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UCPEX > Radiology > Flashcards

Radiology Flashcards

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1
Q

Primary signs of fracture on XR

A

Cortical disruption
Lucency
Impaction sclerosis (esp on weight bearing bones)

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2
Q

Secondary signs of fracture on XR

A

Lipohaemarthrosis
Haemarthrosis
Soft tissue swelling

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3
Q

Common problems with AP CXR

A

Mediastinum is widened
Rotation usually in play due to difficult positioning
Poor inspiration esp if flat or intubated

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4
Q

Lateral CXR features

A

Labelled by side that is closest to cassette
L hemidiphragm has stomach bubble directly under
L oblique fissure more vertical than R
R hemidiaphragm wider than L on L lateral film
R hemidiaphragm complete. L hemidiaphragm incomplete due to cardiac silhouette
Can use lateral decubitus if concern for effusion or PTX and no other imaging modality available. If ?PTX place this side up, if ?effusion, place this side down for best visualisation

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5
Q

CXR assessment of adequacy

A

Inspiratory effort - 6 anterior ribs on R
Rotation
Angulation - clavicles should overlie posterior 3rd rib
Penetration/Exposure

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6
Q

Poor inspiratory effort CXR - complications

A

Enlarged mediastinum
Crowding of vessels at lung bases

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7
Q

Rotation on CXR - complications

A

Hypertranslucecy of ipsilateral lung
Pseudomediastinal mass on R rotation
Aortic arch widened appearance on L rotation

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8
Q

CXR angulation

A

Craniocaudal beam divergence
Clavicles should project over posterior third rib

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9
Q

CXR penetration

A

Thoracic vertebrae should be just visible on a PA CXR
Underpenetration common in mobile AP films due to battery power

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10
Q

CXR over penetration complications

A

Harder to see subtleties

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11
Q

CXR under penetration complications

A

Pulmonary vessels and interstitium appear more prominent
Detail is lost at the lung bases and the vertebrae

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12
Q

Lung zones

A

From anterior rib 2 up = upper zone
Ribs 2-4 = midzone
Rib 4 to diaphragm = lower zone

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13
Q

Silhouette signs on CXR

A

Objects of similar densities will lose their margins when touching each other
RUL forms silhouette with medial pleura of R mediastinum
RML silhouettes to RHB
RLL silhouettes to diaphragm
LUL to LHB and aortic knuckle
LLL to L diaphragm

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14
Q

Silhouette sign CXR pitfalls

A

Pectus excavatum can cause loss of RHB
Pericardial fat pads

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15
Q

ETT on CXR

A

Should be 4cm above carina
Can move up and down by 2cm with neck flexion and extension

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16
Q

CVL on CXR

A

Should be at junction between SVC and RA
Subclavian line may migrate caudally to internal jugular instead of to SVC - increased risk of thrombosis due to decreased size of IJV compared to SVC
If too long can land in RA or RV and cause arrhythmia

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17
Q

Swan-Ganz catheter placement check on CXR

A

In pulmonary artery - between main pulmonary artery and interlobar artery
Forms a loop on CXR
Should be no more than 2cm from cardiac silhouette
NGT should be at least 10cm past GJ junction at T10

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18
Q

Pacemaker placement check on CXR

A

Single chamber - RA or RV
Dual chamber - RA and RV
Biventricular or three lead pacemaker - RA, RV and coronary sinus
ICD lead is thicker than pacemaker
RA lead should be anterosuperior on lateral CXR, RV lead should be anteroinferior

Check the leads have a direct course, no fracture and neither taut nor slack

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19
Q

Heart position on CXR

A

1/3 to the right and 2/3 to the left
RV anterior heart border on lateral CXR
Posterior HB on lateral is LA + LV
Size can vary by 2cm based on insp/exp and systole/diastole

LA enlargement gives subcarinal angle >100’ and a double atria shadow + posterior bulge on lateral
LV or RA enlargement gives prominence of the heart border
RV enlargement appears as filling of the retrosternal space

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20
Q

Signs of pericardial effusion on CXR

A

Globular heart shape
Straight, well defined heart border
Rapid increase in size

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21
Q

Signs of LHF on CXR

A

Enlarged mediastinum
Upper lobe diversion
Pleural fluid/increased interstitial markings/Kerley B lines - followed by airspace opacification
Pleural effusion - R precedes L, usually bilateral

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22
Q

L mediastinal borders

A

LBH:
L subclavian vessels
Aortic knuckle
L pulmonary artery
Auricle
LV

RHB:
R brachiocephalic vessels
R SVC
RA
IVC (not always visible)

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23
Q

How many % of aortic dissections have a normal mediastinal contour?

