Radiology Flashcards
CXR - pneumothorax
region of lucency around the edge of the lung (with a visible lung edge)
lucency of the entire hemithorax
+ mass effect (mediastinal shift/depression of diaphragm) + rib# !! tension !!
*one way flap valve - MS compresses vessels and heart
Rx: A to E, decompress with large bore cannula in safe triangle – insert chest drain
CXR - lobar pneumonia
patchy opacification (with air bronchograms)
+/- pleural collection
+/- cavitation
+ loss of heart border and hemi-diaphragm
most likely a lobar pneumonia - usually CAP (S. pneumo, H. Influenzae)
CXR - lobar collapse
dense shadow in x
+ mediastinal shift/tracheal deviation towards
+/- raised horizontal fissure
Causes - foreign body, asthma (mucus plug), cancer
if RUL = density in the RUZ, raised horizontal fissure, loss of right heart border
if LLL = triangular opacity in the LLZ, obscured left hemidiaphragm
+/- bloods, CT, bronchoscopy
retrieval of foreign body or chest physio
CXR - acute pulmonary oedema
upper lobe diversion inc heart size pleural effusions peri-hilar opacification +/- air bronchograms septal lines
CXR - pleural effusion
blunting of the costophrenic angle with a visible meniscus
I would ideally review a lateral view
DDx for opacification on CXR
fluid (pulm oedema)
pus (pneumonia)
blood (pulm haemorrhage)
cells (malignancy)
DDx for bilateral hilar lymphadenopathy
inf, inflam, malignancy
tb, sarcoid, lymphoma
CXR - NG tube
- descend in the midline
- intersect the carina
- travel through the gastro-oesophageal junction
- tip visible 10cm below the diaphragm
CT head - subdural
peripheral hyperdense crescent-shaped collection (central hypodensity represents active bleeding)
hyperdense > isodense > hypodense
not limited by sutures, may fill dural reflections
+/- mass effect
acute ? head injury
subacute/chronic = confusion/vague neurology
~ tearing of bridging veins
Rx: correct any clotting abnormalities, repeat CT, get neurosurgical opinion
CT head - extradural
peripheral hyperdense lens-shaped collection
(well-demarcated haemorrhage between brain and skull)
acute: hyperdense
bound by skull sutures
+/- associated injuries, e.g. fracture,
+/- mass effect and midline shift
high impact trauma, young patients ~ middle meningeal artery
= headache, focal neurology, LOC
Rx: urgent consideration of neurosurgical intervention - burr hole (smaller bleeds - conservative Rx)
CT head - stroke
post-infarction - hypodense region
acute haemorrhage/clot in vessel - hyperdensity
= sudden neuro deficit, Sx depends on vascular territories
Rx: depends on time of onset but can include thrombolysis (excluded haemorrhagic and no CIs), thrombectomy (for proximal circulation), aspirin > long term clopi
CT head - mass
variety of appearances ~
hypo- or hyperdense, irregular, well-defined, peripheral or deep lesions
+/- mass effect
CT head - subarachnoid
hyperdensity in the cisterns and sulci suggestive of blood
older middle-age ~ rupture of berry aneurysm, or trauma = headache, meningism, confusion/low GCS Ix: LP? Rx: cause, neurosurgical opinion (coil/clip aneurysms), high fluid intake, CCB
AXR - Sigmoid volvulus
large dilated loop of colon which arises in the pelvis (LLQ), extends towards the RUQ, forming a coffee bean sign.
ahaustral
+/- ascending, transverse and descending colon may be dilated
~ chronic constipation
Rx: endoscopic decompression with sigmoidoscope
AXR - Caecal volvulus
twisting of the large bowel which appears to arise in the pelvis RIF and extends towards epigastrium or LUQ
haustral pattern is maintained
+/- distended small bowel
= colicky abdominal pain, vomiting, and abdominal distension
AXR - small bowel obstruction
multiple loops of dilated bowel in the central abdomen, with lines across them suggesting valvulae conniventes
~ adhesions, herniae. Rx: decompression (NG) and IV fluids \+/- surgery * ischaemia, perforation
AXR - large bowel obstruction
dilated bowel in the abdominal peripheries, with haustral markings suggesting a large bowel obstruction
mechanical (neoplasm, diverticular stricture, volvulus) or non-mechanical (pseudo-obstruction - air in bowel)
AXR - colorectal cancer
•Apple-core stricture with shouldered margins
+/- obstruction, perforation
RFs: dec fibre, IBD, familial, smoking
Sx: CBH, PR mass, obstruction, PR bleed, FLAWS
Rx: Duke’s staging, MDT, colonoscopy for biopsy (grade)
Radical excision
CXR - perforation
•Air under the diaphragm aka pneumoperitoneum – forms crescent beneath diaphragm.
