2. Emergency Radiology What to order, When DR ADNAN AHMED MBBS, FCPS
Assistant Professor
Department of Radiology and Imaging
LUMHS, Jamshoro

3. Emergency Radiology What are the different Radiological investigation
to order In different
Emergency situations

4. Emergency Radiology Common Topics CNS Emergencies
Face & Neck Emergencies.
Spinal Emergencies.
Chest Emergencies.
Cardiovascular Emergencies.
Abdominal Emergencies.
Gynecological & Obstetrical Emergencies.
Male Genitourinary Emergencies.
Pelvic Emergencies.
Extremities Emergencies.
Pediatric Emergencies

5. Emergency Radiology CNS Emergencies: Skull Fractures
Hemorrhage: (Traumatic–NonTraumatic)
• Extra-axial
• Parenchymal
Cerebral infarction.
Spinal trauma

6. Emergency Radiology CNS Emergencies: Skull Fractures: What to order:
Plain X-ray of the skull (AP-lateral view)
Computed tomography of the Brain (Axial –
Coronal) (bone window)
When:
History of trauma – evident injury of the scalp

7. Emergency Radiology
Skull fractures (Plain X-ray)

8. Emergency Radiology
Skull Fractures (CT Scan)

9. Emergency Radiology
Skull Fractures (CT Scan)

10. Emergency Radiology CNS Emergencies:
Hemorrhage: Traumatic and Non Traumatic
What to order:
Computed tomography (CT) of the Brain Plain.
When:
Head trauma – focal neurological defect.

11. Emergency Radiology CNS Emergencies: Hemorrhage: Traumatic
Findings in:
Extra Dural Blood
Sub dural Blood.
Cerebral contusion.

12. Emergency Radiology

13. Emergency Radiology

14. Emergency Radiology

15. Emergency Radiology

16. Emergency Radiology

17. Emergency Radiology

18. Emergency Radiology

19. Emergency Radiology CNS Emergencies: Hemorrhage: Non Traumatic
Findings in:
Subarachnoid Blood
Intraparenchymal Blood.
Intraventricular Blood

20. Emergency Radiology

21. Emergency Radiology

22. Emergency Radiology

23. Emergency Radiology

24. Emergency Radiology CNS Emergencies: Cerebral Infarction:
What to order:
Computed tomography (CT) of the Brain
Magnetic Resonance Imaging (MRI) : DWI
When:
Focal neurological defect - Stroke

25. Emergency Radiology

26. Emergency Radiology

27. Emergency Radiology

28. Emergency Radiology

29. Emergency Radiology Facial Emergencies:
What to order?
Plain X-ray of the Skull (Lateral view – PA view)
Computed Tomography of the facial bones
Bone window–Axial & coronal–3D recon.)
When?
History of trauma to the face –
disfigurement – Severe facial contusions

30. Emergency Radiology

31. Emergency Radiology

32. Emergency Radiology

33. Emergency Radiology

34. Emergency Radiology

35. Emergency Radiology

36. Emergency Radiology

37. Emergency Radiology Orbital Injuries: What to order?
Plain X-ray of the Skull (Lateral view – PA view)
Computed Tomography of the Orbit (Axial
Coronal - Bone & Soft tissue settings)
When?
History of trauma to the orbit –
History of FB to the eye

38. Emergency Radiology

39. Emergency Radiology

40. Emergency Radiology

41. Emergency Radiology

42. Emergency Radiology Spinal Emergencies: Trauma
Vertebral fracture (Varieties)
Spinal cord injuries.

43. Emergency Radiology Spinal trauma: What to order?
Plain X-ray of the spine (Lateral view – AP view)
Computed Tomography of the Spine
(Bone & Soft tissue settings–3D recon.)
MRI of the spine. (for cord injury)
When?
History of trauma – Falling from height.

44. Emergency Radiology

45. Emergency Radiology

46. Emergency Radiology

47. Emergency Radiology

48. Emergency Radiology

49. Emergency Radiology

50. Emergency Radiology

51. Emergency Radiology

52. Emergency Radiology Chest Emergencies: Chest Trauma
Rib fractures – Traumatic Hemothorax –
pneumothorax – pneumomediastinum –
pulmonary contusion, laceration &
hematoma – Esophageal injury –
diaphragmatic injury – etc.
Airway Foreign Body.

53. Emergency Radiology Chest Emergencies: What to order?
Plain X-ray of the Chest (PA view – Lateral view)
Computed Tomography of the Chest
Angiography (Aortography)
When?
History of trauma – Difficulty of breathing.

