Imaging the Emergency Patient Flashcards
what are common traumatic injuries (6)
- pneumothorax
- pulmonary contusion
- pleural effusion (fluid)
- ascites
- diaphragmatic rupture
- fracture/luxations
identify the normal structures of the thorax (7)
- trachea
- cranial vena cava
- main stem bronchi
- bronchi
- pulmonary vessels
- caudal vena cava
- diaphragm
what are the criteria of imaging modalities (5)
- readily available
- conscious or mild sedation
- rapid
- minimal stress/not invasive
- easy to interpret (quality of image)
what are the prioritized areas
- thorax
- abdomen
- spine
- head
- limb
what is the effect of over exposure
too dark
lack of contrast
misdiagnose a pneumothorax
what are the effects of under exposure
too white
too little differentiation
misdiagnose abdominal fluid
what are anatomic artefacts
skin fold/lines
what should you normally see in the thorax (5)
- heart
- diaphragm
- trachea
- lungs (blood vessels)
- thoracic wall (ribs, sternum, vertebrae)
what should you look for to identify abnormalities
- loss of normal structure
- loss of normal architechture
what are traumatic lesions that can happen in the thoracic wall (4)
- diaphragmatic rupture
- fractured ribs
- fractured or dislocated sternum
- flail chest
what are some traumatic lesions that occur to the intrathoracic cavity (6)
- pneumothorax
- pulmonary contusion
- pneumomediastinum (cervical, pharyngeal?)
(1-3 more common)
- pleural effusion (hemothorax, chylothorax)
- cardiac tamponade (pericardial effusion)
- lung lobe torsion
(4-6 less common)
how does a pneumothorax present on radiograph (3)
- heart raised from sternum
- retraction of lung lobes –> free gas between lung and thoracic wall & loss of vascular markings peripherally
- increased lung opacity
what is occuring here
pneumothorax
what is occuring here
pneumothorax
free gas with no pulmonary markings
what are lung bulla/blebs
permanent air filled space within the lung –> lung trauma not clinically significant but if pop can lead to development of pneumothorax
what are the signs of a tension pneumothorax (4)
- heart raised from sternum
- retraction of lung lobes –> loss of vascular markings peripherally
- diaphragm pushed caudally –> diaphragm flat or concave
- increased intercostal spaces
what is a tension pneumothorax
air pressure is continually increased that can be developed in the lung paranchyma emergency
diaphragm flattened appearance
rounded chest
very poor gas exchange –> imminent danger for animal
what is the appearance of pulmonary contusions
lung has soft tissue opacity –> blood, edema
commonly seen but not always with pneumothorax
what is shown here
pulmonary contusion
how does pleural effusion appear on radiograph
- loss of cardiac shadow (DV, lateral if marked/severe effusion)
- retraction of lung lobes (soft tissue opacity in pleural space, outlines lungs, interlobar fissures, leaf or scalloped edges)
what is shown here
pleural effusion
may see faint lines running between intercostal spaces
how does a diaphragmatic rupture show on radiograph (6)
- can’t see diaphragm
- gas filled tubes of intestines in thorax
- abdomen is missing small intestine loops –> empty abdomen
- displaced/absent falciform fat
- cranial displacement of pylorus
- loss of diaphragmatic line
+/- pleural effusion
what is shown here
diaphragmatic rupture
how does pneumomediastinum show on radiograph
- visible contents of mediastinum
may track under skin
- tracheal/esophageal perforation
- cervical/pharyngeal wound
air building up in mediastinum space –> increased visibility of structures here (vascular structures)
how is pericardial effusion best diagnosed
ultrasound
what does ability to identify organs depend on
- presence of intra-abdominal fat
- presence of gas in GI tract
what is aFAST and what are the 4 points
4 point check
- diaphragmohepatic: aiming up to liver
- splenorenal (dorsally on left)
- cystocolic (ventrally in front of pubis)
- hepatorenal (right side dorsally, kidney and back of liver)
how does peritoneal fluid appear on radiograph (4)
- organs not visible
- loss of serosal detail (loss of SI wall, only lumenal gas)
- pot belly
- displacement of small bowel may suggest organ of origin
what is shown here
peritoneal fluid
what does presnece of peritoneal fluid appear on ultrasound
anechoic between organs
what does presence of peritoneal fluid indicate
rupture of liver (hemoabdomen), spleen, bladder (uroabdomen), GI tract (septic peritonitis)
what would gas +/- fluid in the abdomen indicate
rupture of GI tract
what is shown here
peritoneal fluid in abdomen
what causes peritoneal gas
GI rupture
what is shown here
peritoneal gas
lat decubital horizontal –> air under abdominal wall
what does peritoneal gas & fluid indicate
peritonitis
what is shown here
peritonitis
loss of detail –> free fluid highlighting of caudal surface of diaphragm
how does GDV appear on radiograph
- rotated stomach
- dilated SI (smurf hat, popeye arm)
how does a spleen hematoma appear on ultrasound
- large mass
- anechoic areas
what is shown here
spleen hematoma
what is shown here
spleen hematoma
how does urinary rupture appear on radiograph
- +/- ascites (free fluid)
- +ve contrast (air runs risk of embolism)
what is shown here
urinary rupture
how does a urinary rupture appear on ultrasound
anechoic area around organ
what is shown here
urinary rupture
what are the sources of urinary rupture
bladder
urethera
ureter/kidney
what occurs on contrast radiograph with a urinary rupture
contrast extravasates
what trauma can occur to the axial skeleton
- ribs & sternum
- head & spine
- fractures
- dislocations
what is shown here
rib fractures
what is flail chest
number of ribs each with 2 fractures –> move paradoxically with respiration
what is shown here
flail chest
collapsing in chest wall moves in when inhale
what is shown here
sternum fractures, dislocations
what is shown here
spinal dislocations
displacement of T11 to T12
what is shown here
spinal dislocation
what trauma can occur to the head
hematoma
hemorrhage
fracture
wha trauma can occur to the appendicular skeleton
fracutres
dislocations
fracture dislocations
what is occuring here
chip fracure with gas under skin –> open
what is occuring here
open fracture –> gas under skin –> infection
what is occuring here
misalignment with C1 and C2 with bone fragments
what is occuring here
retraction of lung lobe with free gas
pneumothorax
increased opacity of lung lobe
pulmonary contusion
free gas under skin emphysemia
what is occuring here
marked subcutaneous air
tracheal wall highlighted –> pneumomediastinum
heart shadow raised from sternum & gas beneath
caudal lobes collapsed from thoracic wall
black area (gas) around lobes –> pneumothorax
lobes increased in soft tissue opacity –> contusion
avulsion of rib 7
what is occuring here
straight white line –> artefact
in good body condition –> subcut and falciform fat
poor abdominal detail –> fluid
suspicious gas in peritoneal cavity –> ruptured viscus
peritonitis
what is occuring here
vessels in mediastinum obvious
air tacking along aorta into abdomen
tracheal wall defined (normal lumen surface only)
trachea elevated
cardaic shadow is wider (4ic) & taller than normal, football shaped –> margins sharp –> pericardial effusion
what is shown in this US
cardiac lumen and wall surrounded by large anechoic area –> pericardial effusion
what is shown here
loss of serosal detail
gas gap betweein diaphragm and liver
free gas bubbles retroperitoneally & in region of small bowel
