emergency radiology Flashcards
levels of treatment in emergencies
- acute / reanimation: 3 hrs
- primer: 1-2 days
- secunder: 3-6 days
- tercier: from day 7
phases of acute level
- “alfa” - ABC -> the first minute
Airway, Breath, Circulation - “bravo” - circulation -> the first 5 minutes -> CXR
- “charlie” - diagnose life-threatening diseases, begin adequate therapy -> the first 30 minutes -> imaging modalities
spinal injuries - imaging
- conventional x-ray
- BUT: spinal cord injuries exist without abnormalities on x-ray (SCIWORA) -> (CT), MRI
- never use ultrasound in spinal injuries
spinal injuries - mechanism
- flexion
- extension
- rotational
- compressional
- “shear”
possible localisation of spinal injury
- 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
x-ray in spinal injury
- bones - fractures
- pathological soft tissue densities
- at least in two directions
- SCIWORA
CT in spinal injuries
- to see more accurately the pathologies (eg. tiny bony fractures)
- 3D reconstructions
- other structures
MRI in spinal injury
- to rule out spinal cord injuries
- SCIWORA
imaging modalities in head injuries
- x-ray
- CT
- not US, MRI
x-ray in head injuries
- bones
- abnormal soft tissue or air densities
- at least in two directions
CT in head injuries
- rule out intracranial bleeding (without CM)
- with CM for angio
- bones, fractures
- also allows evaluation of the ossicles, in the middle ear cavity
injuries of the chest
- 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
x-ray in chest injuries
- cardiopulmonary status
- PTX
- pleural fluid
- status of the mediastinum
- rupture of diaphragm
- contusion
- “radiodens” foreign bodies
- bones
US in chest injuries
- pleural fluid
- pericardial fluid
CT in chest injuries
- without CM: pleural, pericardial fluid, contusion, fractures, radiopaque FBs + localisation
- with CM for angio
imaging modalities in abdominal & pelvic injuries
- x-ray
- US
- CT
- not MRI
x-ray in abdominal & pelvic injuries
- free air
- abnormal soft tissue injuries
- radiopaque FBs
- bones
- CM
US in abdominal & pelvic injuries
- free fluid
- rupture of parenchymal organs
- injuries of vessels
- (free air)
CT in abdominal & pelvic injuries
- without CM: free air, fluid, ruptures, bones, radiopaque FBs + localisation
- with CM: angio, ruptures, injuries of ureters + bladder
- bones
imaging modalities in musculoskeletal system injuries
- x-ray
- US
- CT
- MRI
x-ray for musculoskeletal system
- bones - fractures
- 2 directions
- abnormal soft tissue densities
US for musculoskeletal system
- soft tissues
- joint
- vessels
CT for musculoskeletal system
- bony structures - accurately
- + CM for angio
MRI for musculoskeletal system
- soft tissues
- ligamental injuries
non-traumtic emergencies: headache - causes
- stroke
- sinus thrombosis (sinus cavernosus)
- trigeminal neuralgia
- ophthalmological causes
- sinusitis
- complicated otitis
- infections
- hydrocephalus
imaging modalities for headache
- x-ray
- CT
- MRI
- not US
x-ray in headache
- bones
- abnormal soft tissue densities
- air
- niveau-s (levels)
- 2 directions
CT in headache
- without CM: to rule out bleeding and herniations
- with CM for angio
- bony structures
MRI in headache
- stroke
- infections
- tumors
chest pain - causes
- frequent:
- acute MI
- esophagitis
- pneumonia
- PTX
- pulmonary embolism - rare:
- dissection of aorta
- cholecystitis
- herpes zoster
- rupture of esophagus (Boerhaave syndrome)
- pancreatitis
- compressional fractures of vertebras
imaging modalities for chest pain
- x-ray
- US
- CT
- not MRI
x-ray in chest pain
- cardiopulmonary status
- PTX
- fluid
- pneumomediastinum
- CM
US in chest pain
pleural, pericardial fluid
CT in chest pain
- all that of x-ray -> more accurately
- CM for angio
- bony structures
pain in the epigastrium: causes
- MI
- peptic ulcer
- acute cholecystitis
- perforated esophagus
pain in the LUQ: causes
- ruptures spleen
- gastric ulcer
- aortic aneurysm
- perforated colon
- pyelonephritis
- (L) pneumonia
pain in the LLQ: causes
- upper part:
- intestinal obstruction
- acute pancreatitis
- early appendicitis
- mesenteric thrombosis !
- aortic aneurysm !
- diverticulitis - lower part:
- sigmoid diverticulitis
- salpingitis
- tubo-ovarian abscess
- ruptured ectopic pregnancy !
- incarcerated hernia
- perforated colon
- Chron’s disease
- ulcerative colitis
- renal/ureteral stone
pain in the RUQ: causes
- acute cholecystitis
- duodenal ulcer
- hepatitis
- congestive hepatomegaly
- pyelonephritis
- appendicitis
- (R) pneumonia
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
imaging modalities in abdominal pain
- x-ray
- US
- CT
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
US in abdominal pain
- solid - fluid
- free fluid
- niveau
- (free air)
- color Doppler
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
Hangman’s fracture
On the second cervical vertebra, right under the dens
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
Main goal in head injury imaging
First find possible intracranial bleeding -> start with CT!!
* especially when there is neurological deficit!
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
Fractures - important questions
- where?
- what type?
- location of fragments
- is joint affected?
- complete or incomplete?
