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Trauma > Imaging > Flashcards

Imaging Flashcards

1
Q

Approach to reading Xray?

A

Drs abcdefg
Details
RIPE: rotation, inspiration, picture (ap vs pa ), exposure (penetration)
Soft tissue and bones
Airway
Bones
Cardiac shadow
Diaphragm
Effusions and extras (hardware)
Fields (lung)
Gastric bubble

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2
Q

See picture 6 and label shenton’s line iliopectineal line, ilioischial line, teardrop sign

A

See picture 7
Blue = shenton
Green = iliopectineal
Yellow = ilioischial
Red = teardrop

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3
Q

See picture 8 and label the lines for interpretation of c spine xr (5)

A

See picture 9
Pink= prevertebral soft tissue shadow : between c2-c4 shouldn’t be > 3-5 mm
Blue = anterior vertebral body line :must be in lordosis, smooth, parallel.
Green = posterior vertebral body line
Yellow - spinolaminar line
Black = posterior spinous line. Must converge at 1 point.

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4
Q

How assess rotation on CXR?

A

Distance between clavicular heads must be equal distances from thorace vertebral spinous processes

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5
Q

How assess for adequate inspiration on CXR ?

A

At least 10 ics must be seen (for trauma 9 is fine )

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6
Q

Pa vs ap view CXR ? (Technique, quality, scapula, ribs, clavicles)

A

Pa standing up at radiology department, ap at bedside with portable machine
Pa better quality and can more accurately assess heart size, ap worse quality and often make mediastinum look wide when it is not.
Pa scapula in thorax periphery, ap seen over lung fields
Pa posterior ribs distinct, ap anterior ribs
Pa clavicles project over lung fields, Ap above apex

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7
Q

What is enlarged cardiac shadow on CXR measurement ?

A

> 50% mediastinum

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8
Q

Correct position gastric bubble on CXR ?

A

Left diaphragm

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9
Q

See picture 10 and label the normal CXR

A

See picture 11

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10
Q

What does fracture of ribs 1 and 2 usually indicate?

A

Severe force and potentially severe injury

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11
Q

Possible complication fracture ribs 4-9?

A

Pneumothorax, hemothorax

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12
Q

Possible complication fracture ribs 1-12? (2)

A

Liver or spleen lacerations, diaphragm injury

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13
Q

What is, causes and is the onset of pulmonary contusion?

A

Haemorrhage into lungs
Most common finding in blunt chest trauma
Appears within 6 h injury and resolve within 48h.

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14
Q

See picture 12 and diagnose pathology.

A

Flail chest

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15
Q

See picture 13 and diagnose pathology.

A

Lung contusion R

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16
Q

See picture 17 and diagnose pathology. (3)

A

• Tension pneumothorax L
• fractures ribs 3-5 posteriorly and associated subcutaneous emphysema
. Fracture mid third left clavicle

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17
Q

See picture 18 and diagnose pathology.

A

Pneumomediastinum
Mediastinal pleura displaced from left heart border and continuous diaphragm sign

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18
Q

See picture 19 and diagnose pathology.

A

Pneumopericardium

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19
Q

See picture 20 and diagnose

A

Haemothorax

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20
Q

See picture 21 and diagnose pathology.

A

Haemothorax

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21
Q

See picture 22 and diagnose pathology

A

Widened mediastinum (top) and cardiomegaly

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22
Q

See picture 23 diagnose pathology. (3)

A

• Diaphragm rupture
• herniation bowel through diaphragm L
• resulting in mediastinal shift to right.

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23
Q

See picture 24 and diagnose pathology.

A

Subcutaneous emphysema

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24
Q

See picture 25 and diagnose pathology.

A

Haemopneumothorax. Perfectly straight line due to mixture air and fluid

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25
Q

Name 3 indications emergency Ct abdo

A

• stable with acute abdo
• free air/fluid
• surgery planning

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26
Q

Which 2 imaging investigations are mandatory in trauma?

A

Cxr and pxr

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27
Q

What kind of ct done in trauma?

A

Iv contrast enhancement, except in tbi

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28
Q

What type of scan best for cervical spine if indicated?

A

Ct- plain radiograph poor diagnostic value. Only do if spine stable.

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29
Q

When should Lodox stat scan be used?

A

End of primany survey before commence secondary survey to id major injuries

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30
Q

Which areas should be assessed with efast?

A

• 2x lung fields for pneumothorax
• right upper quadrant for free air
• left upper quadrant
• subcostal
• pelvis

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31
Q

Most common place for free fluid in right upper quadrant on eFAST?

