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

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Presentation on theme: "Emergency Radiology What to order, When DR ADNAN AHMED MBBS, FCPS Assistant Professor Department of Radiology and Imaging LUMHS, Jamshoro."— Presentation transcript:

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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

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

20 Emergency Radiology

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24 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

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29 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

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37 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

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42 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.

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52 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.

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67 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

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72 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

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76 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.

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81 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

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86 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

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

90 Emergency Radiology

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93 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

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

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114 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

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

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

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

141 Emergency Radiology

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145 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.

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154 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).

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167 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.

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

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184 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

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

190 Emergency Radiology

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198 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.

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

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