CLASP - radiology Flashcards
3 - CXR (if AP will usually say)
4 - rounded mass extending from left hilum, left heart border visible
5 - left lower lobe (because PA)
6 - lung cancer
7 - biopsy
8 - CT
9 - lung mass
10 - left pulmonary artery (hilum)
11 - left pulmonary artery, left atrium, pulmonary veins
12 - emphysema (black cystic holes)
13 - liver, brain, bone, andrenal glands
* lymph nodes = hilar, bronchial
14 - liver
15 - metastases, dark and round (streaks are thehepatic veins)
16 - 7th and 8th liver segments
osteolytic lesion (costal metastases)
18 - left and right renal masses
19 - CT contrast (remember T1 and T2 is MRI)
20 - mass in RIGHT frontal lobe
21 - right frontal lobe
22 - metastasis
X-ray density of air? fat? soft tissue/muscle? bone? metal?
air = black
fat = grey
soft tissue/muscle = grey/white
bone = white
metal = bright white
how is CTR measured?
normal?
PA CXR
normal = <50%
how to tell is CXR is adequately inspired?
correctly centred?
will be able to see at least 6 ribs
centred = medial ends of clavicles equal distance from spinous processes of vertebrae
borders that should be visible on CXR?
contents of lung hila?
which hilum sits higher?
contents = pulmonary arteries, pulmonary veins + bronchi
left hilum sits higher than right
are diaphragms normally same height?
no - right diaphragm sits 1.5cm above left
review areas on X-ray
review areas are often missed - so special attention paid to them
* lung apices e.g. pancoast tumour, pneumothorax
* behind heart e.g. consolidation, masses, hiatus hernia
* below diaphragm e.g. free gas, lines and tubes, bowel obstruction
* bones and soft tissue e.g. fractures, masses, subcutaneous emphysema
lung lobes
Ax lobar collapse?
obstrcution of lobar bronchus - tumours, aspirated foodstuffs, mucous impaction
left lower lobe collapse
sail sign!!
also left hemi-dipahragm higher than right
left upper lobe collapse
veil-like heart border
right upper lobe collapse
increased desnity + volume loss
right middle lobe collapse
loss of right heart border
right lower lobe collapse
preservation of heart border
loss of hemi-diaphragm
what is the diagnosis
right middle + lower lobe collapse
cant see diaphragm or heart border + volume loss
diagnosis?
right middle lobe consolidation
* loss of clarity of right heart border but preservation of right hemi-diaphragm
* follows same pattern of collpase without volume loss
left lingular consolidation (part of left upper lobe)
* consolodation of lingula causes left heart border to become obscured
left upper lobe consolidation
* volume preserved
* can still see heart border
* loss of clarity of left upper mediastinum
pleural effusion - meniscus sign
right pneumothorax - cant see lung markings
tension pneumothorax - mediastinal shift
diagnosis?
heart failure - pulmonary oedema
ABCDE
A - alveolar effusion (batwing opacities)
B - kerley B lines
C - cardiomegaly
D - dilated upper lobe vessles
E - pleural effusion
heart failure - pulmonary oedema
* ABCDE
endotracheal tube position?
most common malposition?
normal = tip 5cm above carina
malposition = tip extends past carina
most common malposition = tip in right main bronchus
ET tube positioned correctly?
no - it is in the right main bronchus
ideal position for nasogastric tube?
malposition examples?
ideal position = subdisphragmic, overlying gastric bubble, at least 10cm beyond gastro-oesophageal junction
malposition: remains in oesophagus, bronchus
is NG tube correctly placed?
no it’s in right lower lobe bronchus
central venous catheter vs peripheral venous catheter insertion
CVC = inserted via right and left internal jugular or subclavian veins
PVC = via cephalic, basilic or brachial veins
position of central venous catheter?
malposition?
tip should be in cavoatrial junction
malposition = tip too high (proximal SVC), tip too low (RA or RV)
CVC placed correctly?
no it has gone into subclavian vein
should be in cavoatrial junction
Dx?
cannon ball metastasis from renal cell cancer
lung cancer staging
T - tumour size
N - intrathoracic lymph node
M - metastases
imaging modalities for staging lung cancer
contrast enhanced CT
PET CT
Dx?
pneumoperitoneum
perforation of GI tract results in gas in the peritoneal cavity
radiograph must be taken in the ERECT position (allows gas to rise up under diaphragm)
first line Ix for pneumoperitoneum?
erect CXR
1 - CVA, TIA (recovery is quick)
2 - non-contrast CT
3 - non-contrast CT
4 - thrombus in right middle cerebral artery
5 - right MCA
6 - ischaemic stroke
7 - age, hypertension, angina, irregular HR
8 - thrombolysis
9 - no bleed
10 - hypodense region (ischaemia), hypoattenuation
11 - haemorrhage
12 - CT without contrast
13 - haemorrhage, midline shift
14 - right parietal lobe
15 - haemorrhagic stroke
16 - NG tube in correct position
17 - gliosis (scarring of brain tissue)
18 - AF
fissures CT brain
supracellar = above sella turkica
suprasellar cistern contains?
circle of willis
familiarise anatomy MRI
vascular territories
circle of willis
imaging in stroke?
non contrast CT scan
findings stroke CT?
gliosis
acute on chronic subdural haematoma
see fluid level
subarachnoid haemorrhage
can see blood in sulci, suprasellar cistern, sylvian fissures
left MCA
coning?
tonsillar herniation
….
…
spinal cord compression?
Ax?
surgical emergency!!
Ax
- disc prolapse
- trauma
- tumour
- epidural abscess/haematoma
- spinal meningioma
- nerve sheath tumour
Ix spinal cord compression?
