Spine and Thorax cards brainscape Flashcards
What does routine routine radiologic eval of C-Spine include?
3-5 projections, of AP open-mouth, AP lower C-Spine, Lateral, & sometimes R & L obliques
Which view demonstrates the Atlanto-Axial Joint (C1-C2)?
AP open mouth
Which view shows 5 lowest Cervical vertebrae?
AP lower C-Spine
Which view shows normal alignment of all 7 cervical vertebrae and facet joints?
Lateral
Which view shows 1-side IVF?
R & L obliques
What 3 lines in Lat view tell you if Cervical alignment is normal?
Ant borders of Vert bodies, Post borders of vert bodies, Juntion of laminae/SPs
What are the borders of basic CT scan & MRI of C-Spine?
Base of skull –> T2
When might you limit size of C-Spine CT?
Pediatric population, to minimize radiation exposure
ABCDs of C-Spine
Alignment/Anatomy, Bone Density/Signal, Canal space/CNS, Disc integrity, & Soft tissues
In severe trauma, ______ is used because (1)______, (2)_______, & (3)_______.
CT, because (1) it’s fast, (2) minimal moving of pt, & (3) head/neck imaged at same time as spine
Which view screens for Fx/dislocation of C-Spine in trauma?
Cross-table lateral.
What 3 things suggest trauma in PFs?
ABN soft tissues, abn vert alignment, abn joint relationships
How do you decide if C-Spine injury is stable or unstable?
Is there a threat to spine cord, now or in the future?
What imaging mode decribes injury to ST, nerves, disk, and neuro deficits?
MRI
What 2 Fx types are characteristic in C-Spine?
Avulsion, Compression
Which C-Spine injury is most unstable/life threatening?
Fx-dislocations
What causes isolated unilateral facet joint dislocations?
Flexion-rotation force
What causes isolated B facet joint dislocation?
Hyperflexion force
______ dislocations are stable injuries.
Unilateral dislocatons without anterior translation
______ or _______ dislocations are unstable injuries.
Bilateral, or unilateral with anterior translation
______ sprains injure the posterior ligaments & ST.
Hyperflexion sprains
______ sprains injure the anterior ligaments & ST.
Hyperextension sprains.
What is worst case for cervical sprain?
Ligamentous tearing, w/transient joint sublux and compression Fx.
Since acute disc hernations aren’t Dx’d with PFs, how do we catch them?
Myelography, or MRI
What view is best for DDD, and what do you look for?
Lateral view. Look for decr disk space height.
What techique best shows disk dehydration and degeneration?
MRI
What will you see in Lateral views for DJD?
Decr facet joint space, sclerosis, osteophytes
Age when most people have some DJD
> 60 y/o
What will Cervical DDD cause at vertebral endplates?
C-Spine Spondylosis, spurring
Ouch, I have spurring on my Ant/Ant-Lat vertebral bodies & annulus? What’s it called?
Spondylosis Deformans. At least your disc height won’t shrink!
Ossification flowing along anterior borders of ≥4 adjacent vertebra
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Will you have DDD or DJD with DISH?
No
How often will you see Ossification of Post Long Lig with DISH?
50% of the time
Which vertebrae will usually have anomolies?
Transitional vertebrae between sections (cerv, thor, lumb, etc.)
What anomoly of upper C-Spine could lead to instability?
Diminutive Dens
What 2 views are used for T-Spine?
Anteroposterior, Lateral
What does Anteroposterior show you?
All 12 vertebrae
What does Lateral show you?
All but top 2-3 vertebrae, which are covered by shoulder.
What views are used for the Sternum?
Posterior oblique, Lateral
What does posterior oblique show you about the Sternum?
Shows the sternum, without the spine getting in the way.
What does Lateral show you about the Sternum?
Shows entire sternum in profile
Which are the above diaphragm ribs?
T1-T9
Which are the below diaphragm ribs?
T8-T12
What does AP or PA show you in the rib department?
Posterior or anterior ribs
What does Ant-Obl or Post-Obl show, for ribs?
Shows axillary ribs
What does PA chest view show?
Screens for rib-Fx complications, like Pneumothorax or hemothorax.
Which injury is most commonly seen on PFs in T-Spine?
Anterior vert body compression Fx.
What are PF signs of Vert body compression Fx?
Step defect -Wedge deformity -Linear zone of impaction -displaced endplates -loss of disk height -paraspinal edema -abdominal ileus
Step defect
Superior enplate displaced forward, visible on lateral view
Wedge deformity
Ant vert body collapsed, giving it triangular or trapezoidal appearance from lateral view.
Linear zone of impaction
White line below superior endplate, shows increased density from acute compression Fx, and later shows callus formation.
What does Abdominal Illeus show, and why is it important?
It shows excess gases in intestines in AP view. Suggests injury to paraspinal autonomic nerves/ganglia, 2º Fx.
What causes T-Spine Fx-dislocation injuries?
High-energy hyperflexion forces, such as MVA or falls from great height.
When is potential for instability greatest in T-Spine Fx-dislocation?
When 2-3 columns are involved.
How often is their neuro involvement in Thoracolumbar Fx’s?
15-20% of the time.
How can you catch rib Fx on subsequent PFs?
Callus formation, or displacement of fragments from breathing.
What will you see with osteoporotic compression Fx’s?
