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emergency radiology Flashcards

1
Q

levels of treatment in emergencies

A
  1. acute / reanimation: 3 hrs
  2. primer: 1-2 days
  3. secunder: 3-6 days
  4. tercier: from day 7
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2
Q

phases of acute level

A
  1. “alfa” - ABC -> the first minute
    Airway, Breath, Circulation
  2. “bravo” - circulation -> the first 5 minutes -> CXR
  3. “charlie” - diagnose life-threatening diseases, begin adequate therapy -> the first 30 minutes -> imaging modalities
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3
Q

spinal injuries - imaging

A
  • conventional x-ray
  • BUT: spinal cord injuries exist without abnormalities on x-ray (SCIWORA) -> (CT), MRI
  • never use ultrasound in spinal injuries
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4
Q

spinal injuries - mechanism

A
  • flexion
  • extension
  • rotational
  • compressional
  • “shear”
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5
Q

possible localisation of spinal injury

A
  • anterior column: involves -> ant. longitudinal ligament, ant. half of vertebral body, ant. annulus fibrosus, ant. disc
  • middle column: involves -> post. half of vertebral body, post. annulus / post. disc, post. longitudinal ligament
  • posterior column: involves -> spinous process, laminae, facets, pedicles, post. ligamentous structures: ligamentum flavum, intraspinous ligaments, supraspinous ligaments
  • when at least 2 columns are injured, it means instability
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6
Q

x-ray in spinal injury

A
  • bones - fractures
  • pathological soft tissue densities
  • at least in two directions
  • SCIWORA
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7
Q

CT in spinal injuries

A
  • to see more accurately the pathologies (eg. tiny bony fractures)
  • 3D reconstructions
  • other structures
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8
Q

MRI in spinal injury

A
  • to rule out spinal cord injuries

- SCIWORA

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9
Q

imaging modalities in head injuries

A
  • x-ray
  • CT
  • not US, MRI
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10
Q

x-ray in head injuries

A
  • bones
  • abnormal soft tissue or air densities
  • at least in two directions
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11
Q

CT in head injuries

A
  • rule out intracranial bleeding (without CM)
  • with CM for angio
  • bones, fractures
  • also allows evaluation of the ossicles, in the middle ear cavity
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12
Q

injuries of the chest

A
  • injuries of the chest wall - rib fractures
  • rupture of the diaphragm
  • rupture of the esophagus
  • PTX, hemothorax
  • tamponade
  • rupture of the aorta
  • use x-ray, US, CT
  • not MRI
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13
Q

x-ray in chest injuries

A
  • cardiopulmonary status
  • PTX
  • pleural fluid
  • status of the mediastinum
  • rupture of diaphragm
  • contusion
  • “radiodens” foreign bodies
  • bones
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14
Q

US in chest injuries

A
  • pleural fluid

- pericardial fluid

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15
Q

CT in chest injuries

A
  • without CM: pleural, pericardial fluid, contusion, fractures, radiopaque FBs + localisation
  • with CM for angio
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16
Q

imaging modalities in abdominal & pelvic injuries

A
  • x-ray
  • US
  • CT
  • not MRI
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17
Q

x-ray in abdominal & pelvic injuries

A
  • free air
  • abnormal soft tissue injuries
  • radiopaque FBs
  • bones
    • CM
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18
Q

US in abdominal & pelvic injuries

A
  • free fluid
  • rupture of parenchymal organs
  • injuries of vessels
  • (free air)
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19
Q

