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Radiology Sameer Bahal 28 th January 2013 Slide 2 Content Chest X Rays Abdo X-rays, CT Head, Slide 3 Slide 4 Slide 5 Slide 6 Slide 7 Slide 8 Slide 9 Slide 10 Case 1 A 34-year-old woman, immigrant from Eastern Europe, Complaints of vague chest discomfort 5 days after an upper respiratory tract infection. Not a smoker BCG vaccination as child. Physical examination is normal. PPD is 10-mm induration Induced sputum for acid-fast bacilli is negative. Slide 11 Slide 12 Where is the mass? Slide 13 Case 2 25 year old with sudden onset chest pain Slide 14 Slide 15 Slide 16 Slide 17 Case 3 80-year-old male smoker with history of COPD. Presents with lower chest pain and worsening of shortness of breath. PH 7.30, CO2 3.6 Slide 18 Slide 19 Types of consolidation Slide 20 Slide 21 Slide 22 Case 4 73 year presents with 1 week history of increased drowsiness. Recently started feeling Nauseous and loss of appetite. History of stroke and AF DH: Warfarin Slide 23 Slide 24 Slide 25 CT vs MRI MRI is better for: Soft tissue (ligaments) Spine Younger Patients Cerebellar Imaging Slide 26 Case 5 70 yea old patient, longstanding history of HTN, AF, Diabetes, CRF and Dementia. Admitted after fall with increasing confusion. Slide 27 On Examination Chest Clear, Heart Sounds: I + II + ESM, Abdo: SNT, BS present AMTS: 3/10, (Normally 7/10) Bloods Normal Slide 28 Slide 29 Normal Pressure Hydrocephalus Triad of: Gait Disturbance Dementia Urinary Incontinence Diagnosis CT scan (enlarged ventricles) Slide 30 Case 6 30 year old admitted with headache and confusion Slide 31 Slide 32 Hematoma typeEpiduralSubdural Location Between the skull and the dura Between the dura and the arachnoid Involved vessel Temperoparietal locus (most likely) - Middle meningeal artery Frontal locus - anterior ethmoidal artery Occipital locus - transverse or sigmoid sinuses Vertex locus - superior sagittal sinus Bridging veins Symptoms Lucid interval followed by unconsciousness Gradually increasing headache and confusion CT appearanceBiconvex lensCrescent-shaped Slide 33 Case 7 You are a busy on call F1 Doctor. A nurse bleeps you, she has inserted an NG tube and wants to check the position. Slide 34 Step 1, Check pH, Results: 6 Step 2, CXR Slide 35 Slide 36 Case 8 50 year old patient in hospital following MI. Develops SoB at night Slide 37 Slide 38 Acute Pulmonary oedema Chest X-ray will show fluid in the alveolar walls, Kerley B lines, increased vascular shadowing in a classical batwing peri- hilum pattern, upper lobe diversion (increased blood flow to the superior parts of the lung), pleural effusions. In contrast, patchy alveolar infiltrates are more typically associated with noncardiogenic edema Slide 39 Kerley B Lines These are short parallel lines at the lung periphery. These lines represent interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs. Kerley B lines are seen in Congestive Heart Failure (CHF) and Interstitial Lung Diseases (ILD).pleuracostophrenic angles Slide 40 Case 9 4 year old lady Ms Amin presents to A+E with SoB. Pt unable to speak English Chest Exam: Inspiratory Crackles throughout Slide 41 Slide 42 Case 10 50 year old patient admitted with Nausea and vomiting. Recently developed severe abdo pain PHM, perforated duodenal ulcer, appendicitis. Slide 43 Slide 44 Case 11 60 year old Patient admitted with Abdo Pain. Not opened bowel for 4 days. Slide 45 Slide 46 Case 12 60 year old Patient admitted with Abdo Pain. Not opened bowel for 4 days. Recent history of weight loss, Smoker OE: Abdominal Distension Slide 47 Slide 48 Slide 49 Case 13 30 year old patient presents with sudden onset abdo pain. Multiple abdominal surgeries in the past. Slide 50 Slide 51 WCC 30, CRP 100, BP 85/60 HR 130, Sats 96% Room Air Management? Slide 52 Case 14 30 year old patient with Fibromuscular dysplasia. Has History of Uncontrolled Hypertension. Presents with history of lethargy and fatigue, with recent vomiting Slide 53 Bloods Na 145 K 6.3 Ur 21 Cr 430 GFR 15 What investigation of choice Slide 54 Slide 55 Case 15 46 year old Nigerian lady arrives in UK from Nigeria and visits A+E with Sob. 6 months ago she spent time with a ill relative who turned out to have active TB. Never had BCG While you see her she coughs up blood stained phlegm. Slide 56 Slide 57 Case 16 Slide 58 Case 17 44 year old man on ward History of Dementia, AF, Stoke, MI You are asked to see him at 0200 due to chest pain. Unable to give clear history. Slide 59 ABG: pH 7.36 O2 8.4 CO2: 5.8 WCC 11, CRP 30, (70), Hb 10.8 (11.6) Slide 60