Incr radiolucency, thinning of cortical margins, altered trabecular patterns, wedge deformity, biconcave deformity, vertebra plana deformity, endplate deformity, Schmorl’s nodes
Biconcave deformity
“Fish” deformity, from gradual endplate depression
Vertebra Plana deformity
Vertebra becomes flat-shaped
Endplate deformity
Smooth indentations seen at central enplates
Schmorl’s nodes
Nucleus materal leaks into fissures in vertebral bodies, and appear as radiolucent “nodes”
2 methods used to measure Scoliosis
Cobb method, Pedicle method
How do we measure skeletal maturity from PF?
Compare PF of L hand/wrist to general population. Stage of ossification of vertebral ring apophyses to vert bodies. Risser’s sign: compare iliac apophyses to ileum.
How do you spot Tuberculous Osteomyelitis (Pott’s Disease)?
Lytic destruction of vertebral bodies, usually under the longitudinal ligaments.
S/Sx of Scheuermann’s Disease
Common in adolescence. Back aches, thoracic kyphosis, from osteochondrosis in spine.
A kid has Scheuermann’s Disease. What will his Lateral PF show?
In ≥ 3 adjacent vertebra, irregular bone growth in anterior epiphysis. Also Schmorl’s nodes.
Why is CXR done first in CP assessment?
1 it separates CV from Pulmonary disease 2 Tells you enough info about pathologies to start Tx 3 It narrows D/Dx enough to direct further imaging studies
What does PA view of CXR show you?
Lung fields, mediastinum, & bony thorax
What stuff can we examine in Mediastinum in PA CXR?
Trachea, heart, great vessels, esophagus
What does L Lateral CXR show us?
Heart, L lung, retrosternal space, Ant & Post Mediastinum, & Thoracic Space
What is Cardiothoracic Ratio? What should it be in an adult?
Estimate of heart size in PA CXR. Should be < half width of chest.
What PA CXR sign ID’s watery lesions in specific lung lobes? How does it appear?
Silhouette Sign. Loss of normal heart or diaphragm border with water in adjacent lobe.
Which sign in CXR shows ABN fluid in airspaces? How does it work?
Air Bronchogram Sign. Airways normally invisible, but they become brigt when they have fluid in them.
Why might lung fields be ABN white?
Pneumonia, Atelectasis, Pleural Effusion
Why might lung fields be ABN black?
Pneumothorax, COPD
Why might mediastinum be ABN wide?
Aortic dissection, Lymphadenopathy
Why might heart be ABN shaped?
CHF, Mitral valve stenosis
What can ECG of heart show us?
Blood Flow, Cardiac Output, EF, Valve Fxn, Heart wall motion, & Pericardium
What does Ventilation/Perfusion (V/Q) Scan tell us about?
Flow of air and blood to all segments of the lungs
What does a “Mismatch” in segment in V/Q Scan indicate?
Pulmonary Embolism
Nuclear Perfusion Studies tell us about _______ during _____ & ____.
Perfusion of blood into heart muscle during rest and exercise.
Which study can be made into a movie to eval ventricles & EF?
Multigated Acquisition (MUGA) Scan
What is the best study for PE?
CT Pulmonary Angiography
What is a non-invasive scan for whole-body vascular evaluation?
Magnetic Resonance Angiography (MRA)
Which PF view shows all 5 lumbar vert bodies?
AP view
Which PF view shows alignment of lumbar vertebrae and IV disk spaces?
Lateral view
Which PF view shows detail of lumbosacral junction?
Lateral L5-S1 spot film
Which PF view shows lumbar facet joints and the “Scottie Dog” image?
R & L obliques
Which PF view shows B SI joints at same time?
AP Axial
Which PF view shows each SI joint individually?
R & L obliques
_____ is a common injury in the Thoracolumbar area.
Compression Fx
What is the collar on the Scottie Dog?
Bright streak on Pars Interarticularis, on Oblique view. Dx of Spondylolysis
How do we tell Fx Spondylolisthesis from Degenerative Spondylolisthesis?
Spinous Process Sign
3 regions of possible spinal stenosis
Central Canal, IVF, Lateral or Subarticular Recess
What suggests stenosis on PF?
Location of degenerative changes
Which technique is best for showing stenosis’ canal encroachment and thecal sac constriction.
MRI
How does Ant Herniation cause Spondylosis Deformans?
Ant Long Lig is elevated, causing growth of osteophytes at anterior & lateral margins.
What are 3 directions of IV disk herniations?
Anterior, Intravertebral, & Intervertebral
Why don’t we image for LBP before 4-6 weeks of onset?
Because most pt’s will improve in that time with conservative Tx.
Is X-Ray any good for disk herniation?
Nope! MRI is good, also Discography
At what age is SI PF useful? Why not earlier?
Not until age 15-18. because Sacrum not yet fully ossified, so ABN wide joint space is expected.
Which side of SI joints do PF’s typically image, and why?
Lower halves, because they are synovial.
How does Ankylosing Spondylitis appear in early PFs?
ABN narrowing of upper SI joints, & squaring off of ant borders of vert bodies.
How does Ankylosing Spondylitis appear in later stage PFs?
Syndesmophytes bridge vert bodies, appearing as “bamboo spine”
Are abnormalities in L-Spine PF’s always cause for concern?
No, they are often not clinically signnificant
Most common L-Spine abnormality
Sacralization of L5
Other common abnormalities
Spina Bifida Occulta, Facet Tropism
Facet Tropism
dissimilar facing and/or size of a vertebra’s zygapophyseal joints.
