Imaging Flashcards
(147 cards)
1
Q
Approach to reading Xray?
A
Drs abcdefg
Details
RIPE: rotation, inspiration, picture (ap vs pa ), exposure (penetration)
Soft tissue and bones
Airway
Bones
Cardiac shadow
Diaphragm
Effusions and extras (hardware)
Fields (lung)
Gastric bubble
2
Q
See picture 6 and label shenton’s line iliopectineal line, ilioischial line, teardrop sign
A
See picture 7
Blue = shenton
Green = iliopectineal
Yellow = ilioischial
Red = teardrop
3
Q
See picture 8 and label the lines for interpretation of c spine xr (5)
A
See picture 9
Pink= prevertebral soft tissue shadow : between c2-c4 shouldn’t be > 3-5 mm
Blue = anterior vertebral body line :must be in lordosis, smooth, parallel.
Green = posterior vertebral body line
Yellow - spinolaminar line
Black = posterior spinous line. Must converge at 1 point.
4
Q
How assess rotation on CXR?
A
Distance between clavicular heads must be equal distances from thorace vertebral spinous processes
5
Q
How assess for adequate inspiration on CXR ?
A
At least 10 ics must be seen (for trauma 9 is fine )
6
Q
Pa vs ap view CXR ? (Technique, quality, scapula, ribs, clavicles)
A
Pa standing up at radiology department, ap at bedside with portable machine
Pa better quality and can more accurately assess heart size, ap worse quality and often make mediastinum look wide when it is not.
Pa scapula in thorax periphery, ap seen over lung fields
Pa posterior ribs distinct, ap anterior ribs
Pa clavicles project over lung fields, Ap above apex
7
Q
What is enlarged cardiac shadow on CXR measurement ?
A
> 50% mediastinum
8
Q
Correct position gastric bubble on CXR ?
A
Left diaphragm
9
Q
See picture 10 and label the normal CXR
A
See picture 11
10
Q
What does fracture of ribs 1 and 2 usually indicate?
A
Severe force and potentially severe injury
11
Q
Possible complication fracture ribs 4-9?
A
Pneumothorax, hemothorax
12
Q
Possible complication fracture ribs 1-12? (2)
A
Liver or spleen lacerations, diaphragm injury
13
Q
What is, causes and is the onset of pulmonary contusion?
A
Haemorrhage into lungs
Most common finding in blunt chest trauma
Appears within 6 h injury and resolve within 48h.
14
Q
See picture 12 and diagnose pathology.
A
Flail chest
15
Q
See picture 13 and diagnose pathology.
A
Lung contusion R
16
Q
See picture 17 and diagnose pathology. (3)
A
• Tension pneumothorax L
• fractures ribs 3-5 posteriorly and associated subcutaneous emphysema
. Fracture mid third left clavicle
17
Q
See picture 18 and diagnose pathology.
A
Pneumomediastinum
Mediastinal pleura displaced from left heart border and continuous diaphragm sign
18
Q
See picture 19 and diagnose pathology.
A
Pneumopericardium
19
Q
See picture 20 and diagnose
A
Haemothorax
20
Q
See picture 21 and diagnose pathology.
A
Haemothorax
21
Q
See picture 22 and diagnose pathology
A
Widened mediastinum (top) and cardiomegaly
22
Q
See picture 23 diagnose pathology. (3)
A
• Diaphragm rupture
• herniation bowel through diaphragm L
• resulting in mediastinal shift to right.
23
Q
See picture 24 and diagnose pathology.
A
Subcutaneous emphysema
24
Q
See picture 25 and diagnose pathology.
A
Haemopneumothorax. Perfectly straight line due to mixture air and fluid
25
Name 3 indications emergency Ct abdo
• stable with acute abdo
• free air/fluid
• surgery planning
26
Which 2 imaging investigations are mandatory in trauma?
Cxr and pxr
27
What kind of ct done in trauma?
Iv contrast enhancement, except in tbi
28
What type of scan best for cervical spine if indicated?
Ct- plain radiograph poor diagnostic value. Only do if spine stable.
