Advanced Chest Imaging, Abdominal Imaging, Specialty Abdominal Imaging Flashcards
Pregnancy tests and radiology
Get in habit of asking your pts of child bearing age, order UPT if warranted
Warranted if LMP is >1 mo
10 day rule: if within 10 days of LMP, you know they’re not pregnant
Chest trauma plain films- when to get, components?
True chest trauma, not isolated rib injury
Always indicated AP only and usually portable
Fast, cheap, easy, yields good info
CT chest always indicated ASAP
What can be seen on plain films for chest trauma?
Rib fxs Sternum fxs Clavicle/shoulder fxs Subq emphysema FBS (GSW) Pneumothorax Widened mediastinum
Indications for CT chest
Clinical suspicion vs vague CXR findings, neg CXR with sick pt
CXR findings that are worrisome, 1” wide mediastinum, cardiomegaly, mass
Trauma, 1” blunt chest trauma think seatbelt sign
Known/unknown aneurysm with worrisome presentation
Worrisome for PE
CAD
Pericardial effusion
When to get a CT chest without contrast for chest
Greater than or equal to 50 yo with isolated rib injury/pain
Indeterminate findings on CXR, pt allergic to IV contrast
Indeterminate findings on CXR, pt has abnl renal fxn
Except for suspected PE
CXR neg but pt is ill, suspect pneumonia and has allergy or renal impairment
Radiologist preference or recommendation
Labs you must get before radiologist will give IV contrast
BUN
Creatinine
GFR
When to get a CT chest with contrast for chest
Trauma
Assess aneurysm
Dissection
Radiologist preference
When to get a CT chest with and without contrast for chest
Abscess assessment includes empyema
Tumor assessment
If you don’t know what it is or what it might be
What size needle to use for CT angiography
20g or higher, can’t use EJ IV access
What will a cardiac pt need for a CT angiography?
May need a BB
When to use CTA for chest
PE
CAD
Trauma
Types of u/s
Echo including TEE
FAST
Pericardial effusion
u/s guided thoracentesis
Echo indications for chest
Cardiomegaly Abnl EKG, think a fib IVDU/lupus (valve dz) Untreated HTN (LVH) Diabetic pts (LVH) CHF/CKD (LVH)
When to use chest u/s
Only for fluid location
u/s does not penetrate/image air/bone effectively
Pleural effusion
Assisting with thoracentesis
When to use nuclear medicine for chest imaging?
V/Q lung scan
Bone scan
When to use MRI for chest imaging?
Radiologist recommends
When to use PET for chest imaging?
Radiologist/oncologist recommends
Why do a V/Q?
For r/o PE if pt not able to have IV contrast
Purpose of bone scan
For skeletal abnormalities
Fx age
Bony mets
Types of plain film abdominal imaging
Acute abdominal series (PA chest, flat and upright abdomen)
Flat and upright
KUB
Lateral decubitus
True lateral abdomen if looking for FB, but usually go straight to CT
Why a PA chest for an abdominal complaint?
Can see free air under the diaphragms on a PA chest
Pt may have pneumonia or other lung tissue causing referred pain to the abdomen
If true acute abdomen, pt going to surgery will need a pre-op CXR
Indications for plain film abdominal studies
Abd pain Constipation Suspect bowel obstruction CT unavailable Recent CT with ileus/constipation/kidney stones FB Pediatric indications
Indications for abdominal CT
Abd pain, anywhere, any kind, acute or chronic, post op pain Sepsis with no obvious source Primary CA dx, r/o mets Certain abnl lab values Unintentional weight loss
When to use no contrast in abdominal CT
Suspect kidney stone Vague abd pain complaint Suspect bowel obstruction Hernias FBs (IUD gone missing, etc.) Allergy to IV contrast Impaired renal function Radiologist recommendation/preference