MRI spine!!
what does this CT show
what should be done now?
fracture at L2
MRI must be done to Ix cord compression
1 - pancreatitis, bowel ischaemia, perforation, ectopic rupture, leaking AAA
2 - ABCDE
3 - erect CXR (perforation)
8 - acute pancreatitis
9 - USS to check for gallstones
12 - CT, it shows necrosis of the pancreas
13 - venous thrombosis, ARDS, renal failure, sepsis, abscess
vessles = splenic artery + vein, SMA, hepatic arteries + portal vein
liver
stomach (fasted)
gallbladder
CBD
pancreatic duct
15 - ECRP (gallstones)
peri-pancreati fluid compression (can see compressing stomach anteriorly)
Tx = percutaneous drainage
pancreatic pseudocyst compressing stomach
NJ tube (not NG)
lies in jejunum
acute abdominal pain DDx?
Dx acute appendicitis?
CT and USS
no role for X-ray
USS findings acute appendicitis
aperistaltic = not moving
CT findings acute appendicitis
gold standard imaging for ureteric stones?
non-contrast CT (CT KUB)
LIF pain DDx?
diverticulitis
colitis
colorectal cancer
tubo-ovarian pathology
renal colic
acute diverticulitis s/?
as disease progresses?
LIF pain
unremitting pain with associated tenderness
sometimes ill-defined mass
as disease progresses symptoms become more generalised
gold standard Ix for acute diverticulitis?
CT with IV contrast
epipolic appendagitis can mimic?
what is it?
can mimic diverticulitis
part of colon is torsioned and infarcts
acute cholecystitis Ax?
S/s?
Dx?
almost always secondary to gallstone
s/s = RUQ pain, fever, raised WCC and CRP
Dx = USS first line
where is gallbladder located?
tucked under 5th liver segment
2nd line Ix cholecystitis?
findings?
2nd line = CT
(1st line USS as CT can miss gallstones)
….
diagnostic?
Tx options acute cholecystitis
most common cause is gallstones remember
pancreatitis s/s?
Dx?
acute onset severe epigastric pain
poorly localised, tender
exacerbated by supine position
radiates to back in 50% of pateints
Dx = serum amylase increased
Ix pancreatitis?
Dx?
USS + CT are not diagnostic
- USS is to look for CAUSE i.e. gallstones
- CT is to look for complications e.g. necrosis, vascular comps
Dx = elevated serum amylase
Ix of choice for perforation?
erect CXR
abdominal pain and distention DDx?
bowel obstruction
masses
ascites
Ax small bowel obstruction?
Symptoms?
signs?
Ix?
Ax = adhesions, cancer, hernia, gallstone ileus
symptoms = vomiting, pain, distention
signs = increased (tinkling) bowel sounds, tenderness, palpable loops
Ix = x-ray, CT (USS has no role)
small bowel obstruction x-ray features?
small bowel obstruction CT features?
small bowel obstruction caused by gallstone ileus
large bowel obstruction Ax?
Ix?
colorectal cancer (most common)
volvulus
diverticulitis
Ix = x-ray and CT
large bowel obstruction features x-ray?
large bowel obstruction CT features?
not great pic but can see pneumotosis coli (blakc dots = gas in wall of caecum)
sudden abdominal pain and shock DDx?
bowel ischaemia
perforation
pancreatitis
leaking AAA
ruptured ectopic pregnancy
Ax bowel ischaemia?
arterial occlusion (majority) - SMA, coeliac, IMA
venous occlusion - hepatic portal vein, IMV, SMV, splenic vein
non-occlusive hypoperfusion
bowel ischaemia symptoms?
signs?
symptoms = severe abdominal pain, vomiting, diarrhoea
signs = raised WCC, metabolic acidosis, borderline amylase
Dx bowel ischaemia?
CT!!!!
x-ray and MRI have no role
CT appearance bowel ischaemia?
leaking AAA s/s?
Ix of choice?
what will you see?
what can mimic?
S/s = pain, hypotension, pulsatile abdominal mass
CT is investigation of choice
on CT will see retroperitoneal haemorrhage next to aneurysm
renal colic can mimic this
red = pneumothorax
green = blood (consolidation)
plane = coronal
organ = spleen
injury = splenic laceration
Tx = embolisation (splenic artery + shot gastric artery - dual supply)
catheter angiogram
splenic artery
originates from coeliac trunk
other branches of coeliac trunk = splenic artery, common hepatic, left gastric
sagittal plane
injury = T12 fracture
spinal cord impingement
distal radius + ulna
colles
dinner fork deformity (like a fork)
Tx?
tibia + fibula (ankle)
dislocation - fibula and talus normally articulated
Tx = relocation, cast
flail segment?
more than 3 adjacent ribs are fractured in 2 or more places
…
when do you do AXR?
bowel obstruction/ileus
pneumoperitoneum
signs of pneumoperitoneum AXR?
rigler sign! = pneumoperitoneum
(also known as double-wall sign, gas outlines both sides of bowel wall i.e. gas within bowel’s lumen and gas within peritoneal cavity)
most commonly injured solid organ?
spleen
types of fracture?
which of these are seen in children?
torus and greenstick seen in children
anatomical vs surgical neck humerus fracture
signs of radial head fracture?
greenstick fracture
smiths fracture
blood supply to scaphoid?
at risk of AVN
….
intracapsular fracture - hip replacement
intertrochanteric fracture - dynamic hip screw
double malleolar fracture
+ fibula dislocation?
Dx?
next steps?
RUL collapse
next Ix = CT
Dx?
Hila should look like chevrons (arrow pointing in the way)
Sarcoidosis!! Or TB, or lymphoma
Bilateral hilar lymphadenopathy
Ng tube gone into right bronchus
lateral tibial plateau fracture
posterior dislocation - lightbulb sign
large bowel obstruction