29
When should Lodox stat scan be used?
End of primany survey before commence secondary survey to id major injuries
30
Which areas should be assessed with efast?
• 2x lung fields for pneumothorax
• right upper quadrant for free air
• left upper quadrant
• subcostal
• pelvis
31
Most common place for free fluid in right upper quadrant on eFAST?
Morrison's pouch - hepatorenal recess / subhepatic space
32
How tell If pneumothorax on eFAST?
Presence of pleural sliding line normal. Absence = pneumothorax
33
Name 10 pitfalls of eFAST in trauma
1.operator, equipment, patient dependant
2. Making management decisions on indeterminate or suboptimal images
3. Bowel gas
4. Artefacts
5. Blood clots vs FF
6. Delay resuscitation
7. Binary question vs specific injury
8. No serial scans
9. Non-traumatic fluid collections
10. Retroperitoneal space can't see
34
According to the Canadian Ct head rule, it's only required for minor head injury patients with any one of which findings? (7)
High risk (for neurological intervention)
1. GCS < 15 at 2 hours after injury
2. Suspected open or depressed skull fracture
3. Any sign of basal skull fracture
4 vomiting ≥ 2 episodes
5-age ≥ 65
Medium risk for brain injury on Ct
6. Amnesia before impact ≥ 30 min
7. Dangerous mechanism (pedestrian, occupant ejected, fall from elevation ≥ 3 feet or 5 stairs)
35
To which patients does the Canadian Ct head rule not apply? (5)
• Non-trauma cases
. GCS <13
• age < 16
• Coumadin or bleeding disorder
• obvious open skull fracture
36
Identify pathology picture 37
Compression fracture
37
Identify pathology picture 38
Compression fracture
38
Identify pathology picture 39
Compression fracture
39
Identify pathology picture 40
Compression fracture
40
Identify pathology picture 41
Burst fracture
41
Identify pathology picture 42
Burst fracture
42
Identify pathology picture 44
Flexion distraction injury lumbar
43
Identify pathology picture 47
Fracture dislocation and spinal cord compression
44
Identify pathology picture 48
Fracture dislocation
45
Identify pathology picture 50
Lisfranc injury
46
Identify pathology picture 51
Extradural haematoma- lenticular shape hyperdensity
47
Identify pathology picture 52
Intraventricular haemorrhage
48
Identify pathology picture 53
Pseudo-aneurysm on Ct angio
49
Identify pathology picture 54
Subdural haemorrhage acute and chronic
50
Identify pathology picture 55
Tile pelvic fracture type c: rotationally and vertically unstable
51
Label picture 56
See picture 57
52
Identify pathology picture 58
Knee dislocation
53
Identify pathology picture 59
Salter Harris 1 (physis separations) fracture
54
Identify pathology picture 60
Ruptured diaphragm - air bubble and NGT in L hemithorax
55
Identify pathology picture 61
Anterior knee dislocation
56
Identify pathology picture 63
Posterior knee dislocation
57
Identify pathology picture 65
Torus or buckle fracture
58
Identify pathology picture 66
Plastic ulna deformity (bowing) with radial head dislocation
59
Identify pathology picture 67
Salter Harris 5 (crush) fracture
60
Identify pathology picture 68
Salter Harris 4 (epiphysis to metaphysis ) (intra-articular) fracture
61
Identify pathology picture 69
Pancreatic oedema and necrosis
62
Label picture 70
See picture 71
63
Identify pathology picture 72
Bilateral infiltrates in ARDS
64
Identify pathology picture 73
Monteggia fracture
65
Identify pathology picture 74
Galeazzi fracture
66
Identify pathology picture 75
Surgical emphysema
67
Identify pathology picture 76
Displaced femur neck fracture
68
Identify pathology picture 77
Multiple dilated loops of small bowel with air fluid levels
= small bowel obstruction
69
Identify pathology picture 78
Free air under diaphragm
Could be perforated peptic ulcer
70
Identify pathology in picture 79
Greenstick fracture
71
Identify pathology in picture 80
Osteogenesis imperfecta
72
Identify pathology in picture 81
Supracondylar fracture displaced
Most common fracture around elbow
73
Identify pathology in picture 82
Supracondylar fracture: flag sign
74
Identify pathology in picture 83
Bayonet fracture
75
Identify pathology in picture 84
Osgood schlattler disease
Osteochondrosis-patellar tendon insert onto prox tibia growth plate. Ossicles.
