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Commonly encountered radiographs during clerkship: The Basics Seng Thipphavong, PGY4 Department of Diagnostic Imaging.

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Presentation on theme: "Commonly encountered radiographs during clerkship: The Basics Seng Thipphavong, PGY4 Department of Diagnostic Imaging."— Presentation transcript:

1 Commonly encountered radiographs during clerkship: The Basics Seng Thipphavong, PGY4 Department of Diagnostic Imaging

2 Objectives and Outline To review the commonly encountered radiographs during clerkship, with a review of radiographic anatomy and disease entities To review the commonly encountered radiographs during clerkship, with a review of radiographic anatomy and disease entities Radiographs: Radiographs: –The Chest Radiograph –The Abdominal Radiograph –Miscellaneous Radiographs…

3 The Chest Radiograph 1. Anatomy 2. Cases (3)

4 trachea clavicle SVC right atrium left ventricle left atrial appendage main pulmonary artery aortopulmonary window aortic arch right hemidiaphragm left hemidiaphragmAnatomy

5 Anatomy IVC right heart chambers right pulmonary artery retrosternal airspace trachea left heart chambers left pulmonary artery

6 Case 1 69 y.o. female presents with shortness of breath 69 y.o. female presents with shortness of breath

7 Case 1

8 peribronchial cuffing Kerley B lines

9 Pulmonary edema Radiographic signs of pulmonary edema? (5) 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

10 Case 2 69 y.o. with fever and cough 69 y.o. with fever and cough

11 Case 2

12 Air bronchograms

13 Case 2 Findings of pneumonia on radiograph? Findings of pneumonia on radiograph? –Consolidation (white) and air bronchograms How are pneumonia and atelectasis similar on radiograph? How are pneumonia and atelectasis similar on radiograph? –Both are white How are pneumonia and atelectasis different on radiograph? How are pneumonia and atelectasis different on radiograph? –Look for air bronchograms –Atelectasis will have signs of volume loss

14 Case 3 69 y.o. with chest pain 69 y.o. with chest pain

15 Case 3

16 Visceral pleura

17 Case 3 Causes of pneumothorax? Causes of pneumothorax? –Numerous! Treatment? Treatment? –Urgent –Chest tube –25 G needle 2 nd intercostal space

18 Companion Case

19 Case 3 Deep sulcus sign? Deep sulcus sign? –pneumothorax on supine films –especially seen in ICU patients

20 The Abdominal Radiograph 1. Anatomy 2. Cases (3)

21 Anatomy Right kidney Air in descending colon Left psoas Left kidney Properitoneal fat Hepatic angle

22 Case 1 69 y.o. with abdominal pain 69 y.o. with abdominal pain

23 Case 1

24 What films are obtained in a conventional abdominal series? 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? What are the 4 cardinal symptoms of small bowel obstruction? –Nausea, vomiting, abdominal distension, obstipation What are the causes of SBO? What are the causes of SBO? –Adhesions, hernia, stricture, neoplasm, gallstone ileus

25 Companion Case

26 Case 1 What are the signs of SBO on radiograph? What are the signs of SBO on radiograph? –Dilated and fluid filled loops, “step-ladder” appearance What is the difference between ileus and SBO? What is the difference between ileus and SBO? –SBO indicates mechanical obstruction –Ileus is an adynamic state (“bowel shuts down”)

27 Case 2 69 y.o. with abdominal pain 69 y.o. with abdominal pain

28 Case 2

29 Cupola sign Football sign

30 Case 2 Signs of free intraperitoneal air on upright radiograph? Signs of free intraperitoneal air on upright radiograph? –Air under the diaphragm Signs of free intraperitoneal air on supine radiograph? 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? What is Rigler’s sign? –Free air outlining both sides of bowel

31 Companion case

32 Rigler’s sign

33 Case 2 What are the 2 most common reasons to see free intraperitoneal air? 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? Is free air commonly seen on radiograph from perforated diverticulitis? –No. –Why?  the omenteum usually contains the air, and is not seen on radiograph

34 Case 3 69 y.o. with abdominal pain 69 y.o. with abdominal pain

35 Case 3

36 What are the signs of large bowel obstruction? 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? What are the most common causes of large bowel obstruction? –Colon Ca, stricture (post-inflammatory diverticulitis or IBD), volvulus

37 The Miscellaneous Radiograph Cases (4)

38 Case 1 69 y.o. in a fight 69 y.o. in a fight

39 Case 1

40 What is a Boxer’s fracture? What is a Boxer’s fracture? –Fracture of the 5 th metacarpal Potential complications of a Boxer’s fracture? Potential complications of a Boxer’s fracture? –Metacarpal shortening –Usually the distal fragment is rotated in a radial direction, and may heal with deformity

41 Wrist and hand anatomy Distal phalynx DIP joint Middle phalynx Proximal phalynx Metacarpal Distal ulna PIP joint MCP joint Sesamoid CMC joint Distal radius

42 Wrist anatomy pisiform lunate capitate trapezium triquetrum scaphoid trapezoidhamate

43 Companion case

44 Case 2 69 y.o. who fell 69 y.o. who fell

45 Case 2

46

47 What is the classic clinical presentation for a hip fracture? What is the classic clinical presentation for a hip fracture? –Shortened lower extremity and external rotation

48 Pelvic anatomy Iliac crest SI joint Sacral ala Femoral neck Ischial tuberosity Obturator foramen Inferior pubic ramus Pubic symphysis Superior pubic ramus Iliopectineal line Greater trochanter Lesser trochanter Femoral head

49 Case 3 69 y.o. who fell 69 y.o. who fell

50 Case 3

51 What are the 3 radiographs that are obtained with an ankle series? What are the 3 radiographs that are obtained with an ankle series? –AP, lateral, ankle mortice view How is the ankle mortice view obtained? How is the ankle mortice view obtained? –Internal rotation 15 degrees What does the ankle mortice view tell you clinically? What does the ankle mortice view tell you clinically? –Ankle joint stability!

52 Ankle and foot anatomy 2 nd cuneiform Talus Navicular 3 rd cuneiform 1 st cuneiform Sesamoid Proximal phalynx Calcaneus Cuboid metatarsal

53 Case 4 69 y.o. who fell 69 y.o. who fell

54 Case 4

55 Where is the position of the humerus in an anterior dislocation? Where is the position of the humerus in an anterior dislocation? –Anterior!, and inferior What is a Bankart lesion? What is a Bankart lesion? –Impaction fracture at inferior glenoid rim What is a Hill-Sachs lesion? What is a Hill-Sachs lesion? –Impaction fracture at the superolateral aspect of the humeral head

56 Case 4 Which is more common, anterior or posterior dislocations? Which is more common, anterior or posterior dislocations? –Anterior (90%) What are the causes of posterior shoulder dislocations? What are the causes of posterior shoulder dislocations? –Ethanol, epilepsy, electrocution

57 Shoulder anatomy Acromium Anatomical neck Greater tuberosity Surgical neck of humerus Glenoid Scapula Coracoid Clavicle AC joint

58 End! Questions? Questions?


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