be found an\^vherefrom the costal margin to the crest of the ilium. Gall-stones maybe recognized if they contain a sufficient amount of calcium salts,which unfortunately is true in only 20 to 30 per cent, of the appear as single or multiple shadows which may be thetypical faint ring, a dense homogeneous mass, or a mottled area 188 GASTRO-INTESTINAL TRACT of density due to many small stones packed together. Great caremust be taken to resist the tendency to make positive diagnosisof gall-stones from any faint shadows in the gall-bladder of stones are often very faint but they at least shouldshow definite rings and lie entirely within the limits of the gall-bladder before they can be diagnosed as stones. The proper. Fig. 165.—The large indefinite shadow near the spine is not a gall-stone, as nothingwas found at operation. It is probably a retroperitoneal gland. significance of the negative diagnosis should be realized andinsisted upon at all times. A negative diagnosis is of no positivevalue, for stones may be present and cast no shadow. Further-more, the patients symptoms may be due more to associatedpathology in the gall-bladder than to the stones. Patients occa-sionally refuse a needed operation because stones have not beendemonstrated by the roentgen method. They should be warned BIBLIOGRAPHY 189 in the beginning that gall-stones may not show. When gall-bladderdisease is suspected, a routine gastro-intestinal examination should
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