Transcript Slide 1

Pathology
• Incomplete expansion of lung at
birth or collapse of adult lung
• Negative pressure within the chest
is disturbed
• Causes:
– Obstruction of a bronchus
– Compression of lung by pleural
effusion or pneumothorax.
– Improper placement of endotracheal
tube
– Bronchogenic carcinoma.
• Radiographic Signs:
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Local increased density
Elevation of the hemidiaphram
Displacement of the mediastinum
Compensatory over-inflation of the
lung
Atelectasis
• Chronic dilation of one or
more bronchi
• Causes:
– Repeated pulmonary
infection and bronchial
obstruction
– Lung abscess
• Radiographic Signs:
– Courseness and loss of
definition of interstitial
markings
– Oval or circular cystic
spaces
– Honeycomb pattern
Bronchiectasis
Emphysema / Chronic
Obstructive Pulmonary
Disease (COPD)
• Associated with chronic bronchitis.
• Increased air spaces with associated tissue
destruction.
• “leather lung disease”
– alveoli lose their elasticity and remain filled with air
during expiration.
• Incurable
• Radiographic Signs:
– Hyperinflated lungs
– Depressed diaphram
– Increased Bronchovascular markings
Pleural Effusion (Hydrothorax)
• Fluid in pleural cavity
• Causes
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Congestive Heart Failure
Infection
Neoplasm
Trauma
• Radiographic Signs
– Blunt costophrenic angles
– Air/Fluid levels
– Mediastinal Shift
Pulmonary Embolism
• Potentially Fatal
– Patients with
cardiovascular dz or
severe debilitating
illness often result
with infarction
• 95% arise from the
deep venous
thrombi
• Radiographic Sign
– Hampton’s Hump
• Inverted wedgeshaped opacity of the
lung
TB
• Caused by Myobacterium
Tuberculosis
• Primary Lesion
– Collection of inflammatory cells collects
around a clump of TB to form a mass
– Outcomes depend on the number of
bacilli and the resistance of infected
tissues
• Scars commonly found in posterior
apical segments
• Radiographic Signs:
– Demonstrates cavitation and
calcification
– Lobar or segmental air-space
consolidation
– Enlarged hilar or mediastinal lymph
nodes
– Pleural Effusion
Pneumonoconiosis
• Long-continued irritation of certain dusts
encountered in industrial occupations that
cause a chronic interstitial pneumonia.
• 3 Types:
– Silicosis
– Asbestosis
– Berylliosis
• Medical Emergency!
Volvulus
• Abnormal twisting or torsion of
intestine causing obstruction and
impairment of normal blood flow.
• Small intestine, cecum, and
sigmoid colon are subject to
volvulus.
• Clinical Signs
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Sudden onset
Abdominal pain
Nausea
Vomiting
Blood in stool
• Treatment
– Surgical intervention
• If not treated, a patient may suffer
from:
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Gangrene
Death of that segment of GI tract
Intestinal Obstruction
Perforation of the Intestine
Peritonitis
Fistulae or Sinus Tract
• Fistula
– An abnormal connection between 2 organs or leading from an
internal organ to the surface of the body.
• Most are caused by surgery but may also result from infection or
inflammation.
• Sinus Tract
– Abnormal channel permitting the escape of pus.
Ba study: gastric outlet obstruction with choledochoduodenal and abdominal fistulae.
fistulagram
Ascites
• Accumulation of excessive fluid
within the peritoneal cavity.
• CommonCauses
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Cirrhosis
Heart Failure
Budd-Chiari Syndrome
Cancer
TB
Pancreatitis
• Treatment
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Salt Restriction
Fluid Restriction
Diuretics
Paracentesis
Shunting
Liver Transplant
Portal hypertension. In ascites the soggy bowel
floats medially, there is some separation of the
ill-defined loops and loss of retroperitoneal
planes. Note enlarged spleen.
Prolapse
•
"To fall out of place."
– Rectal prolapse
• Partial prolapse
– The lining of the rectum falls out of place when you strain
to have a bowel movement.
• Complete prolapse
– The entire wall of the rectum falls and usually sticks out of
the body.
