Images Flashcards
Present this x-ray
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?
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?
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?
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
Right subcapital NOF fracture with disruption of shenton’s line
Garden’s classification?
Mx?
Present this xray
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
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
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
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
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?
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?
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?
Double contrast barium enema
Shows diverticular disease and an inflammatory stricture (i.e. has diverticulitis)
What is this?
What does it show?
Double contrast barium enema.
Apple core stricture of the sigmoid colon- sigmoid carcinoma
What is this? What does it show?
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?
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?
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?
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?
Barium meal of the stomach.
Shows para-oesophageal hiatus hernia and a gastric ulcer
What is this?
What does it show?
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?
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.
What is this?
What does it show?
How would you manage?
Erect AP chest radiograph
Shows air under both hemidiaphragms.
Suggests a perforated intra-abdominal viscus e.g. perforated peptic ulcer.
Management- require laparotomy to find perforation.
NB: Size of air does not correlate with perforation location.
What is this?
What does it show?
Plain abdominal radiograph.
Showing air both sides of the bowel (i.e. Rigler’s sign), suggestive of a perforated intra-abdominal viscus.
NB: Skipped over in lecture as “you;ll never see that ever”
What is this?
What does it show?
This is a percutaneous transhepatic cholangiogram- note the presence of a catheter needle to introduce contrast into the biliary tree. Can only do this if there is dilatation of the biliary tree i.e. there is biliary obstruction (they are jaundiced)
Shows a dilated common biliary tree due to stone at ampulla or vater.
What is this?
What does it show?
Erect abdominal radiograph
Shows dilated loops of small bowel with valvulae conniventes
NB Skipped in lecture
What is this?
What does it show?
Supine abdominal radiograph
Showing dilated small bowel loops showing valvulae conniventes
What is this?
What does it show?
This is an intravenous urogram (taken at 60 minutes)
This shows enlarged dilated calyceal systems with the lower poles of the kidney directed medially, suggestive of a horseshoe kidney
What is this?
What does it show?
Intravenous urogram
Shows dilated ureter and pelvis of the left kidney due to obstruction in the upper 1/3rd of the ureter, with clubbing of the calyces
Can see in control image the stone responsible for obstruction
What is this?
What does it show?
Ureteric obstruction due to a pelvico-ureteric junction stone
What is this?
What does it show?
Abdominal radiograph
Calcified panceas due to chronic pancreatitis
What is this?
What does it show?
Erect chest radiograph
Shows a post traumatic diaphragmatic hernia (i.e. diaphragmatic rupture), most commonly post traumatic i.e. RTAs in young men
Here there is some transverse colon herniating through the diaphragm
What is this?
What does it show?
This is an erect chest radiograph.
There is deviation of the trachea to the left. This is associated with a large left sided fluid level and absence of lung markings in the upper zone of the left lung. It is therefore likely that this patient has had a left pneumonectomy
What is this?
What does it show?
This is a double contrast barium enema showing multiple abnormalities:
1) apple core stricture in the upper sigmoid colon, suggestive of an apple core lesion.
2) Mild lead piping, suggestive of long standing UC
3) Some diverticula in the lower sigmoid/rectum
What is this?
What does it show?
Supine abdominal radiograph showing dilated loops of large and small bowel
What is this?
What does it show?
Erect abdominal xr showing dilated small and large bowel with multiple fluid levels
What is this?
What does it show?
Gastrograffin enema of a patient with the enema catheter visible.
Shows a mechanical obstruction at the recto-sigmoid junction
Gastrograffin enema: Used to image colon and rectum. Inserted through catheter. Has a laxative effect
What is this?
What does it show?
Abdominal radiograph showing calcified gallstones
What is this?
What does it show?
Erect chest radiograph showing the presence of air under the diaphragm
Due to a perforated abdominal viscus eg. perforated duodenal ulcer
Perforation is on the right- if can see outline of the liver with air above indicates the lesion is on the right.
