Large vs. Small Bowel l Large Bowel n Peripheral n Haustral markings don't extend from wall to wall n Max diameter 6cm (9cm cecum) l Small Bowel n Central n Plica extend across lumen n Maximum diameter of 3cm
Radiology Report: Plain abdominal radiograph. Multiple dilated loops of small bowel within the central abdomen. Gas is not seen in the large bowel. The three most common causes of small bowel obstruction are: Surgical adhesions Herniae Intraluminal mass eg, small bowel lymphoma or gallstone (in gallstone ileus)
Patient B: LBO The Cecum is considered dilated if >9cm; other if >6cm.
Radiology Report: Plain abdominal radiograph. Multiple dilated loops of large bowel across the abdomen. Gas is not seen in the large bowel. The three most common causes of large bowel obstruction are: Ca Diverticular disease Volvulus
A: Sigmoid Volvulus B: Cecal Volvulus A B A volvulus always extends away from the area of bowel twist. Sigmoid volvulus can only move upwards and usually goes to the right upper quadrant. Cecal volvulus can go almost anywhere.
Tension pneumothorax Complete right- sided pneumothorax Lung is compressed against mediastinum Shift of heart and trachea to left
A smaller Pneumothorax on CT Post Ant Air in pleural space rises to top and displaces normal lung
Another patient with SOB: A skin fold consists of a density (light) and then a lucency (dark), A pneumothorax has a thin white line with similar densities on both sides of it. Skin Fold Pneumothorax
URD, front end collision, high speed MVA Now, same patient, upright cxr… You are looking for a marker of aortic injury: mediastinal hematoma Mediastinal widening >8cm Left paratracheal stripe Displacement of intimal calcifications Apical pleural cap Left pleural effusion Displacement of endotracheal tube or nasogastric tube About 10% will have a normal CXR!
Apical Cap Wide Lt Paratracheal stripe that extends above the knob
Pneumoperitoneum Air outlines both sides of the wall of the stomach-a sign of free air in the peritoneal cavity
Pneumoperitoneum on CT CT scans on 2 different people show a small and large amount of free air in the peritoneal cavity which rises to the highest point (anterior abdomen with the person lying on their back) and is not contained within bowel Free air
Size (not number) of vessels at the apex exceeds size of vessels at the base in this upright person. This is “cephalization.” Normally the vessels at the base exceed the size of the vessels at the apex
Tip of endotracheal tube is in right mainstem bronchus (red arrow) leading to atelectasis of the right upper lobe and entire left lung
Endotracheal Tubes Where Tip should be at least 5cm above carina Between clavicles and carina Carina usually at level of T4 Balloon should never distend tracheal walls; if >2.8 cm, suspect laceration
Central Venous Catheters Where Subclavian joins brachiocephalic vein behind medial end of clavicle Catheter should reach this point before descending Catheter should descend lateral to spine and tip should be in the SVC
l Tip positioned at apex of right ventricle n Tip may have slight bend as it abuts wall of right ventricle l Not a sharp bend l Some pacers may also have lead(s) in right atrium and/or coronary sinus Pacemakers Where
Two-lead pacemaker (red circle) shows one lead in right atrium (green arrow) and the second in the right ventricle (red arrow).
Two different people who fell & complain of neck pain A B
Fracture through posterior elements of C2 Forward displacement of the body of C2 (red arrows) Spinolaminar white line of C2 does not align with other vertebral bodies Fracture of C2 - “Hangman’s Fracture” A A
Locked facets The inferior articular facet of C5 (red arrow) has slipped forward and lies anterior to the superior articular facet of C6 (green arrow) — a condition known as a “locked facet” C5 C6 B
Two patients-one with pain in the ankle, the other with pain in the wrist
Fractures of the metaphysis (red arrow) and epiphysis (green arrow) (Salter- Harris IV) extend into joint Fracture of radial styloid (yellow arrows) extends into wrist joint Fractures extending into joints
Posterior “fat- pad sign” indicates fluid in the joint Fracture of radial head Fracture of the radial head with traumatic joint effusion
Two different patients with acute shoulder pain 1 2
Anterior Dislocation of the Shoulder 2 Humeral head (red arrow) lies inferior to the coracoid process of the scapula (green arrow) Humeral head (red arrow) lies inferior to the glenoid fossa of the scapula (yellow arrow) Humeral head (red arrow) lies inferior to the coracoid process of the scapula (green arrow) and anterior to the glenoid (yellow oval)
Posterior Dislocation of the Shoulder 1 Humeral head (red arrow) lies posterior to the glenoid fossa of the humerus (yellow arrow) Humeral head (red arrow) lies beneath the acromion process of the scapula (green arrow) and posterior to glenoid (yellow oval) Humeral head (red arrow) assumes the shape of a “lightbulb” because it is fixed in internal rotation