Images Flashcards
NG tube position checklist
Extradural
Contusion
Subdural haematoma
Intracapsular NOF
Digital subtraction angiography showing occlusion of left common iliac artery
Sigmoid volvulus
Apple core lesion - oesophageal carcinoma
ERCP with stone in common bile duct
Colles’ fracture
Pneumothorax
Hiatus hernia
Diaphragmatic hernia
Misplaced NG
Barium enema - diverticulosis
Ruptured AAA
AAA
Polycystic kidney disease
Raised hemidiaphragm (phrenic nerve injury) due to lung cancer
C6 fracture
Radioisotope bone scan showing metastases
Small bowel obstruction
Large bowel obstruction
Fracture in left parietal bone with fracture under scalp
Pneumoperitoneum
AC joint dislocation
Dynamic hip screw (DHS)
Hip replacement
Extracapsular NOF
Tibia and fibula fractures
This is therefore a junctional supraventricular tachycardia (SVT): a narrow-complex tachycardia originating from the AV node.
Treatment includes vagal manoeuvres followed by adenosine.
Atrial flutter would be a reasonable differential as the rate is regular and close to 150. However, there is no variation in the baseline and not a hint of sawtooth appearance so this is less likely than SVT.
IVH - On CT imaging it appears as hyperdensity within the dark CSF spaces within the ventricles.
Colles - ‘dinner fork type deformity’
Features of the injury
1. Transverse fracture of the radius
2. 1 inch proximal to the radio-carpal joint
3. Dorsal displacement and angulation of the distal radius
Smith’s fracture (reverse Colles’ fracture)
1. Volar angulation of distal radius fragment (Garden spade deformity)
2. Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
Optic disc swelling secondary to raised ICP – papilloedema
Mimics:
* Papillitis = inflammation of optic disc, optic neuropathies
* Malignant HTN
* Uveitis
* Graves’ compressive ophthalmopathy
* Pseudopapilloedema (optic disc drusen, hypermetropic discs, tilted discs)
Investigations:
* BP
* Urgent neuroimaging with MR venography to rule out cavernous sinus thrombosis
Heart failure
Alveolar batwing shadowing
Kerley B lines
Cardiomegaly
Upper lobe Diversion
Pleural Effusion
R renal stones (also horseshoe kidney)
Pleural effusion
Opaque shadowing with blunting of costophrenic angle and meniscus
Transudative (protein <25): CCF, nephrotic syndrome, CLD, hypothyroidism, Meig’s syndrome
Exudative (protein >35): infection, inflammation, malignant
Light’s criteria used if protein 25-35. Exudative if:
* Effusion:serum protein >0.5
* Effusion:serum LDH >0.6
* Pleural LDH >⅔ upper limit of normal serum
AV nipping – Grade 2
Hypertensive retinopathy
Grade 1 – mild-moderate arteriolar narrowing 🡪 copper wiring
Grade 2 – moderate-severe arteriolar narrowing; exaggerating light reflex; arteriovenous crossing changes 🡪 silver wiring, AV nipping
Grade 3 – retinal arteriolar narrowing and focal constriction, retinal oedema, retinal haemorrhage, cotton wool spots
Grade 4 – above + optic disc swelling
Gout of MTP
Soft tissue swelling in early disease
Periarticular erosions ‘punched out lesions’ in late disease
Normal joint space
Type B aortic dissection - decending aorta
Ring enhancing lesion (T1 w/contrast)
DDx - abscess, TB, neurocysticercosis, mets, glioblastoma, lymphoma, toxo
Sub retinal haemorrhage = rupture of choroidal vessels under fovea in interface between choroid and retina
Commonly a/w age-related macular degeneration
Psoriatic arthropathy
Pencil in cup
X-ray showing some of changes in seen in psoriatic arthropathy. Note that the DIPs are predominately affected, rather than the MCPs and PIPs as would be seen with rheumatoid. Extensive juxta-articular periostitis is seen in the DIPs but the changes have not yet progressed to the classic ‘pencil-in-cup’ changes that are often seen.
Pancreatic cancer - lumpy area in the middle
Small bowel obstruction
tension pneumothorax
Small chest drain in situ
Basal atelectasis left
Surgical emphysema within mediastinum and soft tissue
Digital Subtraction Angiogram Left leg demonstrating occlustion of the left SFA – reconstituting lower through collaterals
Left NOF
Barium enema demonstrating diverticular disease within the sigmoid colon
AP Pelvis demonstrating a Left THR
Left subdural with some midline shift
Achalasia
Double contrast enema. Apple core stricture with lead piping of sigmoid colon (UC). Some diverticular disease
UC with loss of haustration, lead piping
Autosomal Dominant Polycystic Kidney Disease
Autosomal dominant polycystic kidney disease
CT of the abdomen (coronal reformats) demonstrates both kidneys to be markedly enlarged by innumerable cysts ranging in size from a few millimetres to multiple centimetres. These cysts also vary in density: most are near-water density, some are hyperdense, others are calcified.