76
Identify pathology in picture 85
Acromioclavicular joint dislocation
77
Identify pathology in picture 86
Undisplaced supracondylar fracture (flag sign)
78
Most common place free fluid on efast?
Between spleen and diaphragm (subdiaphragmatic)
79
Most common place free fluid on efast LUQ?
Subdiaphragmatic between diaphragm and spleen
80
Most common place free fluid on efast pelvis?
Pouch of Douglas between uterus and rectum
81
Most common place free fluid on efast subcosta/sub-xiphisternal?
Pleural effusion /tamponade
82
What diagnosis can you make on fast of lung fields?
Pneumothorax
83
Identify pathology on picture 87
Inferior vena cava, not free fluid!
Other pitfalls of RUQ include gallbladder, perinephric fat, fluid in bowel, rib shadow
84
Identify pathology on picture 88
Perinephric fat, not free fluid!
Other pitfalls LUQ include stomach, rib shadow
85
Identify pathology on picture 89
Free fluid subdiaphragmatic between spleen and diaphragm. Most common place for free fluid on fast!
86
Label picture 90 of LUQ fast.
See picture 91
87
Identify pathology on picture 92
Free fluid in morrison's pouch and around free edge of liver
From l to R: LIVER, r kidney, free fluid
88
Label RUQ fast on picture 93
See picture 94
89
Label RUQ fast on picture 95
See picture 96
90
Identify pathology on picture 97
Free fluid in pouch of Douglas.
From l to R: uterus, bladder (top),
91
Label pelvis fast on picture 98
See picture 99
92
Identify pathology on picture 100
Edge artifact on pelvis view, not free fluid!
Other pitfall = seminal vesicles
93
Identify pathology on picture 101
Pericardial effusion
94
Identify pathology on picture 102
Pleural effusion left, pericardial effusion right.
Other pitfalls: epicardial fat, aorta,
From top to bottom: rv, lv, ra, LA
95
Identify pathology on picture 103
None, normal lung field with pleural sliding line
On either side: ribs
96
Identify pathology on picture 104
Rib shadows, not free fluid!
97
Identify pathology on picture 105
Rib shadows, not free fluid!
98
How assess c spine xray?
ABCDe
Adequate coverage, alignment
Bodies
Cortical outlines
Disc spacing
Edges and soft tissue
99
What should be requested if top of t1 not visible on lateral c spine xray?
Swimmer's view
100
Where is the spinal cord on lateral C spine xray?
Between posterior vertebral and spinolaminar line
101
What could disruption of spinolaminar line on lateral c spine xray indicate?
Subluxation (dislocation)
102
What does shortening of vertebral body on xray indicate?
Compression fracture
103
What should soft tissues measure on lateral C spine xray?
373 rule
C1 to edge c3, soft tissue line should be < 7 mm
From c3 onwards shouldn't be more than 3 cm. (Haematoma )
104
What should be looked for in odontoid view of c spine? (5)
Adequacy: c1 and c2
Alignment: lateral processes same, space between lateral masses of c1 and odontoid peg equal
Bodies: c2 body clearly seen
Cortical outline: c2, check especially for fracture around odontoid peg
Edges and soft tissue: mandible fracture
105
Name the phases of Ct scan
• Pre-contrast
. Contrast: arterial, porto-venous, venous
• delayed
106
Identify pathology on picture 106
Liver laceration with extravasation. (Leakage)
Blue arrow = large laceration r lobe liver
Black arrows = blood in peritoneal cavity
Red = active extrasation of iv contrast
107
Identify pathology on picture 107
Liver laceration
108
Identify pathology on picture 108
Liver lacerations
109
Identify pathology on picture 109
Splenic rupture
110
Identify pathology on picture 110
Gastric perforation
111
Identify pathology on picture 111
Perforated gastric ulcer
112
Identify pathology on picture 112
Pneumoperitoneum due to perforated gastric ulcer
113
Identify pathology on picture 113
Left Ct scan. Black arrows= intracerebral haemorrhage right temporal lobe
White = subarachnoid haemorrhage in basal cisterns.
