Radiology

Question 1

CXR

Answer 1

Line
Trachea
Carina
Lung Field
Heart & borders
Apices, costophrenic angles, behind heart
Soft tissue

3 zones of lung - Nb this is different to the lobes due to the pyramidal shape

Assessing quality

Usually CXR is PA - reduce heart shadow, and therefore ID megaly

Rotated or in the middle (trachea vs the sternum)

Inspiration 7th lateral to midclavicular line (anterior section)

Can you see the spine (penetration)

Assessing normality

Heart shadow should be < half of thoracic

Nb lateral view to see what the heart shadow is covering and posterior costophrenic angle (should be acute)
For tracheal deviation think about the size of lung pushing or pulling
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Mass - greater than 1cm
Nodule - solitary or multiple
Atelectasia - round, linear, segmental
Consolidation - fills alveoli with fluid, ill-defined. Lobar, diffuse, multifocal
Interstitial - fine or coarse. Reticular or fine

Nb consider history first e.g. infection,fever etc.

With increase in age there is interstitial deutestasis. Ie Nb age.

NB when you scan the patient

Interstitial shadowing - usually bilateral and due to viral infection

Don’t forget the lymph nodes - sarcoidosis, lymphoma

Question 2

Abdomen

Answer 2

Diaphragm to hernial orifices

NB to do erect - look for perforation air (wait 10-20min)
- guarded
- tender
Can detect as little as 1ml

Rule of 3/6/9cm for normal
3 = small bowel
6 = colon
9 = caecum

NB structures

NB bones used as landmarks for other structures e.g. ureter and calcifications along this

NB what a calcified structure might be

• underlying anatomy
• if not obvious consider a lymph node

Small bowel
• CENTRAL
• Identify - valvulae conniventes (small white stripes)
• Obstruction
- Presents with: emnesis, nausea, distension, pain
- 3 cm calibre
- Crohn’s - inflammation of distal
- Ileus - no peristalsis e.g. post op, infection, trauma
- if localised, consider pancreatitis

Large bowel
• PERIPHERAL
• Identify - haustra (larger)
• Common conditions
- Colo-rectal carcinoma
- Diverticulitis
- Hernias
- Volvulus
- Adhesions
• Sigmoid volvulus - coffee bean sign (more common)
• Caecal volvulus - caecal embryo sign

Calcified structures

• costochondral cartilages
• gallstones
• lymph nodes
• renal stones
• phlebolite

Lines
JJ stent
NG tube
IVC filter

Bowel wall inflammation
• thumb printing
• lead pipe

Ascites
• blurry

Question 3

Cranial

Answer 3

Fossa:
Anterior
Medial
Posterior

NB cannot see meningeal layers unless there is an abnormality

NB white matter is black on CT

NB shrinkage in the elderly makes trauma more likely

NB calcification of choroid plexus in lateral ventricle is not abnormal

Compression of Foramen of Munro (between third and lateral) is a common cause of hydrocephalus in
• stroke and oedema
• haemorrhage
• cancer

CT is the best modality for haemorrhage

NB lenticulostriate arteries are small and easy to obstruct or haemorrhage -> stroke

Haemorrhages:

1) Intraparenchymal
2) Haemo-ventricle
3) Subarachnoid
- occupies that space
- tear of veins
- usually associated to other injuries
4) Extradural - NB emergency
- convex
- of the dural arteries, small and won’t stop bleeding
- almost always due to fracture
- e.g. pterion and middle meningeal art
- limited by the dural sutures
5) Subdural
- cresent shaped
- torn bridging veins
- e.g. from shaking
- fills that hemisphere