*if shown an abdominal x-ray (double wall sign), you should request to see the erect x-ray.
Causes:
•Spontaneous perforation i.e. ulcer
•Iatrogenic: laparoscopy insufflation.
•Traumatic
Rx: drip and suck, NBM, fluids, analgesia, Abx
Barium swallow - oesophagus (cancer)
•Irregular, shouldered stricture of the oesophagus – an ‘apple-core’ lesion.
•Where?
*Distal third – adenocarcinoma (more common ~ GORD - Barrett’s).
*Proximal third – squamous cell carcinoma (~smoking/ETOH).
Sx: prog dysphagia, wt loss, if upper - hoarseness, cough
Ix: OGD + biopsy.
•Staging: CT, EUS, laparoscopy, mediastinoscopy.
Management:
•MDT.
•Oesophagectomy: 25% (Ivor-Lewis 2 stage, McKeown 3 stage)
•Palliation: 75% of patients (stenting, analgesia)
Barium swallow - oesophagus (achalasia)
•Proximal dilatation of the oesophagus with smooth distal tapering towards the GEJ – the bird’s beak appearance.
+/- aspiration pneumonia
Focal motility disorder of the oesophagus caused by degeneration of the myenteric plexus = disrupted oesophageal peristalsis causing impaired relaxation of the lower oesophageal sphincter
Sx: dysphagia to liquids then solids, cramps, regurg, wt loss
Rx: CCB, botox injection, balloon dilation, myotomy
CXR - causes of white out
Complete white out of the left hemithorax
? massive effusion - trachea away
? collapse - trachea towards
? pneumonectomy - trachea towards
? pneumonia/oedema/mesothelioma - same position
Bilateral - ARDS - pneumonia, sepsis, drowning
CXR - causes of cavitating lesion
Infection - S aureus, TB
Inflammation - granuloma, rheumatoid
Malignancy - SCC
CXR - lung metastases
peripheral, round lesions of variable size, scattered throughout both lungs
~ metastases
breast carcinoma colorectal carcinoma renal cell carcinoma uterine leiomyosarcoma head and neck squamous cell carcinoma
Digital subtraction angiogram
- Vessel stenosis.
- Distal filling by collaterals.
Presentation:
Acute: 6Ps = pain, pallor, pulseless, perishingly cold, paraesthesia, paralysis.
Chronic: asymptomatic, intermittent claudication, rest pain, ulceration and gangrene, Leriche Syndrome (ED + buttock claudication).
XR - colles fracture
Extra-articular # of the distal radius.
Dorsal displacement and angulation of distal fragment.
FOOSH + osteoporosis
- Resuscitate + manage life-threating injuries.
- Assess NV injury: median nerve + radial artery.
- Reduction + fixation:
o Bier’s block (with prilocaine) – allows analgesia.
o Dorsal backslab with 3-point pressure. - Fracture clinic appointment for orthopaedic assessment
Describe this fracture on XR
“This is a plain radiograph of the upper/lower of x patient. Ideally, I’d have another view and compare to any previous imaging”
PADS
Pattern- “There is a complete/incomplete, transverse/olique/spiral’ fracture”
Anatomy- “of the distal/mid/proximal 1/3rd of the left/right x bone”
Deformity- “with anterior/posterior, medial/lateral, dorsal/volar” translation or angulation
Soft tissues, joint involvement, ?impaction
“I’d ideally assess for soft tissue injury, if the fracture is open/closed and the neurovascular status of the limb”
Complications
There are general complications associated with surgery and immobility and specific. Specific complications can be immediate, early or late. Immediate includes damage to NV or adjacent soft tissue, bleeding and pain. Early includes compartment syndrome, VTE/PE, infection.
Late includes malunion or non-union, AVN, joint disease and neuropathic pain.
General - surgery = ABD, BPI, immobility = 5Ws