• Internal prolapse (intussusception)
– Causes
– Part of the wall of the colon telescopes into or over another
part. (occurs inside of the body)
• Straining to have bowel movements
• Child Birth
• Weakening of anal sphincter muscle & ligaments that
support rectum
• Neurologic problems
Rectal Prolapse
– Symptoms
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Stool leakage
Bleeding, anal pain, itching, irritation
Tissue that protrudes from rectum
Small stools
Urgency for bowel movement
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Fiber rich diet
Increased fluids
Physical Therapy
Surgery
– Treatment
Prolapsed Transverse Colon
Colon and Rectal Cancer
• Leading cause of
death from cancer
in US
• Annular
carcinoma has
“apple-core”
pattern imaged
during BE
Crohn’s Disease
• Chronic bowel
inflammation
• Separated by
normal segments
of bowel
Diverticulosis
• Pouch-like
herniations
through wall of
colon
Intussusception
• Prolapse of one
segment of bowel
into another
segment
• Telescoping
Small / Large Bowel Obstruction
• Massive accumulation
of gas proximal to the
obstruction
• Absence of gas distal
to obstruction
• High risk perforation
• EXAMPLE: Ileus
– Adynamic:
• Caused by bowel
immobility
– Mechanical
• Caused by mechanical
obstruction
Urinary System
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Bladder Cancer
Cystitis
Glomerulonephritis
Polycystic Kidney
Disease
Pyelonephritis
Renal Calculus
Renal Carcinoma /
Wilm’s Tumor
Renal Cysts
Reflux
Myelogram
• Herniated
intervertebral
disks
• Degenerative dz
• Space occupying
lesions
– L3-L4 interspace
– Subarachnoid
Space
Arthrography
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Joint Trauma
Meniscal Tears
Capsular Damage
Deformities caused
by arthritis
• Rupture of articular
ligaments
Spina Bifida Occulta
“Open Spine”
• Congenital deformity of the
vertebral column in which
the laminae fail to unite
posteriorly at the midline.
www.pbs.org
Vertebral Subluxation
• Misalignment or
partial dislocation
– one or more
vertebrae move out of
position and create
pressure on or irritate
spinal nerves.
Spondylolisthesis
A developmental crack in one of the vertebrae (usually at the L5-S1 junction.) The cracked
vertebra slips forward over the vertebra below it. This is known as adult isthmic
spondylolisthesis.
Ankylosing Spondylitis
Chronic inflammatory disease that causes arthritis of the spine
and SI joints. It is a systemic rheumatic disease and can affect
other joints & cause inflammation of the eyes, lungs, & kidneys.
Herniated Nucleus Pulposus
“Slipped Disc”
Compression Fracture
• A bone break that disrupts
osseous tissue and collapses
the affected bone.
• This injury tends to happen
in 2 groups of people.
– Patients involved in
traumatic accidents when the
load placed on the vertebrae
exceeds its stability. (This is
commonly seen after a fall)
– Patients with osteoporosis
(most common)
Osteitis Deformans/Pagets
• chronic bone disorder that results in enlarged, deformed bones due
to
excessive breakdown &
formation of bone tissue that
can cause bones to weaken
and may
result in bone pain,
arthritis, bony
deformities and
fractures.
Osteochondroma
• A benign tumor that contains both bone and cartilage
and usually occurs near the end of a long bone.
Ewing’s Sarcoma
(Peripheral Primitive Neuroectodermal Tumors )
• Bone cancer found in
children and young adults.
Multiple myeloma
• Multiple myeloma is a cancer of
your plasma cells. Plasma cells
are a type of white blood cell
present in your bone marrow.
Osteomyelitis
• Infection of the bone or bone marrow caused
by pyogenic bacteria or myobacteria.
Neuroma
• Any tumor of cells of the nervous system.
Neuromas may be benign or malignant.
Bakers Cyst
Osgood-Schlatter’s Disease
• The large powerful quadriceps contracts
& the patellar tendons can pull away from
the shin bone.
• Athletes present with pain and swelling at
the tibial tubercle.
• Repetitive activity and tight quadriceps
cause
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cartilage swelling
cortical bone fragmentation
patellar tendon thickening
infrapatellar bursitis.
Rheumatoid Arthritis
• Chronic Systemic Disease
of unknown origin.
• Manifests as an inflamed
peripheral joint.
• Polymorphonulear
leukocytes are attracted to
the joint space causing
destruction of the joint
structures.
“Open Book” Injury
• Widening of the anterior pubic arch
www.scielo.br.com
www.wheelessonline.com
diastasis of > 2.5 cm = ligament damage at the SI joint
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Duverney’s Fracture
• Stable fracture at the lateral margin of the iliac wing
(just below the anterior inferior spine) caused by
vertically directed forces
Complications:
Possible
hemorrhage from
the internal iliac
arterial system.
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Osteosarcoma
• Most common type of malignant bone cancer. Often
localized at long bones. Commonly affects the lower
end of the femur or the upper end of the tibia or
humerus.
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POSITIONING REVIEW
What are the proximal and distal rows
in the wrist?
Carpals
• 8 Carpal Bones
– Proximal Row
• Scaphoid
(Navicular)
• Lunate
(Semilunar)
• Triquetrum
(Cuneiform)
• Pisiform
– Distal Row
• Trapezium
(Greater
Multangular)
• Trapezoid
(Lesser
Multangular)
• Capitate
(Os Magnum)
• Hamate
(Unciform)
In what position was this image taken?
What bone is demonstrated in this
position?
In what position was the patient for
this image?
In what position was the patient
placed for this shoulder image?
What image is demonstrated? How do
you determine anterior/posterior
dislocation?
Scapular Y
• Useful in demonstrating
dislocations
– Anterior Subcoracoid
dislocation
• Head beneath the
coracoid process
– Posterior Subacromial
dislocation
• Head projected
beneath acromion
process
What is the attempted image? How
was it accomplished?
