Radiology Flashcards
AXR Tox Ingestions
Radio-dense Tablets
- Iron tablets
- Potassium Chloride (KCL Tablets)
Metals
- Mercury
Iatrogenic
- Barium
Aortic Dissection CXR
- Widened mediastinum > 8cm aortic arch
- Abnormal aortic contour - Aortic knuckle deformity/irregular or indistinct
- Calcium sign >5mm (separation of intiminal calcification from vessel wall)
- Pleural effusion L>R
- Tracheal shift to RHS
- Left apical cap
- NGT deviation to RHS at T4
- Widening of Right paratracheal-stripe >5mm
- Normal in 11-16%
Apical cap is formed when blood dissects above the lung on either side Left more sensitive than Right
CXR
ADV
Readily available
Bedside
Fast
Low radiation
May see other pathologies
CONS
Low sensitivity for some pathologies
May miss other diagnoses
AXR / XR KUB
ADV
Readily Available
Fast
Low radiation - monitoring renal stone
CONS
Low sensitivity
Unable to assess complications of pathology
USS
ADV
Readily available
Non-invasive
No radiation
Preferred mode for pregnant patient
Bedside procedure
CONS
Operator dependent
Formal may not be available 24/7
Difficult with large body habitus
Echo
ADV
Readily available
Non-invasive
No radiation
Bedside procedure
CONS
Operator dependent
Formal may not be available 24/7
Difficult with large body habitus
Limited by pt positioning or SC emphysema
Ct angio
CT A/P
MRI
ADV
Non-invasive
No radiation
Other causes identified
CONs
Not easily available
Time consuming
Expensive
Accuracy may be less than IVP
IR
USS Duplex
ADV
Non-invasive
Avoids contrast
Bedside
Monitor in ED for deterioration
CONS
Not always available 24/7
Operator dependent
Less sensitive below knee for DVT/embolism
CT KUB
ADV
High sensitivity for renal calculi
Measure size
Location
Detect obstruction
ID other causes of flank pain
Avoid contrast
CONS
Radiation
Higher cost
IVP
ADV
Size and location stone
Measures renal function
CONS
Contrast nephropathy
Contrast allergy
More time consuming than CT
Unable to exclue other diagnoses
Radiation
CXR - Foreign Body aspiration
- Radio-opaque FB
- Hyperinflation affected side
- +/- atelectasis on affected side
- Lobar atelectasis
- Whole lung atelectasis
- Shift of mediastinal shadow
- Aeration within area of atelectasis
C-spine Soft Tissue Swelling
USS Causes No Lung Slide
- Loss of pleural apposition
a. PTx / Pleural
b. Bullae - Increased adhesion between pleural layers
a. Pleural adhesions
b. ARDS
c. Pulmonary fibrosis
d. Pneumonia
e. VATS / pleurodesis - Absent local ventilation
a. Mainstem bronchial intubation
b. Atelectasis
C-spine XR
- Adequate views - C1-T1
- Alignment
- Ant Longitudinal Line
- Post Longitudinal Line
- Spinolaminal Line
- Spinous Process Line
- Bones
- Assess each vertebra for Fracture / Collapse / Avulsion
- Cartilage
- Soft tissue - Prevertebral ST swelling
- 6mm at C2 or 22mm at C6
- 6mm C2 or 14mm at C6 - kids
- Spaces
- Predental space - betw/ C1 tubercle and anterior face of dens
* <3mm adults
* <5mm children - Basion Dental interval
* <12mm XR
* <8.5mm CT - Power’s Ratio (atlanto-occipital dislocation
* AB/CD should be < 1 - Line of Swischuck - line from anterior aspect C1 to C3 spinous processes
* Anterior aspect of C2 should be < 2mm of this line
* Deviated > 2mm ? subluxation
* Deviated < 2mm ? pseudosubluxation
- Predental space - betw/ C1 tubercle and anterior face of dens
- Scan base skull, airway, sinuses
- AP and Odontoid views
[https://www.nyp.org/professionals/emergency-medicine/how-to-read-emergency-images/how-to-read-a-c-spine-film]
[https://dontforgetthebubbles.com/c-spine-x-ray-interpretation/
Power’s Ratio
Basion Dental Interval
Line of Swischuck
Pre-Dental Space
CXR Cavitating Lesions
Infection
Bacterial - Abscess, infected bullae, TB, Empyema
Fungal - Coccidiomycosis, Apergillis, Cryptococcus
Parasitic - Amebiasis, Entomaeba histolytica
Neoplastic
Bronchogenic - SCC or Adenocarcinoma
Metastatic
Lymphoma
Inflammatory
Sarcoidosis
Wegner’s
RA nodules
Vascular - (both bland and septic pulmonary emboli)
Trauma - pneumatoceles
Other
FB aspiration
Younger pts -
CPAM (congenital pulmonary airway malformation)
pulmonary sequestration
Bronchogenic cyst
CXR Solitary Nodules
Only 30-40% malignant
Malignant - Primary Lung or lymphoma
Benign - Hamartoma, chrondroma
Infection - Tuberculoma, Aspergilloma, Abscess, round pneumonia, hydatid disease
Autoimmune - RA, Wegeners
Vasc - AV malformatio, infarct, haematoma
Congenital - brnchial atresia, sequestration
CXR in Pneumonia
Segmental or lobar opacity with air bronchogram – Strep. pneumonia
Cavitation - Klebsiella, Staph aureus
Cavitation + Pleural effusion:
- Staph aureus
- Anaerobes
- Gram negatives
- TB
Lower zones: Legionella
Upper Zones: Klebsiella
*multifocal peripheral ground glass appearance - COVID -19
*round pneumonia (solitary pulmonary nodule)
-C Burnetti
-S pneumoniae
-L pneumophilia
-S aureus
Urogenital injury imaging
USS
ADV- scrotal or penile trauma may be seen
DISADV not sensitive enough for renal/ureteric injury
CT KUB - not helpful
CT IVP
RUG
Foetal Exposure with Imaging
USS Cholecystitis
GB wall > 3mm
Pericholecystic fluid
Enlarged GB
Sonogrpahic Murphy’s sign
Gallstones
Dilated CBD > 10mm (usually less than 6mm)
Gas in biliary tree
Gas in gall bladder - acalculus or gangrenous cholecystitis
USS pleural effusion
Hypoechoic region above diaphragm
Sinusoid sign - atelectic lung moving with respirations
Thoracic psine sign - see spine aobve vlevel of diaphragm
Effusions > 5cm depth usually indicates at least 500ml of pleural fluid
CXR in TB
- Consolidation upper and mid-zone prevelance
- Hilar lymphadenopathy
- Cavitating lesions
- Ghon focus - subpleural calcifcation remains after inital infection
- Fibrosis calcification
- Tuberculoma - well defined mass
- Miliar Pattern - small nodules throughout the lungs
USS Features appendicitis
Appendiceal diameter >6mm
Appendiceal wall thickness >3mm
Non-compressible
Hyperaemia
Surrounding oedema or fat stranding
Appendicolith
