IMAGING - Imaging Emergency Patients Flashcards
Identify the following features on this normal right lateral radiograph of the thorax
Identify this commonly seen artifact seen on thoracic radiographs
You can tell it is a skin fold as the line of the fold will extend beyond the thoracic cavity
What is a TFAST ultrasound?
A TFAST is a systematic ultrasound examination that focuses on identifying the presence of fluid within the pleural and pericardial cavities
Which two quadrants should you assess when carrying out an TFAST ultrasound?
Pericardial region
Chest tube region
What are you looking for in the pericardial region during a TFAST ultrasound?
You are looking for a pericardial effusion at the pericardial region during a TFAST ultrasound
Where do you place the transducer (probe) to assess the pericardial region during a TFAST ultrasound?
Place the transducer (probe) on the ventral thorax between the 5th and 6th intercostal spaces to evaluate the pericardial region
What are you looking for in the chest tube region during a TFAST ultrasound?
You are looking for a pleural effusion at the chest tube region during a TFAST ultrasound
Where do you place the transducer (probe) to assess the chest tube region during a TFAST ultrasound?
Place the transducer (probe) on the dorsolateral thorax between the 7th and 9th intercostal spaces to evaluate the chest tube region
What are the three characteristic signs of a pneumothorax on a radiograph?
- Heart elevated from the sternum
- Retraction of the lung lobes with free gas between the lung and the thoracic wall
- Increased lung opacity
How can you tell if there is free gas between the lungs and the thoracic wall?
If there is a loss in demarcation of the pulmonary vessels then it is free gas
Why does a pneumothorax result in increased lung opacity on a radiograph?
A pneumothorax causes lung collapse which reduces the air in the lung, resulting in increased opacity on a radiograph
Identify the features of this radiograph that indicate this patient has a pneumothorax
Identify the features of this radiograph that indicate this patient has a pneumothorax
What is a bulla/bleb?
A bulla/bleb is a pocket of gas within the lung parenchyma itself
What are two possible causes of a bulla/bleb?
Traumatic rupture of the lung parenchyma
Age related change
(T/F) An existing bulla/bleb can cause a spontaneous pneumothorax
TRUE.
What are the five characteristic signs of a tension pneumothorax on a radiograph?
- Heart elevated from the sternum
- Retraction of the lung lobes with free gas between the lung and the thoracic wall
- Increased lung opacity
- Flat or concave diaphragm
- Increased size of intercostal spaces
What is one of the characteristic signs of a pneumothorax on ultrasound?
In a normal patient, you should see the pleural line glide slightly on ultrasound as the patient breathes. If the patient has a pneumothorax, this glide sign is lost
What is the characteristic sign of pulmonary contusions on a radiograph?
Increased lung opacity/alveolar lung patterns
Why do pulmonary contusions result in increased lung opacity/alveolar lung patterns on a radiograph?
Pulmonary contusions are bruising of the lung parenchyma caused by leakage of blood and oedema into the alveoli and thus this fluid accumulation within the alveoli increases lung opacity on radiographs
(T/F) Pulmonary contusions are often seen in conjunction with a pneumothorax
TRUE. This is important as you get increased lung opacity with both pneumothorax and pulmonary contusions so it is important to monitor pneumothorax patients for several days to check for progressive pulmonary contusions
Which two features on ultrasound can be indicative of pulmonary contusions?
B-lines
C-lines
What are B-lines and how can they be indicative of pulmonary contusions?
B-lines are vertical artifacts that appear as echogenic lines extending from the pleural line into the lung parenchyma on ultrasound. B-lines are indicative of fluid accumulation in the alveoli and are thus indicative of pulmonary contusions
What are C-lines?
C-lines are irregular pleural lines
What are three characteristic signs of pulmonary effusion on a radiograph?
Decreased visualisation of the cardiac shadow
Retraction of the lung lobes surrounded by fluid opacity
Scalloped margins of the lung
(T/F) A loss of the cardiac shadow on lateral radiographs inidcates increased severity of the pleural effusion compared to dorsoventral and ventrodorsal radiographs
TRUE.
