Radiology

Front 1

5 Radiologic Densities

Back 1

Gas, Fat, Fluid, Bone, Metal

Front 2

CXR Views

Back 2

1. AP vs. PA: heart enlarged and fuzzy because farther from film
2. Lateral
3. Decubitus: for pleural effusion on that side

Front 3

Approach to CXR

Back 3

Labels
Previous Exams
Quality of film
1. Inspiration - 9 ribs
2. Exposure - want to see spine and vessels in lungs
3. Rotation - distance between clavicle and spinous process

Front 4

Landmarks on an AP Chest Radiograph

Back 4

Front 5

Landmarks on Lateral Chest Radiograph

Back 5

Front 6

Lung Lobes

Back 6

Right: Upper, Middle (against heart), Lower; Oblique and Horizontal Fissures
Left: Upper (with lingula against heart), Lower; Oblique fissure

Front 7

Silhouette Sign

Back 7

Obscured Borders
Right Heart Border: RML
Left Heart Border: Lingula
Right Hemidiaphragm: RLL
Left Hemidiaphragm: LLL
Descending Aorta: LLL

Front 8

Air Bronchogram Sign

Back 8

Alveoli filled with blood, puss or fluid cause bronchi filled with air to become visible.
Pathology in the lung

Front 9

Kerly B Line

Back 9

Horizontal lines extending to pleura.
Increased fluid density material in interlobal septa.
Pulmonary edema (CHF), tumour (lymphangitic carcinomatosis)

Front 10

Snowball Sign

Back 10

Nodule is round: located in lung.
Nodule is flattened: located in chest wall, pleura, mediastinum.

Front 11

3 Lung Disease Patterns

Back 11

1. Interstitial:thin white lines from fluid in interstitium
2. Air space disease (consolidation): white opacity from fluid in alveoli
3. Honeycomb: interstitial scaring from interstitial lung disease

Front 12

Appearance of Aortic Laceration on CXR

Back 12

1. Wide mediastinum
2. Blurred aortic arch
3. Apical caps (blood at lung apices)
4. Deviated trachea to right

Front 13

Enlarged Cardiac Silhouette

Back 13

Transverse measurement > 1/2 width of chest
Cardiomegaly: CHF, cardiomyopathy, valvular disease
Pericardial Effusion

Front 14

Atalectasis (cause, signs)

Back 14

Signs:
1. White area (lines, lobe,etc)
2. Displacement of interlobar fissue toward collapsed lobe

Causes:
1. Obstruction (tumor, foreign body)
2. Compression (pneumothorax, pleural effusion)
3. Traction (scarring from infection, TB, fibrosis)

Front 15

Cavitating Lession (cause, signs)

Back 15

Signs:
1.White density ring with dark center

Causes:
1. abscesses
2. fungal pneumonia
3. TB
4. tumours

Front 16

Effusion (types, signs)

Back 16

Types: pleural effusion, hemothorax, empyema
Signs:
1. Blunted costophrenic angles (mostly posterior best seen on lateral view)

Front 17

CHF (signs)

Back 17

1. Cardiomegaly
2. Vascular Redistribution: vessels in upper lungs bigger than lower lungs
3. Interstitial pattern + Kerly B lines
4. Peribronchial cuffing: bronchi seen head on surrounded by fluid
5. Pleural effusions
6. Batwing pattern: symmetrical air space disease adjacent to hila

Front 18

Lung Nodules/Masses

Back 18

Nodule < 3cm
Benign Cause: hemartoma, granuloma; small, well defined, smooth, round, calcieid, stable in size
Malignant: primary (ill-defined, spiculated, grow); mets (multiple, smooth, round, variable in size)

Front 19

White on CXR (causes)

Back 19

1. Infection
2. Atalectasis
3. Cavitating Lesion
4. Effusion
5. CHF
6. Interstitial Lung Disease
7. Nodule/Mass

Front 20

Black on CXR (causes)

Back 20

1. Pneumothorax
2. Emphysema
3. PE

Front 21

Pneumothorax

Back 21

Black area (usually at apex) with no vessels extending through
Best seen on expiration
When lying flat: black in costrophrenic angles

Front 22

Emphysema CXR

Back 22

Decreased density (air trapping)
Fewer visible blood vessels
Flattening of diaphragm
Hyperinflation
Bullae

Front 23

PE CXR

Back 23

Usually normal
Non specific: Atalectasis, pleural effusion
Hampton's Hump: white wdge area of air space disease

Front 24

AXR Views

Back 24

1. Supine
2. Erect
3. Left lateral decubitus

Front 25

Approach to AXR

Back 25

Free ABDO
1. Free fluid
2. Air: outside lumen, inside lumen
3. Bowel wall thickening
4. Densities
5. Organs

Front 26

AXR Free Fluid

Back 26

Ascites
Distance between colon and flank fat stripe > pinky finger

Front 27

Free Air AXR

Back 27

Normal 10 days after sx.
Under diaphragm
Rigler's Sign: on supine view, both sides of bowel wall visible from intra and extra luminal air
Causes of bowel perforation: PUD, diverticulitis, CA, obstruction

Front 28

Dilated Bowel AXR

Back 28

3cm Small Bowel
6 cm Large Bowel
9cm Cecum
Causes:
1. Ileus: localized (inflammation) or generalized (drugs, sx, pain)
2. Bowel Obstruction: look for air in rectum, air fluid levels
3. Volvulus