CT in abdominal & pelvic injuries

A
  • without CM: free air, fluid, ruptures, bones, radiopaque FBs + localisation
  • with CM: angio, ruptures, injuries of ureters + bladder
  • bones
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20
Q

imaging modalities in musculoskeletal system injuries

A
  • x-ray
  • US
  • CT
  • MRI
21
Q

x-ray for musculoskeletal system

A
  • bones - fractures
  • 2 directions
  • abnormal soft tissue densities
22
Q

US for musculoskeletal system

A
  • soft tissues
  • joint
  • vessels
23
Q

CT for musculoskeletal system

A
  • bony structures - accurately

- + CM for angio

24
Q

MRI for musculoskeletal system

A
  • soft tissues

- ligamental injuries

25
non-traumtic emergencies: headache - causes
- stroke - sinus thrombosis (sinus cavernosus) - trigeminal neuralgia - ophthalmological causes - sinusitis - complicated otitis - infections - hydrocephalus
26
imaging modalities for headache
- x-ray - CT - MRI - not US
27
x-ray in headache
- bones - abnormal soft tissue densities - air - niveau-s (levels) - 2 directions
28
CT in headache
- without CM: to rule out bleeding and herniations - with CM for angio - bony structures
29
MRI in headache
- stroke - infections - tumors
30
chest pain - causes
1. frequent: - acute MI - esophagitis - pneumonia - PTX - pulmonary embolism 2. rare: - dissection of aorta - cholecystitis - herpes zoster - rupture of esophagus (Boerhaave syndrome) - pancreatitis - compressional fractures of vertebras
31
imaging modalities for chest pain
- x-ray - US - CT - not MRI
32
x-ray in chest pain
- cardiopulmonary status - PTX - fluid - pneumomediastinum - + CM
33
US in chest pain
pleural, pericardial fluid
34
CT in chest pain
- all that of x-ray -> more accurately - + CM for angio - bony structures
35
pain in the epigastrium: causes
- MI - peptic ulcer - acute cholecystitis - perforated esophagus
36
pain in the LUQ: causes
- ruptures spleen - gastric ulcer - aortic aneurysm - perforated colon - pyelonephritis - (L) pneumonia
37
pain in the LLQ: causes
1. upper part: - intestinal obstruction - acute pancreatitis - early appendicitis - mesenteric thrombosis ! - aortic aneurysm ! - diverticulitis 2. lower part: - sigmoid diverticulitis - salpingitis - tubo-ovarian abscess - ruptured ectopic pregnancy ! - incarcerated hernia - perforated colon - Chron's disease - ulcerative colitis - renal/ureteral stone
38
pain in the RUQ: causes
- acute cholecystitis - duodenal ulcer - hepatitis - congestive hepatomegaly - pyelonephritis - appendicitis - (R) pneumonia
39
pain in the RLQ: causes
- appendicitis - salpingitis - tubo-ovarian abscess - ruptured ectopic pregnancy - renal/ureteric stone! - incarcerated hernia - mesenteric adenitis - Meckel's diverticulum - Chron's disease - perforated caecum - Psoas abscess
40
imaging modalities in abdominal pain
- x-ray - US - CT
41
x-ray in abdomina pain
- free air - abdominal distention - niveau - abnormal soft tissue densities - abnormal calcifications - Silhouette sign (loss of normal border between thoracic structures -> radiopaque mass) - radiopaque FBs - + CM
42
US in abdominal pain
- solid - fluid - free fluid - niveau - (free air) - color Doppler
43
CT in abdominal pain
- without CM: same as in x-ray and US (except info for vessels), higher sensitivity, localisation, signs of inflammation - with CM: AAA leakage / rupture, vasculature information
44
Hangman’s fracture
On the second cervical vertebra, right under the dens
45
Whiplash mechanism
Typical for car accidents. Irregular shape of spine. X-ray is not enough to give a diagnosis, on spinal cord injury -> MRI will be needed a couple of days later
46
Main goal in head injury imaging
First find possible intracranial bleeding -> start with CT!! * especially when there is neurological deficit!
47
Types of intracranial bleeding
1) crescent shape hyperdensity -> no spread -> subdural 2) epidular: stops at the suture lines -> lense shaped hyperdensity -> due ti direct injury if the meningeal artery 3) contusion - parenchymal bleeding 4) subarachnoidal -> due to aneurysmal rupture
48
Fractures - important questions
- where? - what type? - location of fragments - is joint affected? - complete or incomplete?

radiology (13 decks)

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