Images Flashcards
Present this x-ray
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/628/470/q_image_thumb.jpg?1457337558)
Pneumoperitoneum + Rigler’s sign
Causes of pneumoperitoneum: Perforated hollow viscus e.g. PUD, malignancy, obstruction, diverticulitis/appendicitis, pneumomediastunum, post op, PD
Most sensitive ix?: Erect CXR
Mx: Omental patch repair (open/lap)
DDX: Pseudopneumoperitoneum
What is this?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/628/532/q_image_thumb.jpg?1457538999)
Barium swallow (fluoroscopy) of achalasia- bird beak sign
What is achalasia?: Disorder characterised by impaired relaxation of the lower oesophageal sphincter and failure of peristalsis –> dysphagia
Ix: Barium swallow, oesophageal manometry- see dilated oesophagus with food particles and narrowing at the gastro-oesophageal junction
Mx: Medical- CCBs
Non-surgical- botulinum toxin injection, lasts 12 months
Surgical: Pneumatic dilatation, surgical myotomy (Heller’s procedure) + Nissen fundoplication
What is this?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/628/615/q_image_thumb.jpg?1457338479)
CT head showing extradural heamatoma with midline shift
Subperiosteal haematoma between the skull and the dura mater. Limited by cranial sutures. Typically biconvex (lentiform) shape seen
Cause: Young patients post head trauma with associated skull fractures. Clear history of head trauma, lucid period.
Mx: ABCD, neurosurgical clot evacuation
Which artery is damaged?: Middle meningeal artery most common
What is this?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/628/878/q_image_thumb.jpg?1457338898)
ERCP showing multiple gallstones in the gallbladder and cystic duct
Mx: Conservative, cholecystectomy, ERCP- removed using basket
Complications?: High- 5% risk pancreatitis (especially with sphincterotomy), haemorrhage, infection (cholangitis) and perforation (pneumoperitoneum)
Present this x-ray
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/875/862/q_image_thumb.jpg?1457515742)
Right subcapital NOF fracture with disruption of shenton’s line
Garden’s classification?
Mx?
Present this xray
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/876/242/q_image_thumb.jpg?1457516821)
Bilateral pneumocaths
Multiple right sided rib fractures
Abnormal density LL zone, cannot trace gastric bubble
Gas bubble appears above normal position
Mild right shift of mediastinum
Diaphragmatic rupture- most commonly due to trauma e.g. RTA
Present this xray
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/876/930/q_image_thumb.jpg?1457517247)
L shoulder showing prosthetic humerus but intact glenoid
Stemmed shoulder hemiarthroplasty
Indications: OA, RA with pain limiting every day activities and all medical mx (physio, NSAIDS, steroid injection) failed
Present this xray
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/877/115/q_image_thumb.jpg?1457517482)
Resurfacing hemiarthroplasty
Preserves bone, reduces risk of loosening associated with TSR
REcommended if humoral head severely fractured or arthritic but socket normal, or large rotator cuff tear and likely TSR would fail
Present this xray
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/877/319/q_image_thumb.jpg?1457517726)
Total shoulder arthroplasty- both glenoid and humerus replaced
What should you always say when presenting any xray?
- What the XR is
- What part of the body
- What does it show?
- Then likely to discuss condition you see
Present this x-ray
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/899/272/q_image_thumb.png?1457539087)
Plain abdominal radiograph showing a calcified abdominal aortic aneurysm.
Abdominal aortic aneurysms are operated on once they are 5.5cm+ as this is when the risk of rupture exceeds the risk of morbidity and mortality at surgery
Screening surgery exists- one off USS at 65 yo
What is this?
Which side is the patient lying on?
How is this imaging done?
What is the abnormality?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/900/996/q_image_thumb.png?1457539258)
Double contrast barium enema
Lying on right side as can see from fluid level
Get a Foley catheter through the anus, pass barium in. Patient asked to move or table is tipped so barium moves around.
Abnormality- apple core lesion in ascending colon, indicates malignancy
What is this?
How is it done?
What does it show?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/901/655/q_image_thumb.png?1457539444)
Barium follow through
Barium contrast agent is swallowed and a series of radiographs can be taken to visualise the small intestine.
Shows cobblestoning (islands of normal tissue interspersed with disease) and rose thorn ulcers (look prickly), suggestive of Crohn’s colitis
What are barium meals used for? How are they done?
To study the lower oesophagus, stomach and duodenum
Barium contrast swallowed, radiographs then taken
What is a barium swallow used for?
To examine the pharynx and oesophagus
What is a double contrast barium enema?
Series of x-rays taken after insertion of barium into the rectum as an enema.
Air is put into the colon to further enhance the images
A series of radiographs are then taken
What is this?
What does it show?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/902/303/q_image_thumb.png?1457539873)
Double contrast barium enema
Shows diverticular disease and an inflammatory stricture (i.e. has diverticulitis)
What is this?
What does it show?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/902/547/q_image_thumb.png?1457539972)
Double contrast barium enema.
Apple core stricture of the sigmoid colon- sigmoid carcinoma
What is this? What does it show?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/903/725/q_image_thumb.png?1457540876)
Double contrast barium enema
Shows loss of haustra resulting in a “lead pipe” appearance- suggestive of ulcerative colitis
What is this?
What does it show?
How would this patient present?
How do you manage it?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/903/836/q_image_thumb.png?1457540996)
ERCP- endoscopic retrograde cholangiopancreatography
Shows multiple impacted gall stones with a dilated common bile duct.
Patient would likely present with pain and jaundice
Remove the stones using a basket or balloon- can cannulate through ERCP to remove
What is this?
What does it show?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/903/976/q_image_thumb.png?1457541187)
Plain abdominal radiograph
Four large calcified gallstones in the gallbladder (lie outside outline of kidney therefore has to be gallbladder)
NB: Only cholesterol and pigment gallstones are radioopaque depending on the degree of calcification. I.e. only 10-30% of gallstones radioopaque. Imaging of choice for cholelithiasis is USS.
What is this?
What does it show?
What is this condition?
How do you diagnose it?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/904/105/q_image_thumb.png?1457541449)
This is a barium swallow of a patient with linitis plastica.
This is an infiltrative disease of the stomach that is cancerous and prevents the stomach from dilating. It is often picked up late, resulting in a poor prognosis.
Aka leather bottom stomach. Often associated with breast and lung cancer.
Diagnosed using a barium meal or follow through.
What is this?
What does it show?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/904/571/q_image_thumb.png?1457541698)
Barium meal of the stomach.
Shows para-oesophageal hiatus hernia and a gastric ulcer
What is this?
What does it show?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/904/804/q_image_thumb.png?1457541900)
This is a barium swallow shown in 2 views.
Demonstrates a stricture in the middle 1/3rd of the oesophagus
Suggestive of oesophageal carcinoma
What is this?
What does it show?
What is the pathology? How is it acquired? Why does it develop?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/182/904/881/q_image_thumb.png?1457542020)
This is a barium swallow shown in 2 views
This shows multiple filling defects affecting the whole eosophagus, suggestive of oesophageal varices.
Abnormal dilation of the venous system, acquired due to portal hypertension. Varices can also develop in the rectum and oesophagus. Occur as there is a large pressure difference- in the peritoneum there is anastamosis of the portal system, the GI system and the systemic system. Wherever a differential in pressure develops, varices will develop.