RadiologySameer Bahal

28th January 2013

Content Chest X –Rays Abdo X-rays, CT Head,

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.

Where is the mass?

Case 225 year old with sudden onset chest pain

Case 380-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

Types of consolidation

Case 473 year presents with 1 week history of increased drowsiness. Recently started feeling Nauseous and loss of appetite.

History of stroke and AFDH: Warfarin

CT vs MRI MRI is better for:

Soft tissue (ligaments) Spine Younger Patients Cerebellar Imaging

Case 570 yea old patient, longstanding history of HTN, AF, Diabetes, CRF and Dementia.

Admitted after fall with increasing confusion.

On Examination Chest Clear, Heart Sounds: I + II + ESM, Abdo: SNT, BS present AMTS: 3/10, (Normally 7/10) Bloods Normal

Normal Pressure Hydrocephalus•Triad of:

–Gait Disturbance–Dementia–Urinary Incontinence

•Diagnosis–CT scan (enlarged ventricles)

Case 630 year old admitted with headache and confusion

Hematoma type Epidural Subdural      

LocationBetween the skull and the dura

Between the dura and the arachnoid

Involved vessel

Temperoparietal locus (most likely) - Middle meningeal arteryFrontal locus - anterior ethmoidal arteryOccipital locus - transverse or sigmoid sinusesVertex locus - superior sagittal sinus

Bridging veins

SymptomsLucid interval followed by unconsciousness

Gradually increasing headache and confusion

CT appearance Biconvex lens Crescent-shaped

Case 7You are a busy on call F1 Doctor. A nurse bleeps you, she has inserted an NG tube and wants to check the position.

Step 1, Check pH,

Results: 6

Step 2, CXR

Case 850 year old patient in hospital following MI. Develops SoB at night

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

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).

Case 94 year old lady Ms Amin presents to A+E with SoB. Pt unable to speak English

Chest Exam: Inspiratory Crackles throughout

Case 1050 year old patient admitted with Nausea and vomiting.

Recently developed severe abdo pain

PHM, perforated duodenal ulcer, appendicitis.

Case 1160 year old Patient admitted with Abdo Pain. Not opened bowel for 4 days.

Case 1260 year old Patient admitted with Abdo Pain. Not opened bowel for 4 days.

Recent history of weight loss, SmokerOE: Abdominal Distension

Case 1330 year old patient presents with sudden onset abdo pain.

Multiple abdominal surgeries in the past.

WCC 30,CRP 100,BP 85/60HR 130, Sats 96% Room Air

Management?

Case 1430 year old patient with Fibromuscular dysplasia.

Has History of Uncontrolled Hypertension.Presents with history of lethargy and fatigue, with recent vomiting

Bloods Na 145 K 6.3 Ur 21 Cr 430 GFR 15

What investigation of choice

Case 1546 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 BCGWhile you see her she coughs up blood stained phlegm.

Case 16

Case 1744 year old man on wardHistory of Dementia, AF, Stoke, MIYou are asked to see him at 0200 due to chest pain.

Unable to give clear history.

ABG: pH 7.36 O2 8.4 CO2: 5.8

WCC 11, CRP 30, (70), Hb 10.8 (11.6)