What type of pleural effusion is indicated by rounded lung lobes
Rounded lung lobes are indicative of more chronic pleural effusions or an exudate effusion
What are the two characteristic features of a pneumomediastinum on a radiograph?
Visible contents within the mediastinum
Increased visibility of the ventral wall of the trachea
What are two characteristic features of a diaphragmatic rupture on a radiograph?
Presence of abdominal structures in the thorax
Loss of visualisation of the diaphragm
What are two characteristic features of a diaphragmatic rupture on ultrasound?
Presence of abdominal structures in the thorax
Loss of diaphragmatic line
What is the characteristic feature of a pericardial effusion on a radiograph?
Large rounded heart with undefined margins
What is the characteristic feature of a pericardial effusion on ultrasound?
Heart surrounded by anechoic fluid
Identify the anatomical structures on this normal lateral radiograph of the canine abdomen
Identify the anatomical structures on this normal lateral radiograph of the feline abdomen
Identify the anatomical structures on this normal ventrodorsal radiograph of the feline abdomen
Where do you place the transducer (probe) to assess the diaphragmatic-hepatic region during an AFAST ultrasound?
Place the transducer (probe) in a subxiphoid location to evaluate the diaphragmatic-hepatic region
Where do you place the transducer (probe) to assess the spleno-renal region during an AFAST ultrasound?
Place the transducer (probe) on the left dorsal flank to evaluate the spleno-renal region
Where do you place the transducer (probe) to assess the cysto-colic region during an AFAST ultrasound?
Place the transducer (probe) on the caudoventral abdomen to evaluate the cysto-colic region
Where do you place the transducer (probe) to assess the hepato-renal region during an AFAST ultrasound?
Place the transducer (probe) on the right dorsal flank to evaluate the hepato-renal region
What is the characteristic sign of a peritoneal effusion on a radiograph?
Loss of demarcation of the abdominal organs, usually with only lumenal gas still easily visible
Why do you get a loss of demarcation of the abdominal organs with peritoneal effusion?
Usually the abdominal organs are demarcated due to the presence of serosal fat surrounding the organs (remember fat appears darker on radiographs than soft tissue) however when there is fluid in the abdomen, this demarcation is lost as fluid is the same colour as soft tissue which causes the organs to blend in with the fluid
What is the characteristic sign of a peritoneal effusion on ultrasound?
Anechoic fluid surrounding the abdominal organs
Why is it important to use ultrasound over radiography to identify peritoneal effusion in thin or young animals?
Thin and young animals have limited serosal fat so have poor demarcation of their abdominal organs normally, so it can be difficult to identify a peritoneal effusion in these animals on a radiograph
What is the characteristic sign pneumoperitoneum on a radiograph?
Being able to clearly see the caudal margin of the diaphragm
When would it be normal to see peritoneal gas?
It would be normal to see peritoneal gas following an exploratory laparotomy
What is usually indicated by the presence of both free gas and fluid in the abdomen?
Perforation of the gastrointestinal tract
What are the three characteristic signs of a gastric dilatation volvulus (GDV)?
Rotated stomach (pylorus is dorsal and the fundus is ventral)
Gaseous distention of the stomach
Dilated small intestine
What are the characteristic signs of splenic and hepatic haematomas on ultrasound?
Heterogenous mass with anaechoic areas
What kind of diagnostic imaging should you use to diagnose a urinary tract rupture?
Positive contrast radiography
What is the characteristic sign of urinary rupture on a positive contrast radiograph?
Contrast extravasation (leakage of the contrast)
What is depicted on this radiograph?
Multiple rib fractures
What is depicted on this radiograph?
Sternal dislocation
What is depicted on this radiograph?
Spinal dislocation
What is a characteristic sign of an open fracture on a radiograph?
Free gas within the soft tissues
