3 Large vs. Small Bowel Large Bowel Small Bowel Peripheral Haustral markings don't extend from wall to wallMax diameter 6cm (9cm cecum)Small BowelCentralPlica extend across lumenMaximum diameter of 3cm
5 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 adhesionsHerniaeIntraluminal mass eg, small bowel lymphoma or gallstone (in gallstone ileus)
6 Patient B: LBOThe Cecum is considered dilated if >9cm; other if >6cm.
7 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:CaDiverticular diseaseVolvulus
9 A: Sigmoid Volvulus B: Cecal Volvulus 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.
19 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 >8cmLeft paratracheal stripeDisplacement of intimal calcificationsApical pleural capLeft pleural effusionDisplacement of endotracheal tube or nasogastric tubeAbout 10% will have a normal CXR!
20 Apical CapWide Lt Paratracheal stripe that extends above the knob
37 PneumoperitoneumAir outlines both sides of the wall of the stomach-a sign of free air in the peritoneal cavity
38 Pneumoperitoneum on CT Free airFree airCT 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
40 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
48 Tip of endotracheal tube is in right mainstem bronchus (red arrow) leading to atelectasis of the right upper lobe and entire left lung
49 Endotracheal Tubes Where Tip should be at least 5cm above carinaBetween clavicles and carinaCarina usually at level of T4Balloon should never distend tracheal walls; if >2.8 cm, suspect laceration
50 Central Venous Catheters Where Subclavian joins brachiocephalic vein behind medial end of clavicleCatheter should reach this point before descendingCatheter should descend lateral to spine and tip should be in the SVC
52 Pacemakers Where Tip positioned at apex of right ventricle Tip may have slight bend as it abuts wall of right ventricleNot a sharp bendSome pacers may also have lead(s) in right atrium and/or coronary sinus
53 Two-lead pacemaker (red circle) shows one lead in right atrium (green arrow) and the second in the right ventricle (red arrow).
55 Two different people who fell & complain of neck pain BTwo different people who fell & complain of neck pain
56 A A Fracture of C2 - “Hangman’s Fracture” AASpinolaminar white line of C2 does not align with other vertebral bodiesFracture through posterior elements of C2Forward displacement of the body of C2 (red arrows)Fracture of C2 - “Hangman’s Fracture”
57 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”BC5C6Locked facets
58 Two patients-one with pain in the ankle, the other with pain in the wrist
59 Fractures extending into joints Fracture of radial styloid (yellow arrows) extends into wrist jointFractures of the metaphysis (red arrow) and epiphysis (green arrow) (Salter-Harris IV) extend into jointFractures extending into joints
61 Fracture of the radial head with traumatic joint effusion Fracture of radial headPosterior “fat-pad sign” indicates fluid in the jointFracture of the radial head with traumatic joint effusion
62 Two different patients with acute shoulder pain 12Two different patients with acute shoulder pain
63 Anterior Dislocation of the Shoulder Humeral head (red arrow) lies inferior to the coracoid process of the scapula (green arrow) and anterior to the glenoid (yellow oval)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)2Anterior Dislocation of the Shoulder
64 Posterior Dislocation of the Shoulder 1Humeral 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 rotationHumeral head (red arrow) lies posterior to the glenoid fossa of the humerus (yellow arrow)Posterior Dislocation of the Shoulder