Also present are numerous cysts in the liver. The pancreas is unremarkable.
Features are consistent with autosomal dominant polycystic kidney disease, which was subsequently confirmed.
Sigmoid volvulus
dilation causes the classic coffee-bean sign, a pathognomonic of sigmoid volvulus.
Patient presenting with hypercalcaemia
Multiple osteolytic lesions secondary to multiple myeloma
Also know as ‘rain-drop skull’
Subcapital fracture (intracapsular)
Pneumothorax
Causes of white out on CXR
Pleural plaques: associated with asbestos exposure (but also previous empyema or radiotherapy); classically apex sparing
Upper zone opacification
RUL = limited by horizontal fissure
LUL = indistinct heart border if lingula
Middle lobe opacification
Indistinct heart border
Lower lobe opacification
Indistinct diaphragm border
Lobar collapse on CXR
raised hemidiaphragm, tracheal deviation - may be from obstruction WITHIN airway e.g. tumour/mucous plugging/inhaled FBAO or OUTSIDE the airway e.g. tumour/lymphadenopathy
Right upper lobe collapse
Right middle lobe collapse
Depression of the horizontal fissure with subtle middle zone pacification
Right lower lobe collapse
Sail sign = triangular opacity with double R heart edge
Left upper lobe collapse
Veil sign = whole left lung field covered by veil (extends from left hilum and fades inferiorly) with elevated left hemidiaphragm and tracheal deviation
Left lower lobe collapse
Sail sign = triangular retrocardiac opacity with apparent double R heart edge
Retrocardiac mass: lung cancer until proven otherwise
General approach for AXR interpretation
SBO vs LBO
Sigmoid vs caecal volvulus
Pneumatosis intestinalis (intramural gas): ischaemia until proven otherwise - shows as foci of gas densities that outline bowel wall
Pneumoperitoneum: perforated viscus; Rigler’s sign may be visible; proceed to erect CXR after 15 minutes
Anterior vs posterior shoulder dislocation on XR
Anterior shoulder dislocation
Posterior shoulder dislocation
Hill Sachs
Bankart lesion
Normal XR elbow
Radial head dislocation
Classification of supracondylar fractures
Supracondylar fracture (Gartland 1 - minimally displaced)
Supracondylar fracture (Gartland 2 - displaced, posterior cortex intact)
Colles vs Smith fracture
Supracondylar fracture (Gartland 3 - displaced, complete)
Colles fracture
Typically FOOSH forwards
Extra-articular radial # with dorsal (posterior / back of hand) angulation and displacement
Smith Fracture
Typically FOOSH back of hand
Extra-articular radial # with volar (anterior / palmar) angulation and displacement
Monteggia vs Galeazzi
Galeazzi Injury
Galeazzi = Radial # (near wrist) Ulnar dislocation
GRUesome MURder
Monteggia Injury
Monteggia = Ulnar # (near elbow) Radial dislocation
GRUesome MURder
Radial styloid fracture
typically blunt trauma or FOOSH
(AKA Chauffeur / Hutchinson)
Ulnar styloid fracture: typically blunt trauma or FOOSH
Scaphoid fracture: FOOSH / sporting / steering wheel injury
Presents with pain in anatomical snuffbox / on telescoping thumb +/- wrist joint effusion
Boxer’s fracture
Fracture neck 5th metacarpal (little finger) due to axial loading
Bennett fracture
Forced abduction of the thumb = intra-articular fracture proximal first metacarpal
Osteoarthritis
Rheumatoid arthritis
Psoriatic arthritis
Arthritis hands: compare osteoarthritis, rheumatoid arthritis and psoriatic arthritis
Normal hip xray
Anterior hip dislocation
Posterior hip dislocation
Intracapsular (Garden classification)
Intracapsular NOF fracture
Garden classification type I
Intracapsular NOF fracture
Garden classification type II
Intracapsular NOF fracture
Garden classification type III
Intracapsular NOF fracture
Garden classification type IV
Extracapsular (intertrochanteric) fracture
Extracapsular (subtrochanteric) fracture
Knee XR: gout vs pseudogout
congenital bipartite patella
Patella dislocation
Subdural on CT head
Extradural on CT head
Subarachnoid haemorrhage on CT head
SAH
Causes of a ring enhancing lesion on CT/MRI
DR MAGICAL
Cerebral oedema: loss of greywhite matter differentiation; may be result of:
- Vasogenic oedema (disrupted BBB)
- Cytotoxic oedema (normal BBB, ischaemic damage)
Hydrocephalus: ventriculomegaly with compression of the brain parenchyma
Intraventricular haemorrhage: hyperintense (bright) blood within the ventricles (with a fluid level); may be primary: started in ventricles or secondary: extension of extra-ventricular bleed (usually SAH or intracerebral e.g. basal ganglia)
Basal ganglia bleed