Front 29

Bowel Wall Thickening AXR

Back 29

Causes: IBD, ischemia

Front 30

Densities AXR

Back 30

1. Bones: vertebral column, pelvis
2. Appendicolith: small calcifications suggestive of appendicitis
3. Stones: renal, gallstones
4. Pancreatic Calcifications: chronic pancreatitis
5. AAA > 3cm

Front 31

Vertebrae Anatomy

Back 31

Front 32

C-Spine Anatomy

Back 32

C1: Atlas
C2: Axis with odontoid process
C3-7
Intervertebral Disks
Lordosis
Vertebral arteries run through transverse foramina
Spinal cord through vertebral foramen
Intravertebral Foramen - nerve root

Front 33

C-Spine x-ray Views

Back 33

Lateral
Frontal
Odontoid

Front 34

Approach to C-Spine lateral View

Back 34

1. 7 Cervical bodies and top of !st thoracic vertebrae
2. Alignment: anterior vertebral line, posterior vertebral line, spinolaminar line, spinous process line
3. Bones: fractures, osteophytes
4. Cartilage: space between vertebrae
5. Soft Tissue: prevertebral soft tissue enlargement

Front 35

Fracture Description

Back 35

1. Location: bone, part of the pone (distal/proximal), intra/extra-articular
2. Pattern: simple (transverse, oblique, spiral, vertical), comminuted (>2 pieces), compound)
3. Deformity: a. translation (latera, medial, anterior, posterior) b. angulation c. rotated (distal fragment relative to proximal) d. impaction e. dislocation
4. Type: pathologic, stress

Front 36

Hill-Sachs Lesion

Back 36

Impaction of superolateral humeral head against glenoid as should dislocates

Front 37

Bankart Lesion

Back 37

Inferior glenoid rim breaks with anterior dislocation of shoulder

Front 38

Associated Inury with Radial Shaft Fracture

Back 38

Radial Nerve Injury

Front 39

Glenohumeral Joint Dislocation

Back 39

90% Anterior
10% Posterior

Front 40

AC Joint Seperation - Grade

Back 40

1. Ligament injury with no radiologic abnormality
2. Some par tof clavicle associated with acromion
3. No association
Mechanism: falling on shoulder

Front 41

Distal Humeral Fracture

Back 41

1. Supracondylar - transverse fracture above condyles
2. Transcondylar - seperation of lateral or medial condyle
3. Intercondylar - seperates both condyles

Front 42

Distal Humeral Fracture

Back 42

1. Supracondylar - transverse fracture above condyles
2. Transcondylar - seperation of lateral or medial condyle
3. Intercondylar - seperates both condyles

Front 43

Sail Sign

Back 43

Posterior fat pad visible at elbow.
Anterior fat pad normally a little visible

Front 44

1. Galeazzi fractures
2. Monteggia fractures

Back 44

1. Fracutre of distal radius and dislocation of radio-ulnar joint at wrist (FOOSH)
2. Fracture of ulna with dislocation of radial head at elbow.

Front 45

Colles' Fracture

Back 45

Distal extraarticular radial fracture with dorsal displacement of distal fragment and plamar angulation.
Look for ulnar styloid fracture
FOOSH

Front 46

Foot Anatomy

Back 46

Front 47

Hand Anatomy

Back 47

Front 48

Hand Anatomy

Back 48

Front 49

Hip Fractures

Back 49

1. Subcapital: just under the head - leads to avascular necrosis
2. Intertrochanteric
3. Subtrochanteric

Front 50

Hip Dislocations

Back 50

1. 90% Posterior

Front 51

Septic Arthritis

Back 51

1. Soft tissue swelling
2. Periarticular osteopenia (dark)
3. Joint space narrowing (cartilage distruction)

Front 52

Osteoarthritis

Back 52

1. Asymmetric joint space narrowing
2. Periarticular sclerosis
3. Osteophytes
4. Subarticular cysts

Front 53

Rheumatoid Arthritis

Back 53

1. Soft tissue swelling
2. Periarticular osteopenia
3. Bony erosion
4. Joint subluxation
5. Symmetrical joint space narrowing
6. No osteophytes

Front 54

Avascular Necrosis

Back 54

1. Osteopenia
2. Sclerosis
3. Dark Crescent
4. Collapse
Affects one side of joint

Front 55

Malignant Bone Tumour

Back 55

1. lytic lesion
2. wide transition area between lesion and normal bone
3. periosteal reaction
4. soft tissue mass
5. cortical destruction

Front 56

Head CT - 1st Brain Slice

Back 56

Front 57

Head CT - 2nd Brain Slice

Back 57

Front 58

Head CT - 3rd Brain Slice

Back 58

Front 59

Head CT - 4th Brain Slice

Back 59

Front 60

Head CT - 5th Brain Slice

Back 60

Front 61

Head CT - 6th Brain Slice

Back 61

Front 62

Head Ct - Ischemic Stroke

Back 62

May look normal for 12 hours.
1st: loss of gray-white differentiation, sulcal flattening
2nd: wedge-shaped dark area involving gray and white matter

Front 63

Osteomyelitis

Back 63

1. Lytic Lesion (dark focal area)
2. Sequestrum (bright spot in lesion from devascularized bone)
3. Periostitis (inflammed periosteum)