24
Q

5 signs of aortic dissection on CXR

Study These Flashcards
A

Widened mediastinum
Enlarged aortic knuckle (8cm or more is abnormal)
Pericardial effusion
L pleural effusion (16%)
Interval change in size of mediastinal silhouette
Aortic wall calcification displaced from outer margin by >1cm also a sign

25
Causes of pneumomediastinum
Trauma to airway or oesophagus Infection Rupture of alveolus eg diving Perforated viscous to retroperitoneum
26
Pneumomediastinum findings on CXR
Lucent halo around heart "Tubular artery sign" (gas surrounding great vessels) "Continuous diaphragm" sign (gas at inferior mediastinum) Subcutaneous emphysema (supraclavicular region)
27
What is the hilar on CXR?
Pulmonary artery and vein chiefly Small component bronchi + LN + fat
28
Features of hilar on CXR
Left should be <2cm higher than right. 5% are same height Left should never be lower than R Hila to apex distance should be equal to hila to base distance Enlargement can be LN or vascular Unilateral enlargement frequently due to artefact eg rotation/scoliosis but can be due to nodes/cancer
29
CXR bones
Rib fractures occult 20% Rib fractures in infants usually lateral and posterior in NAI due to squeezing Distal clavicle erosion can be due to hyperparathyroidism, RA or post-traumatic osteolysis
30
CXR review areas
Behind the heart Hila Apices Below the diaphragm
31
Signs of collapse on CXR
Displacement of: -fissure -mediastinum (sometimes) -hila (sometimes) Narrowing of spacing between ribs Elevation of hemidiaphragm
32
Number of C-spine injuries occult on XR
Up to 20%
33
Signs of fracture on lateral C-spine XR
Loss of vertical alignment Disruption of Harris ring at C2 Loss of vertebral body height Facet joint dislocation? Check disc height Anterior soft tissue -should taper at thoracic inlet -should be <1/2 the width of the the adjacent vertebral body C1-C4 and
34
Hangman's fracture
C2 - both pedicles are fractured
35
Sign's of fracture on peg view
Check lateral processes of C1 match with C2 -if C1 is wider than C2 = Jefferson "burst" fracture of C1 Assess atlanto-axial interval and Atlanta-odontoid interval (if this is abnormal check lateral masses line up, if they do it could just be rotation)
36
Peg fractures
Type 1 = just the tip Type 2 = across the base Type 3 = extends into the body of the C2
37
Thoracolumbar fracture types
Burst fractures - due to compression Chance - due to flexion/extension eg lap belt and extend through anterior and posterior aspects
38
Assessing thoracolumbar spine XR
Check spinous process line is congruent Check interspinous distance Check interpedicle distance Check anterior and posterior vertebral lines Check anterior and posterior vertebral heights Check vertebrae for primary signs of fracture
39
Tibial plateau fractures
80% lateral Use lateral tibial plateau line Get oblique view if necessary, or CT Segond fracture off lateral tibial plateau is pathognomonic (means ACL injury 90% of the time)
40
Shatzker classification of tibial plateau fractures
1 = lateral split fracture 2 = lateral split fracture + depression of lateral tibial plateau 3 = pure depression of lateral plateau 4 = pure depression of medial plateau 5 = bilateral condyle fracture 6 = lateral split fracture + horizontal component
41
Patella ligament on lateral XR
Patella length should be roughly similar to infra patella tendon length High riding patella = patella alta (patella tendon rupture) Low riding patella = patella baja (quads tendon rupture)
42
What is Böhlers angle?
A line drawn between the highest point of the posterior articular surface of the calcaneus and the highest point of the anterior process intersects with a line drawn between the highest point of the calcaneal tuberosity and the highest point of the posterior articular surface Normal is 20-40'
43
Common complication of taller neck fracture
Avascular necrosis of talar dome
44
Where is the Lis Franc ligament?
Medial cuneiform to the base of the 2nd metatarsal. On normal XR AP foot the medial base of the 2nd metatarsal aligns with the medial aspect of the intermediate cuneiform. On oblique the medial 3rd metatarsal aligns with the medial aspect of the lateral cuneiform
45
Which metatarsals most affected in March fractures?
2nd and 3rd
46
Hills-Sachs and Bankart's lesions
Hills-Sachs is humeral head Bankarts is glenoid
47
AC injury classification and ligaments involved
Grade 1 - AC ligament strain. XR may be normal Grade 2 - AC ligament disruption. Discontinuity +/- widening of ACJ Grade 3 - 100% superior displacement of clavicle. Both ligaments disrupted
48
Neer classification of humeral head fractures
1 - head 2 - greater tuberosity 3 - lesser tuberosity 4 - surgical neck/diaphysis
49
Radio-capitellum line
Line drawn along centre of radius and extending towards humerus should pass through capitellum on all views
50
Anterior humeral line
Line drawn down anterior humerus on lateral view should pass through capitellum/trochlea. 1/3 should lie anterior, 2/3 should lie posterior to this line. Can indicate supracondylar fracture
51
What are McGrigor's lines?
3x lines used to aid in interpretation of skull XR running horizontally across fadein supra-orbital, infra-orbital/zygomatic and maxillary areas
52
Large bowel vs small bowel on AXR?
Valvular conniventes in SB Haustra in LB
53
Signs of SBO on AXR
Dilated loops >3cm Valvular conniventes/plicae circulates is SB Multiple air/fluid levels String of pearls sign Paucity of gas in large bowel
54
Signs of LBO on AXR
Haustra Dilated loops >5-7cm or 9cm for caecum
55
Volvulus locations by frequency
Sigmoid > caecum > transverse colon
56
Volvulus signs on AXR
Sigmoid = coffee bean sign Caecal = dilated loop in upper abdomen, some SBO likely, paucity of distal large bowel gas
57
Jefferson fracture
C1 burst fracture commonly due to axial loading injury

UCPEX (27 decks)

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