A

Morrison’s pouch - hepatorenal recess / subhepatic space

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32
Q

How tell If pneumothorax on eFAST?

A

Presence of pleural sliding line normal. Absence = pneumothorax

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33
Q

Name 10 pitfalls of eFAST in trauma

A

1.operator, equipment, patient dependant
2. Making management decisions on indeterminate or suboptimal images
3. Bowel gas
4. Artefacts
5. Blood clots vs FF
6. Delay resuscitation
7. Binary question vs specific injury
8. No serial scans
9. Non-traumatic fluid collections
10. Retroperitoneal space can’t see

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34
Q

According to the Canadian Ct head rule, it’s only required for minor head injury patients with any one of which findings? (7)

A

High risk (for neurological intervention)
1. GCS < 15 at 2 hours after injury
2. Suspected open or depressed skull fracture
3. Any sign of basal skull fracture
4 vomiting ≥ 2 episodes
5-age ≥ 65

Medium risk for brain injury on Ct
6. Amnesia before impact ≥ 30 min
7. Dangerous mechanism (pedestrian, occupant ejected, fall from elevation ≥ 3 feet or 5 stairs)

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35
Q

To which patients does the Canadian Ct head rule not apply? (5)

A

• Non-trauma cases
. GCS <13
• age < 16
• Coumadin or bleeding disorder
• obvious open skull fracture

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36
Q

Identify pathology picture 37

A

Compression fracture

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37
Q

Identify pathology picture 38

A

Compression fracture

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38
Q

Identify pathology picture 39

A

Compression fracture

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39
Q

Identify pathology picture 40

A

Compression fracture

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40
Q

Identify pathology picture 41

A

Burst fracture

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41
Q

Identify pathology picture 42

A

Burst fracture

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42
Q

Identify pathology picture 44

A

Flexion distraction injury lumbar

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43
Q

Identify pathology picture 47

A

Fracture dislocation and spinal cord compression

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44
Q

Identify pathology picture 48

A

Fracture dislocation

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45
Q

Identify pathology picture 50

A

Lisfranc injury

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46
Q

Identify pathology picture 51

A

Extradural haematoma- lenticular shape hyperdensity

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47
Q

Identify pathology picture 52

A

Intraventricular haemorrhage

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48
Q

Identify pathology picture 53

A

Pseudo-aneurysm on Ct angio

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49
Q

Identify pathology picture 54

A

Subdural haemorrhage acute and chronic

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50
Q

Identify pathology picture 55

A

Tile pelvic fracture type c: rotationally and vertically unstable

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51
Q

Label picture 56

A

See picture 57

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52
Q

Identify pathology picture 58

A

Knee dislocation

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53
Q

Identify pathology picture 59

A

Salter Harris 1 (physis separations) fracture

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54
Q

Identify pathology picture 60

A

Ruptured diaphragm - air bubble and NGT in L hemithorax

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55
Q

Identify pathology picture 61

A

Anterior knee dislocation

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56
Q

Identify pathology picture 63

A

Posterior knee dislocation

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57
Q

Identify pathology picture 65

A

Torus or buckle fracture

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58
Q

Identify pathology picture 66

A

Plastic ulna deformity (bowing) with radial head dislocation

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59
Q

Identify pathology picture 67

A

Salter Harris 5 (crush) fracture

60
Q

Identify pathology picture 68

A

Salter Harris 4 (epiphysis to metaphysis ) (intra-articular) fracture

61
Q

Identify pathology picture 69

A

Pancreatic oedema and necrosis

62
Q

Label picture 70

A

See picture 71

63
Q

Identify pathology picture 72

A

Bilateral infiltrates in ARDS

64
Q

Identify pathology picture 73

A

Monteggia fracture

65
Q

Identify pathology picture 74

A

Galeazzi fracture

66
Q

Identify pathology picture 75

A

Surgical emphysema

67
Q

Identify pathology picture 76

A

Displaced femur neck fracture

68
Q

Identify pathology picture 77

A

Multiple dilated loops of small bowel with air fluid levels
= small bowel obstruction

69
Q

Identify pathology picture 78

A

Free air under diaphragm
Could be perforated peptic ulcer

70
Q

Identify pathology in picture 79

A

Greenstick fracture

71
Q

Identify pathology in picture 80

A

Osteogenesis imperfecta

72
Q

Identify pathology in picture 81

A

Supracondylar fracture displaced
Most common fracture around elbow

73
Q

Identify pathology in picture 82

A

Supracondylar fracture: flag sign

74
Q

Identify pathology in picture 83

A

Bayonet fracture

75
Q

Identify pathology in picture 84

A

Osgood schlattler disease
Osteochondrosis-patellar tendon insert onto prox tibia growth plate. Ossicles.