54. Emergency Radiology

55. Emergency Radiology

56. Emergency Radiology

57. Emergency Radiology

58. Emergency Radiology

59. Emergency Radiology

60. Emergency Radiology

61. Emergency Radiology

62. Emergency Radiology

63. Emergency Radiology

64. Emergency Radiology

65. Emergency Radiology

66. Emergency Radiology

67. Emergency Radiology Chest Emergencies: FB of the Airway:
What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Computed Tomography of the Chest
When?
Children – difficulty in breathing – Unconscious
patient

68. Emergency Radiology

69. Emergency Radiology

70. Emergency Radiology

71. Emergency Radiology

72. Emergency Radiology Cardiovascular Emergencies: CHF
Pericardial effusion
Aortic dissection, trauma.
Pulmonary Edema
Pulmonary Embolism.
Peripheral ischemia (acute)
DVT.

73. Emergency Radiology Cardiovascular Emergencies: CHF: What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Echocardiography
When?
Dyspnea – signs of low cardiac output

74. Emergency Radiology

75. Emergency Radiology

76. Emergency Radiology Cardiovascular Emergencies: Pericardial effusion:
What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Echocardiography
When?
Chest pain – friction rub – faint heart
sounds on auscultation.

77. Emergency Radiology

78. Emergency Radiology

79. Emergency Radiology

80. Emergency Radiology

81. Emergency Radiology Cardiovascular Emergencies: Aortic dissection:
What to order?
Plain X-ray of the Chest (PA view–Lat. view)
CT scan.
MRI
Aortography
When?
Sudden severe tearing substernal chest pain

82. Emergency Radiology

83. Emergency Radiology

84. Emergency Radiology

85. Emergency Radiology

86. Emergency Radiology Cardiovascular Emergencies:
Acute peripheral ischemia:
What to order?
Arteriography
Color doppler Ultrasound (chronic)
When?
Sudden onset of severe pain, coldness,
numbness or pallor in a portion of an extremity.

87. Emergency Radiology

88. Emergency Radiology

89. Emergency Radiology Cardiovascular Emergencies:
DVT (Deep Vein Thrombosis):
What to order?
Color Doppler Ultrasound.
Venography
When?
Asymptomatic – pain – edema – skin discoloration.

90. Emergency Radiology

91. Emergency Radiology

92. Emergency Radiology

93. Emergency Radiology Abdominal Emergencies: Abdominal Trauma
Hemoperitonium
Visceral injuries (Liver, Spleen, Kidney, UB, etc.)
Non-Traumatic emergencies.
Intestinal obstruction, Appendicitis, GUT
perforation,
Ascites, Jaundice, peritonitis, GI bleeding

94. Emergency Radiology Abdominal Emergencies: Abdominal trauma:
What to order?
Chest & Abdominal radiographs.
Ultrasound (FAST)
CT scan
Arteriorgraphy.
When?
History of trauma to the abdomen – Motor
vehicle accidents

95. Emergency Radiology

96. Emergency Radiology

97. Emergency Radiology

98. Emergency Radiology

99. Emergency Radiology

100. Emergency Radiology

101. Emergency Radiology

102. Emergency Radiology

103. Emergency Radiology

104. Emergency Radiology

105. Emergency Radiology

106. Emergency Radiology Abdominal Emergencies: Intestinal Obstruction
What to order?
Abdominal radiograph.
CT scan
When?
Crampy abdominal pain – nausea &
vomiting – abdominal tenderness.

107. Emergency Radiology

108. Emergency Radiology

109. Emergency Radiology

110. Emergency Radiology

111. Emergency Radiology

112. Emergency Radiology

113. Emergency Radiology

114. Emergency Radiology Abdominal Emergencies:
Gut Perforation (e.g. Perforated DU)
What to order?
Abdominal radiograph (Erect). US
CT scan
When?
History of peptic ulceration – signs of
peritonitis

115. Emergency Radiology

116. Emergency Radiology

117. Emergency Radiology

118. Emergency Radiology

119. Emergency Radiology

120. Emergency Radiology

121. Emergency Radiology

122. Emergency Radiology

123. Emergency Radiology

124. Emergency Radiology Abdominal Emergencies: Jaundice What to order?
Ultrasound
CT scan
PTHC
ERCP
When?
Yellowish discoloration of the skin – dark urine –
pale stools

125. Emergency Radiology

126. Emergency Radiology

127. Emergency Radiology

128. Emergency Radiology

129. Emergency Radiology

130. Emergency Radiology

131. Emergency Radiology

132. Emergency Radiology Abdominal Emergencies: Appendicitis What to order?
Abdominal radiograph.
Ultrasound
CT scan
When?
Sudden onset of RIQ pain – rebound tenderness.

