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now we will be discussing the different signs in abdominal x-rays this is an annotated x-ray of the abdomen highlighting the key anatomical structures that are often visualized on the right we can see the outlines of liver right kidney right transverse process of lumbar one vertebra ascending colon right so is major small bowel pelvic bone and right femur on the left the outlines of splenic flexure transverse colon left kidney left eleventh rib descending colon left pedicle of lumbar three vertebrae spinous process of lumbar four vertebra left cycloiliac joint and bladder are seen apple core sign is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma this also can be caused by other diseases lymphoma with colonic involvement crohns disease chronic ulcerative colitis ischemic colitis chlamydia infection colonic tuberculosis or amabiasis colonic cytomegalovirus villas adenoma etc this barium enema shows the apple core sign