Cf- LHS, bubble in stomach, contained
What is this?
What does it show?
Plain Chest radiograph showing
1) Right sided pneumothorax
2) left upper lobe consolidation
What is this?
What does it show?
AP abdominal radiograph showing dilated stomach and small bowel with valvulae conniventes
This is suggestive of a small bowel obstruction
What is this?
What does it show?
Barium swallow
Achalasia
What is this?
What does it show?
Plain radiograph of the pelvis showing numerous osteolytic bone metastases
From breast ca
What is this?
What does it show?
What other investigations can be done?
When does this pathology occur? Why?
How would the patient present?
How would you manage this patient?
Abdominal radiograph showing a caecal volvulus (coffee bean sign)
Other ix- contrast enema with “bird’s beak” sign,
Due to twisting of the caecum on its mesentery causing varying degrees of luminal obstruction and compression of vessels, resulting in ischaemia.
Present with gradual onset abdominal pain (colicky) with obstructive features- nausea, vomiting, constipation with tender and distended abdomen ± peritonitis
Mx: Emergency laparotomy if very distended with ischaemia. Otherwise right hemicolectomy or ileocaecal resection with anastamosis.
What is this?
What does it show?
Chest radiograph showing lung metastases
Look like “little balls”, not associated with lung parenchyma,
What is this?
What does it show?
Where and when does this pathology occur?
Pharyngeal pouch- an outpouching proximal to the upper oesophageal sphincter.
Most patients present age 60-80 with dysphagia and globus sensation. Due to weakness in the oesophageal wall.
Strong association with hiatus hernia and GORD
Ix- barium swallow.
Mx- endoscopic or open diverticulectomy
What is this?
What does it show?
Barium swallow showing an enlarged stomach due to pyloric outlet obstruction
Causes: Benign including PUD and malignant
What is this?
What does it show?
Why does the pathology occur?
What symptoms would the patient complain of?
How would you manage this patient?
Abdominal radiograph showing a sigmoid volvulus (bent inner tube sign).
When the sigmoid colon twists on its mesentery causing luminal obstruction and mesenteric vessel compression causing venous obstruction.
Gradual onset continuous ± colicky pain with vomiting, constipation and abdominal distension
Mx: Flexi sigmoidoscopy to reduce the volvulus. Emergency laparotomy in patients with suspected ischaemia or peritonitis or where flexi sig has failed.
What is this?
What does it show?
What is the clinical signficance of this?
How would you manage this patient?
MRI scan showing the mesorectum.
The arrow is pointing to a tumour encroaching the mesorectum
Part of the staging process- if the circumferential margin of the mesorectum is threatened, require radiotherapy prior to surgery to improve prognosis. Also enables visualisation of metastasis.
What is this?
What does it show?
This is an MRI scan of the rectum and mesorectum.
It shows a metastasis of one the lymph nodes of the pelvic side wall.
MRIs can also be done to determine the presence of metastases which is important for staging
What is this?
How is this carried out?
What does it show?
This is a CT pneumocolon
Patient requires bowel prep, a small catheter is inserted into the anorectum and used to fill the bowel with air before being put into the CT scan.
This shows malignancy
What is this?
What else can this investigation be used for?
What does it show?
CT pneumocolon. ? normal?
Can use software to do a virtual reconstruction of the bowel- virtual colonoscopy.
NB not obstructed! have introduced air.
What is this?
What does it show?
When does this occur?
How does it present?
How is it managed?
Abdominal radiograph showing toxic megacolon, most commonly affecting the right or transverse colon. Dilatation >6cm on supine films
Usually occurs as a complication of IBD or infectious colitis
Patients often present with bloody diarrhoea, lower abdominal tenderness and distension along with peritonitis and signs of being systemically unwell.
Mx:
IV corticosteroids for IBD + abx and bowel rest and decompression with NGT
Surgical mx: Indications include perforation and haemorrage. Usually subtotal colectomy with end ileostomy and subsequent reanastamosis is usually performed.
