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Radiology (Ben) > emergency radiology > Flashcards

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
Q

non-traumtic emergencies: headache - causes

A
  • stroke
  • sinus thrombosis (sinus cavernosus)
  • trigeminal neuralgia
  • ophthalmological causes
  • sinusitis
  • complicated otitis
  • infections
  • hydrocephalus
26
Q

imaging modalities for headache

A
  • x-ray
  • CT
  • MRI
  • not US
27
Q

x-ray in headache

A
  • bones
  • abnormal soft tissue densities
  • air
  • niveau-s (levels)
  • 2 directions
28
Q

CT in headache

A
  • without CM: to rule out bleeding and herniations
  • with CM for angio
  • bony structures
29
Q

MRI in headache

A
  • stroke
  • infections
  • tumors
30
Q

chest pain - causes

A
  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
Q

imaging modalities for chest pain

A
  • x-ray
  • US
  • CT
  • not MRI
32
Q

x-ray in chest pain

A
  • cardiopulmonary status
  • PTX
  • fluid
  • pneumomediastinum
    • CM
33
Q

US in chest pain

A

pleural, pericardial fluid

34
Q

CT in chest pain

A
  • all that of x-ray -> more accurately
    • CM for angio
  • bony structures
35
Q

pain in the epigastrium: causes

A
  • MI
  • peptic ulcer
  • acute cholecystitis
  • perforated esophagus
36
Q

pain in the LUQ: causes

A
  • ruptures spleen
  • gastric ulcer
  • aortic aneurysm
  • perforated colon
  • pyelonephritis
  • (L) pneumonia
37
Q

pain in the LLQ: causes

A
  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
Q

pain in the RUQ: causes

A
  • acute cholecystitis
  • duodenal ulcer
  • hepatitis
  • congestive hepatomegaly
  • pyelonephritis
  • appendicitis
  • (R) pneumonia
39
Q

pain in the RLQ: causes

A
  • 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
Q

imaging modalities in abdominal pain

A
  • x-ray
  • US
  • CT
41
Q

x-ray in abdomina pain

A
  • 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
Q

US in abdominal pain

A
  • solid - fluid
  • free fluid
  • niveau
  • (free air)
  • color Doppler
43
Q

CT in abdominal pain

A
  • 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
Q

Hangman’s fracture

A

On the second cervical vertebra, right under the dens

45
Q

Whiplash mechanism

A

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
Q

Main goal in head injury imaging

A

First find possible intracranial bleeding -> start with CT!!
* especially when there is neurological deficit!

47
Q

Types of intracranial bleeding

A

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
Q

Fractures - important questions

A
  • where?
  • what type?
  • location of fragments
  • is joint affected?
  • complete or incomplete?

Radiology (Ben) (13 decks)

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