Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Ultrasound-Guided, Targeted Liver Lesion Biopsy Using
Document related concepts
no text concepts found
Transcript
Commonly encountered radiographs during clerkship: The Basics Seng Thipphavong, PGY4 Department of Diagnostic Imaging Objectives and Outline To review the commonly encountered radiographs during clerkship, with a review of radiographic anatomy and disease entities Radiographs: – The Chest Radiograph – The Abdominal Radiograph – Miscellaneous Radiographs… The Chest Radiograph 1. 2. Anatomy Cases (3) trachea Anatomy clavicle SVC aortic arch aortopulmonary window main pulmonary artery right atrium left atrial appendage left ventricle right hemidiaphragm left hemidiaphragm Anatomy trachea retrosternal airspace left pulmonary artery right pulmonary artery right heart chambers left heart chambers IVC Case 1 69 y.o. female presents with shortness of breath Case 1 Case 1 Kerley B lines peribronchial cuffing Pulmonary edema Radiographic signs of pulmonary edema? (5) – Enlarged cardiac silhouette – Kerley B lines (fluid in the interlobular septae) – Peribronchial cuffing – Indistinctness of the pulmonary vessels – Pleural effusion Case 2 69 y.o. with fever and cough Case 2 Case 2 Air bronchograms Case 2 Findings of pneumonia on radiograph? – Consolidation (white) and air bronchograms How are pneumonia and atelectasis similar on radiograph? – Both are white How are pneumonia and atelectasis different on radiograph? – Look for air bronchograms – Atelectasis will have signs of volume loss Case 3 69 y.o. with chest pain Case 3 Case 3 Visceral pleura Case 3 Causes of pneumothorax? – Numerous! Treatment? – Urgent – Chest tube – 25 G needle 2nd intercostal space Companion Case Case 3 Deep sulcus sign? – pneumothorax on supine films – especially seen in ICU patients The Abdominal Radiograph 1. 2. Anatomy Cases (3) Anatomy Right kidney Hepatic angle Left kidney Left psoas Properitoneal fat Air in descending colon Case 1 69 y.o. with abdominal pain Case 1 Case 1 What films are obtained in a conventional abdominal series? – Supine and upright abdomen, chest radiograph What are the 4 cardinal symptoms of small bowel obstruction? – Nausea, vomiting, abdominal distension, obstipation What are the causes of SBO? – Adhesions, hernia, stricture, neoplasm, gallstone ileus Companion Case Case 1 What are the signs of SBO on radiograph? – Dilated and fluid filled loops, “step-ladder” appearance What is the difference between ileus and SBO? – SBO indicates mechanical obstruction – Ileus is an adynamic state (“bowel shuts down”) Case 2 69 y.o. with abdominal pain Case 2 Case 2 Cupola sign Football sign Case 2 Signs of free intraperitoneal air on upright radiograph? – Air under the diaphragm Signs of free intraperitoneal air on supine radiograph? – “football sign”, football shaped lucency central abdomen – “cupola sign”, free air in the mid-subphrenic space What is Rigler’s sign? – Free air outlining both sides of bowel Companion case Companion case Rigler’s sign Case 2 What are the 2 most common reasons to see free intraperitoneal air? – Post-operative or perforated duodenal ulcer Is free air commonly seen on radiograph from perforated diverticulitis? – No. – Why? the omenteum usually contains the air, and is not seen on radiograph Case 3 69 y.o. with abdominal pain Case 3 Case 3 What are the signs of large bowel obstruction? – Dilated large bowel proximal to the site of obstruction – Paucity of air distal to obstruction What are the most common causes of large bowel obstruction? – Colon Ca, stricture (post-inflammatory diverticulitis or IBD), volvulus The Miscellaneous Radiograph Cases (4) Case 1 69 y.o. in a fight Case 1 Case 1 What is a Boxer’s fracture? – Fracture of the 5th metacarpal Potential complications of a Boxer’s fracture? – Metacarpal shortening – Usually the distal fragment is rotated in a radial direction, and may heal with deformity Wrist and hand anatomy Distal phalynx DIP joint Middle phalynx PIP joint Proximal phalynx MCP joint Metacarpal Sesamoid CMC joint Distal ulna Distal radius Wrist anatomy hamate lunate trapezoid trapezium capitate scaphoid pisiform triquetrum Companion case Case 2 69 y.o. who fell Case 2 Case 2 Case 2 What is the classic clinical presentation for a hip fracture? – Shortened lower extremity and external rotation Pelvic anatomy Iliac crest SI joint Sacral ala Femoral head Iliopectineal line Superior pubic ramus Femoral neck Ischial tuberosity Obturator foramen Greater trochanter Lesser trochanter Inferior pubic ramus Pubic symphysis Case 3 69 y.o. who fell Case 3 Case 3 What are the 3 radiographs that are obtained with an ankle series? – AP, lateral, ankle mortice view How is the ankle mortice view obtained? – Internal rotation 15 degrees What does the ankle mortice view tell you clinically? – Ankle joint stability! Ankle and foot anatomy Proximal phalynx Sesamoid metatarsal 3rd cuneiform Cuboid 2nd cuneiform Talus Calcaneus 1st cuneiform Navicular Case 4 69 y.o. who fell Case 4 Case 4 Where is the position of the humerus in an anterior dislocation? – Anterior!, and inferior What is a Bankart lesion? – Impaction fracture at inferior glenoid rim What is a Hill-Sachs lesion? – Impaction fracture at the superolateral aspect of the humeral head Case 4 Which is more common, anterior or posterior dislocations? – Anterior (90%) What are the causes of posterior shoulder dislocations? – Ethanol, epilepsy, electrocution Shoulder anatomy AC joint Acromium Clavicle Anatomical neck Greater tuberosity Surgical neck of humerus Coracoid Glenoid Scapula End! Questions? Email: – [email protected]