Arrowhead = intraventricular haemorrhage 4th ventricle.
Right Ct angio = aneurysm
114
Identify pathology on picture 114
Intracranial haemorrhage parietotemporal lobe
115
Identify pathology on picture 115
Hydrocephalus (dilatation lat ventricles)
116
Which injury should not get iv contrast for ct?
TBI
117
Indication for angiography?
Endovascular intervention required eg embolization, stenting
118
Identify pathology on picture 116
Unifacetal dislocation: bow tie sign
Anterior dislocation vertebral bodies
119
Identify pathology on picture 117
Hangman fracture c2 (red = fracture)
Disruption ant line, pre-vertebral soft tissue swelling (orange)
Blue = ant dislocation c2
120
Identify pathology on picture 119 (2)
Loss alignment lateral masses c1 and c2
Widened space between peg and lateral masses c1
121
Identify pathology on picture 120 (4)
Loss alignment posterior and spinolaminar lines
Perched facets and dislocation injury c5 c6
Displacement of body is more than 50% of body width therefore bifaceted dislocation
Widening pre-vertebral soft tissue
122
Identify pathology on picture 121
Odontoid peg fracture
Cortical ring c2 incomplete and break in ant line at c1 level
123
Which phase of Ct scan is represented in picture 122?
Arterial
Aorta round circle and take up contrast, vena cava no contrast and oval shape.
124
Identify phase of Ct contrast on picture 123
Venous
Vena cava has taken up more contrast, vena cava and aorta almost =
125
Identify pathology on picture 124
Chronic epidural haematoma
126
Identify pathology on picture 125
A: depressed skull fracture after shotgun injury
Bi contusion
127
Identify pathology on picture 126
A: linear skull fracture
Bi epidural haematoma secondary to MMA rupture
128
Identify why this xray is inadequate picture 127
Overexposed because can se all vertebral bodies with obvious intervertebral spaces
129
Identify pathology on picture 128
Acetabular fracture
130
Identify Ct phase picture 129
Portovenous
Still some contrast in aorta, but not as much. Portal vein clear. IVC beginning to fill
131
Identify Ct phase picture 130
Delayed phase
No contrast in aorta or vena cava. Renal calices contrasted.
132
Identify pathology on picture 131
Pubic ramus fracture
133
Identify pathology on picture 133
Pubic rami and ischium fracture
134
Identify pathology on picture 134
Fracture body C7
135
Identify pathology on picture 135 (3)
C2 body fracture
Misalignment lateral borders c1 and c2
Difference in space between odontoids process and lateral masses c2
136
Identify pathology on picture 136
Open book fracture
Pubic symphysis and sacroiliac joint separation
137
Why is picture 138 not adequate?
Can't see C7 and neck too extended hiding C1
(Must see c1 - T1)
138
Identify pathology on picture 139
Magnification of heart and widened mediastinum
139
Why picture 140 not adequate xray?
Underexposed - can't see any vertebrae.
140
Identify pathology on picture 141
Right femoral neck fracture
141
Identify pathology on picture 142
Antero-inferior hip dislocation (rare)
142
Identify pathology on picture 143
Posterior hip dislocation-common
143
Identify pathology on picture 144 (3)
LODOx
Unstable floating knee
Tib-fib comminuted fractures
Femur distal fracture
144
Identify pathology on picture 145
Spinous process of c7 fracture and T1 fracture
145
Identify pathology on picture 146
Abdominal aortic aneurysm
146
Identify pathology on picture 147
Extradural bleed
147
Sign of duodenal injury on barium xray?
Coil spring sign
