Normal cervical spine

After assessing that the lateral radiograph is a true lateral, the following lines should always be checked. Fig. 4.4 Rotated lateral radiograph. Lack of superimposition of the articular masses, giving the appearance of double articular facets (arrows). Fig. 4.4 Rotated lateral radiograph. Lack of superimposition of the articular masses, giving the appearance of double articular facets (arrows). Fig. 4.5 Normal AP radiograph. The AP view usually only demonstrates C3-C7. The uncovertebral joints...

Percutaneous transhepatic cholangiogram and biliary stent

A percutaneous transhepatic cholangiogram (PTC) is performed in cases of biliary obstruction when ERCP is not possible (previous Bilroth II gastrectomy, choledochojejunostomy) or if ERCP has failed. A fine needle (22 guage) is used to puncture the biliary tree and inject radiographic contrast in order to demonstrate the anatomy of the dilated bile ducts. This initial puncture can be performed under fluoroscopy or using ultrasound guidance (when a specific duct is targeted). From the...

Contrast agents in MRI

Despite the excellent inherent tissue contrast in MR images, intravenous contrast medium is often given to highlight abnormal tissue. Chelates of the paramagnetic substance gadolinium are used - they shorten the relaxation times of nearby protons which results in high signal on Tl-weighted images. Gadolinium has similar pharmacokinetics to the iodinated contrast media used in CT - it is distributed throughout the intra- and extravascular spaces, does not cross the intact blood-brain barrier, is...

Diverticular abscess

Absess Colon

There is a 10-12 cm abscess cavity with an air-fluid level in the left flank. Immediately adjacent to the abscess is a loop of bowel affected by diverticular disease with signs of direct communication. Therapeutic options are either to insert a drainage tube under CT or ultrasound guidance or to proceed to laparotomy. If there is a large fistulous communication, then the surgical option would be favoured. Although the origin of the abscess is probably diverticular, the differential diagnosis...

Injury to the cervical spine

Gregor Linie

One of the most important questions in suspected cervical injury is the question of stability of a fracture or a dislocation. Stability of the vertebral column usually depends on the integrity of the major skeletal components, discs, apophyseal joints and ligamentous structures. Radiographic findings 175 1. Prevertebral soft tissue line, 2. anterior vertebral body line, 3. posterior vertebral body line, 4. spinolaminar line, 5. interspinous process line, 6. clivus to dens line (Wackenheim...

Comment

Papillary Muscle Rupture Nursing

On a film with diffuse increased pulmonary opacification you have to decide early on whether it is air space consolidation or interstitial pattern shadowing. Air space shadowing has a number of characteristic features. It has poorly defined margins, a tendency to coalesce, produces air bronchograms and air alveolagrams. The causes of air space shadowing are extensive. If a chest X-ray simply shows a focal patch of consolidation and there are no further radiological clues or clinical history, it...

Cirrhosis and portal hypertension

Hepatocellular Adenoma Mri

The commonest cause of portal hypertension is cirrhosis secondary to alcoholic liver disease or chronic hepatitis B or C (see Fig. 6.24), further causes are listed in Table 6.3. Imaging features of cirrhosis and portal hypertension include liver nodularity, reversal of portal blood flow (demonstrated on ultrasound), porto-systemic colateral vessels, splenomegaly, ascites and complications such as hepatoma. Porto-systemic colateral vessels occur at many sites (see Table 6.4) as a consequence of...

Atrial septal defect

Pulmonary Arteryenlargement

ASD causes increased pulmonary arterial flow due to blood being shunted from the left to the right atrium and, subsequently, through the pulmonary arteries and veins. This overcirculation causes pulmonary plethora making the vessels appear distended. The right atrium, right ventricle, pulmonary artery and veins become enlarged. The vessels appear crisper than pulmonary venous hypertension (due to lack of oedema) and upper lobe distension is absent. After time persistent overcirculation through...

Competencybased training and assessment

Becoming a safe and competent anaesthetist is not only about passing the appropriate examinations workplace assessments must be successfully completed by an SHO to achieve the SHO training certificate in order to apply for an SpR post. An SpR must pass the appropriate competency tests in order to receive accreditation. An SHO must be able to interpret simple radiological images showing clear abnormalities including chest radiographs, CT and MRI scans of head, neck and thoracic inlet films, and...

Crohns disease

Haustral Markings

This is one of the images taken during a barium follow-through examination. The small bowel can be examined using a barium follow-through technique or by intubating the proximal jejunum and injecting barium - small bowel enema enteroclysis. A number of abdominal films are taken in the prone position to separate the small bowel loops to examine the small bowel as the barium passes to the colon. Further views are taken of the terminal ileum as this is an area particularly affected by Crohn's...

Renal artery stenosis

This selective renal artery arteriogram demonstrates the string of beads sign, which is characteristic of fibromuscular dysplasia of the renal artery. There are alternating areas of stenosis and aneurysm. This is the commonest cause of renovascular hypertension in young adults and children. There is a female predominance. The renal arteries are not exclusively involved and the carotid vessels or other aortic branches are also affected, but less commonly than the renal arteries. The mid- and...

Extension teardrop fracture

This is usually the result of a hyperextension injury caused by a force delivered to the face or the mandible that drives the head and neck into an abnormal extension. The extension teardrop fracture is a relatively large triangular fragment with its vertical height equal to or greater than its transverse width. The fractured fragment usually arises from the antero-inferior corner of the involved vertebra, most commonly the C2 vertebral body Figs 4.47 and 4.48 . This is an avulsion fracture at...