76
Q

Identify pathology in picture 85

A

Acromioclavicular joint dislocation

77
Q

Identify pathology in picture 86

A

Undisplaced supracondylar fracture (flag sign)

78
Q

Most common place free fluid on efast?

A

Between spleen and diaphragm (subdiaphragmatic)

79
Q

Most common place free fluid on efast LUQ?

A

Subdiaphragmatic between diaphragm and spleen

80
Q

Most common place free fluid on efast pelvis?

A

Pouch of Douglas between uterus and rectum

81
Q

Most common place free fluid on efast subcosta/sub-xiphisternal?

A

Pleural effusion /tamponade

82
Q

What diagnosis can you make on fast of lung fields?

A

Pneumothorax

83
Q

Identify pathology on picture 87

A

Inferior vena cava, not free fluid!
Other pitfalls of RUQ include gallbladder, perinephric fat, fluid in bowel, rib shadow

84
Q

Identify pathology on picture 88

A

Perinephric fat, not free fluid!
Other pitfalls LUQ include stomach, rib shadow

85
Q

Identify pathology on picture 89

A

Free fluid subdiaphragmatic between spleen and diaphragm. Most common place for free fluid on fast!

86
Q

Label picture 90 of LUQ fast.

A

See picture 91

87
Q

Identify pathology on picture 92

A

Free fluid in morrison’s pouch and around free edge of liver
From l to R: LIVER, r kidney, free fluid

88
Q

Label RUQ fast on picture 93

A

See picture 94

89
Q

Label RUQ fast on picture 95

A

See picture 96

90
Q

Identify pathology on picture 97

A

Free fluid in pouch of Douglas.
From l to R: uterus, bladder (top),

91
Q

Label pelvis fast on picture 98

A

See picture 99

92
Q

Identify pathology on picture 100

A

Edge artifact on pelvis view, not free fluid!
Other pitfall = seminal vesicles

93
Q

Identify pathology on picture 101

A

Pericardial effusion

94
Q

Identify pathology on picture 102

A

Pleural effusion left, pericardial effusion right.
Other pitfalls: epicardial fat, aorta,
From top to bottom: rv, lv, ra, LA

95
Q

Identify pathology on picture 103

A

None, normal lung field with pleural sliding line
On either side: ribs

96
Q

Identify pathology on picture 104

A

Rib shadows, not free fluid!

97
Q

Identify pathology on picture 105

A

Rib shadows, not free fluid!

98
Q

How assess c spine xray?

A

ABCDe
Adequate coverage, alignment
Bodies
Cortical outlines
Disc spacing
Edges and soft tissue

99
Q

What should be requested if top of t1 not visible on lateral c spine xray?

A

Swimmer’s view

100
Q

Where is the spinal cord on lateral C spine xray?

A

Between posterior vertebral and spinolaminar line

101
Q

What could disruption of spinolaminar line on lateral c spine xray indicate?

A

Subluxation (dislocation)

102
Q

What does shortening of vertebral body on xray indicate?

A

Compression fracture

103
Q

What should soft tissues measure on lateral C spine xray?

A

373 rule
C1 to edge c3, soft tissue line should be < 7 mm
From c3 onwards shouldn’t be more than 3 cm. (Haematoma )

104
Q

What should be looked for in odontoid view of c spine? (5)

A

Adequacy: c1 and c2
Alignment: lateral processes same, space between lateral masses of c1 and odontoid peg equal
Bodies: c2 body clearly seen
Cortical outline: c2, check especially for fracture around odontoid peg
Edges and soft tissue: mandible fracture

105
Q

Name the phases of Ct scan

A

• Pre-contrast
. Contrast: arterial, porto-venous, venous
• delayed

106
Q

Identify pathology on picture 106

A

Liver laceration with extravasation. (Leakage)
Blue arrow = large laceration r lobe liver
Black arrows = blood in peritoneal cavity
Red = active extrasation of iv contrast

107
Q

Identify pathology on picture 107

A

Liver laceration

108
Q

Identify pathology on picture 108

A

Liver lacerations

109
Q

Identify pathology on picture 109

A

Splenic rupture

110
Q

Identify pathology on picture 110

A

Gastric perforation

111
Q

Identify pathology on picture 111

A

Perforated gastric ulcer

112
Q

Identify pathology on picture 112

A

Pneumoperitoneum due to perforated gastric ulcer

113
Q

Identify pathology on picture 113

A

Left Ct scan. Black arrows= intracerebral haemorrhage right temporal lobe
White = subarachnoid haemorrhage in basal cisterns.
Arrowhead = intraventricular haemorrhage 4th ventricle.