Which ribs are demonstrated in RAO
position?
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AP Axial “Outlet” projection
(Taylor Method)
• 10X12 crosswise
(14X17 for entire
pelvis) Pt supine
without rotation
CR 2 inches distal to
the superior border
of the pubic
symphysis
• Males: 20-35 degree
cephalad
• Females: 30-45
degree cephalad
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Superoinferior Axial “Inlet” Projection
(Bridgeman Method)
• 10X12 crosswise
(14X17 if entire
pelvis is routine)
CR 40 degrees caudad centered @
level ASIS
• Demonstrates axial
projection of pelvic
ring, or inlet, in its
entirety
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Which way do you rotate?
How was this image accomplished?
AP Knee
• Central ray depends on the measurement
between the ASIS and the tabletop
Thin pelvis
18 cm and below
Average 19-24 cm
perpendicular
Large pelvis
25 cm and above
3-5 degrees caudad
3-5 degrees cephalic
What does this image demonstrate?
How was it done?
Name the parts of the scottie dog.
L5-S1 SPOT PROJECTION
Where to you center?
Center on coronal plane 2 in posterior to ASIS and
1.5 in inferior to the iliac crest.
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L5-S1 SPOT PROJECTION
Where to you center?
Center on coronal plane 2 in posterior to ASIS and
1.5 in inferior to the iliac crest.
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How was this image taken?
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What is the evaluation requirement for
this image?
How was this image taken?
C Spine
T Spine
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L Spine
AP side down
PA side up
Caldwell Sinus Projection Film
• This view will provide a clear
view of the frontal and
ethmoid sinuses.
• The super orbital rims can be
evaluated for fracture when
facial bone are of interest.
• To project the petrous ridges
farther down, increase angle
to 30 degrees
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Sinus Lateral
• Lateral – External auditory meatus externally
and mandible inferiorly with supracillary arch
superiorly in view.
• CR centered to zygoma, midway between
outer canthus and EAM
• Midsagittal plane is parallel to IR
• IPL is perpendicular to IR
Lateral Sinus Anatomy
Positioning: Waters
• Prone or seated upright
• Chin on bucky -OML 37 angle
with plane of cassette
• Mentomeatal line should be
perpendicular to film with mouth
closed.
• Nose 3/4 inch from IR
• Suspend respiration
• CR perpendicular to exit
acanthion
Waters Radiograph
• Distance from lateral
border of skull and orbit
equal on each side
• Petrous ridges
projected immediately
below maxillary sinuses
Modified Parietoacanthial
(Modified Waters)
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OML 55 degrees to the IR
Chin and nose on table
Petrous pyramids are seen mid-maxillary sinus
CR exits acanthion
Blowout Fractures
• See pg. 355 (Merrill’s 12th Edition)
Modified Waters Radiograph
• Petrous ridges
projected immediately
below the inferior
border of the orbits
• Equal distance from
lateral orbit to lateral
skull on both sides
Reverse Waters
• Supine
• Extend neck so OML is 37
degree with plane of IR
• MML perp
• Suspend respiration
• CR perpendicular and
enters acanthion
Lateral Nasal Bones
• Semiprone
• IPL perpendicular
• CR perpendicular to the
bridge of nose at a
point ½ inch distal to
the nasion
Bilateral Arches - SMV
• IOML parallel to IR and perpendicular to CR
• CR midsaggital and collimate to outer edges of
zygoma
Oblique Tangential
• Same position as SMV
except head tilt 15
degrees toward side of
interest
(Merrill’s p. 362 12 ed)
Esophagus
• RAO
• Left side elevated
35-40 degrees
• Center at T-5 or T-6
• PA
Stomach
– Center at pylorus L2 (midway
between xiphoid and
umbilicus)
– Expiration
• RAO
– L side elevated 40-70 degrees
– Between vertebrae and
elevated surface
– Center at duodenal bulb
– Expiration
• Lateral
– Recumbant (R lateral), Erect (L
lateral)
– Between axilla and anterior
surface
– Center at pylorus
Small Bowel
• Central ray at iliac
crest (or slightly
above for early
exposures)
Colon
• PA or AP
– Center at iliac crest
• PA Axial (may be done AP)
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Prone
Center @ iliac crest
CR 30-40 degrees caudad
Sigmoid Colon
Smaller IR; CR enters @
ASIS
• Bilat Obliques
• Lateral Decubitus
• Lateral Rectum
– Enter at ASIS
Intravenous Urography
• KUB
• Obliques
– Rotated 30 degrees –
kidney farthest from
IR is parallel; kiney
closest is
perpendicular to film
• AP Bladder
– CR at ASIS
Cystography
• AP Axial
– 10-15 degrees caudal
– CR 2-3 in above pubic
syphysis
• Oblique
– 40-60 degrees
• PA Bladder
– CR 1 in distal to tip of
coccyx
– 10-15 degree cephalad
angle
• Lateral