133. Emergency Radiology

134. Emergency Radiology

135. Emergency Radiology

136. Emergency Radiology

137. Emergency Radiology

138. Emergency Radiology

139. Emergency Radiology

140. Emergency Radiology Abdominal Emergencies: Cholecystitis
What to order?
Ultrasound (Gold standard)
When?
Sudden onset of epigastric pain – rebound
tenderness

141. Emergency Radiology

142. Emergency Radiology

143. Emergency Radiology

144. Emergency Radiology

145. Emergency Radiology Genitourinary Emergencies: UT stones Hematuria
Urinary tract trauma.
Urethral Injuries, stones (male)
Scrotal injuries, swellings, testicular
torsion, epididymitis (male)

146. Emergency Radiology Genitourinary Emergencies:
Ureteric Stones (Renal Colic):
What to order?
Plain X-ray of the urinary tract (PUT)
Ultrasound
Intravenous Urography (IVU)
CT of the abdomen
When?
Sudden onset of loin pain radiating to the
groin.

147. Emergency Radiology

148. Emergency Radiology

149. Emergency Radiology

150. Emergency Radiology

151. Emergency Radiology

152. Emergency Radiology

153. Emergency Radiology

154. Emergency Radiology Genitourinary Emergencies:
Hematuria (Painful-Painless):
What to order?
Plain X-ray of the urinary tract (PUT).
Ultrasound.
Intravenous Urography (IVU).
CT of the abdomen.
Cystogram.
When?
Passage of blood or blood clots with urination
(either painful or painless).

155. Emergency Radiology

156. Emergency Radiology

157. Emergency Radiology

158. Emergency Radiology

159. Emergency Radiology

160. Emergency Radiology

161. Emergency Radiology

162. Emergency Radiology

163. Emergency Radiology

164. Emergency Radiology

165. Emergency Radiology

166. Emergency Radiology

167. Emergency Radiology Genitourinary Emergencies:
Urinary tract trauma (Renal Bladder male urethra):
What to order?
Plain X-ray of the urinary tract (PUT)
Ultrasound
Intravenous Urography (IVU)
CT of the abdomen
Ascending urethrocystography
When?
History of blunt trauma to the abdomen – Falling
astride.

168. Emergency Radiology

169. Emergency Radiology

170. Emergency Radiology

171. Emergency Radiology

172. Emergency Radiology

173. Emergency Radiology

174. Emergency Radiology

175. Emergency Radiology Genitourinary Emergencies: Scrotal emergencies:
What to order?
Ultrasound with color Doppler.
When?
Acute scrotal pain – trauma to testis.

176. Emergency Radiology

177. Emergency Radiology

178. Emergency Radiology

179. Emergency Radiology

180. Emergency Radiology

181. Emergency Radiology

182. Emergency Radiology

183. Emergency Radiology

184. Emergency Radiology Gyncological & Obstetric Emergencies:
Ovarian Torsion
PID
Abortion
Ectopic pregnancy
Placenta Previa

185. Emergency Radiology Gyncological & Obstetric Emergencies:
What to order?
Ultrasound (Color Doppler)
When?
Lower abdominal pain – fever – vaginal
discharge

186. Emergency Radiology

187. Emergency Radiology

188. Emergency Radiology

189. Emergency Radiology Obstetric Emergencies: What to order?
Ultrasound (Color Doppler)
When?
Bleeding in early / late pregnancy

190. Emergency Radiology

191. Emergency Radiology

192. Emergency Radiology

193. Emergency Radiology

194. Emergency Radiology

195. Emergency Radiology

196. Emergency Radiology

197. Emergency Radiology

198. Emergency Radiology Muscloskeletal Emergencies:
Upper & lower extremities Fractures &
dislocations
Pelvic Fractures.
Joint injuries
Ligaments and tendons injuries.

199. Emergency Radiology Muscloskeletal Emergencies: What to order?
Plain X-ray.
CT scan.
MRI
When?
History of trauma.

200. Emergency Radiology

201. Emergency Radiology

202. Emergency Radiology

203. Emergency Radiology

204. Emergency Radiology

205. Emergency Radiology

206. Emergency Radiology

207. Emergency Radiology

208. Emergency Radiology

209. Emergency Radiology

210. Emergency Radiology

211. Emergency Radiology

212. Emergency Radiology Pediatric Emergencies:
Neonatal emergencies (intestinal obstruction, Intussception.)
Foreign body aspiration.
Bone injuries.

213. Emergency Radiology

214. Emergency Radiology

215. Emergency Radiology

216. Emergency Radiology

217. Emergency Radiology

218. Emergency Radiology

219. Emergency Radiology

220. Emergency Radiology

221. Emergency Radiology

222. Emergency Radiology

223. Emergency Radiology

224. Emergency Radiology

225. Emergency Radiology

226. Emergency Radiology

227. Emergency Radiology

228. Emergency Radiology

229. Emergency Radiology

230. Emergency Radiology