Right Ct angio = aneurysm

114
Q

Identify pathology on picture 114

A

Intracranial haemorrhage parietotemporal lobe

115
Q

Identify pathology on picture 115

A

Hydrocephalus (dilatation lat ventricles)

116
Q

Which injury should not get iv contrast for ct?

A

TBI

117
Q

Indication for angiography?

A

Endovascular intervention required eg embolization, stenting

118
Q

Identify pathology on picture 116

A

Unifacetal dislocation: bow tie sign
Anterior dislocation vertebral bodies

119
Q

Identify pathology on picture 117

A

Hangman fracture c2 (red = fracture)
Disruption ant line, pre-vertebral soft tissue swelling (orange)
Blue = ant dislocation c2

120
Q

Identify pathology on picture 119 (2)

A

Loss alignment lateral masses c1 and c2
Widened space between peg and lateral masses c1

121
Q

Identify pathology on picture 120 (4)

A

Loss alignment posterior and spinolaminar lines
Perched facets and dislocation injury c5 c6
Displacement of body is more than 50% of body width therefore bifaceted dislocation
Widening pre-vertebral soft tissue

122
Q

Identify pathology on picture 121

A

Odontoid peg fracture
Cortical ring c2 incomplete and break in ant line at c1 level

123
Q

Which phase of Ct scan is represented in picture 122?

A

Arterial
Aorta round circle and take up contrast, vena cava no contrast and oval shape.

124
Q

Identify phase of Ct contrast on picture 123

A

Venous
Vena cava has taken up more contrast, vena cava and aorta almost =

125
Q

Identify pathology on picture 124

A

Chronic epidural haematoma

126
Q

Identify pathology on picture 125

A

A: depressed skull fracture after shotgun injury
Bi contusion

127
Q

Identify pathology on picture 126

A

A: linear skull fracture
Bi epidural haematoma secondary to MMA rupture

128
Q

Identify why this xray is inadequate picture 127

A

Overexposed because can se all vertebral bodies with obvious intervertebral spaces

129
Q

Identify pathology on picture 128

A

Acetabular fracture

130
Q

Identify Ct phase picture 129

A

Portovenous
Still some contrast in aorta, but not as much. Portal vein clear. IVC beginning to fill

131
Q

Identify Ct phase picture 130

A

Delayed phase
No contrast in aorta or vena cava. Renal calices contrasted.

132
Q

Identify pathology on picture 131

A

Pubic ramus fracture

133
Q

Identify pathology on picture 133

A

Pubic rami and ischium fracture

134
Q

Identify pathology on picture 134

A

Fracture body C7

135
Q

Identify pathology on picture 135 (3)

A

C2 body fracture
Misalignment lateral borders c1 and c2
Difference in space between odontoids process and lateral masses c2

136
Q

Identify pathology on picture 136

A

Open book fracture
Pubic symphysis and sacroiliac joint separation

137
Q

Why is picture 138 not adequate?

A

Can’t see C7 and neck too extended hiding C1
(Must see c1 - T1)

138
Q

Identify pathology on picture 139

A

Magnification of heart and widened mediastinum

139
Q

Why picture 140 not adequate xray?

A

Underexposed - can’t see any vertebrae.

140
Q

Identify pathology on picture 141

A

Right femoral neck fracture

141
Q

Identify pathology on picture 142

A

Antero-inferior hip dislocation (rare)

142
Q

Identify pathology on picture 143

A

Posterior hip dislocation-common

143
Q

Identify pathology on picture 144 (3)

A

LODOx
Unstable floating knee
Tib-fib comminuted fractures
Femur distal fracture

144
Q

Identify pathology on picture 145

A

Spinous process of c7 fracture and T1 fracture

145
Q

Identify pathology on picture 146

A

Abdominal aortic aneurysm

146
Q

Identify pathology on picture 147

A

Extradural bleed

147
Q

Sign of duodenal injury on barium xray?

A

Coil spring sign

Trauma (21 decks)

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