Imaging of the emergency patient

Question 1

What are causes of pneumomediastinum?

Answer 1

perforation of trachea and oesopagus or a cervical or pharyngeal wound

Question 2

Describe a tension pneumothorax

Answer 2

• air pressure in pleural space is increasing above that can be tolerated in the lung creating compression of the lungs resulting in very poor gas exchange
• diaphragm pushed caudally
• diaphragm flat or concave
• retraction of lung lobes
• loss of vascular markings peripherally

Question 3

Describe pulmonary contusion

Answer 3

accompanies pneumothorax

lungs => soft tissue opacity

blood oedema

Question 4

Describe pleural effusion

Answer 4

build up of fluid in the pleural space

loss of cardiac shadow

retraction of lung lobes

soft tissue opacity in outline of lung lobes

interlobar fissures

Question 5

Describe diaphragmatic rupture

Answer 5

not common

empty abdomen

displaced/absent falciform fat

displacement of pylorus

loss of diaphragmatic line- pleural effusion

cant see diaphragm but they are gas filled chambers within the thoracic cavity

Question 6

Describe pneumomediastinum

Answer 6

when air builds up within the mediastinum space

• leads to increased visibility
• greater clairty of vascular structures
• air build up under skin

Question 7

What are the uses of aFast and Tfast?

Answer 7

detect abdominal fluid and pericardial fluid

Question 8

What is checked in Afast?

Answer 8

1. diaphragmohepatic area- behind the sternum at base of liver
2. splenorenal area- dorsally on left looking at L kidney, top of spleen
3. cystocolic area- ventrally infront of pubis looking at the colon and bladder
4. Hepatorenal quadrant- right side dorsally behind last ribs looking at R kidney and back of liver

Question 9

What is checked in Tfast?

Answer 9

1. pericardial site- move ventrally 5-6th intercostal space identify heart
2. chest ube- dorsolateral, 7-9 intercostal space look for pleural effusion

Question 10

What happens to organs due to peritoneal fluid?

Answer 10

become invisible in x-ray

loss of serosal detail- loss of SI wall, only lumneal gas

appearance of pot belly

displacement of intestine

Question 11

What does free gas and fluid in the abdomen suggest?

Answer 11

rupture to the GI tract

Question 12

What are causes of peritoneal gas?

Answer 12

GI rupture or perforation

wound in body cavity

Question 13

How can peritoneal gas be diagnosed?

Answer 13

radiography

caudal margin cant be seen as it is pressed against the liver/stomach

Question 14

What is GDV?

Answer 14

Gastric dilation volvulus syndrome

torsion of the stomach where the pylorus that should be caudal is cranial and the fundus is caudal

Question 15

How is GDV diagnosed?

Answer 15

appears as a smurf hat- band of soft tissue separating the 2 compartments of the stomach

Question 16

How can a spleen haematoma be assessed?

Answer 16

large mass

no free fluid

anechoic areas

spleen

Question 17

How can a urinary rupture be diagnosed?

Answer 17

radiograph with a positive contrast injected up the urethra