Transcript Ultrasound-Guided, Targeted Liver Lesion Biopsy Using an

Commonly
encountered
radiographs during
clerkship:
The Basics
Seng Thipphavong, PGY4
Department of Diagnostic Imaging
Objectives and Outline
To review the commonly encountered
radiographs during clerkship, with a
review of radiographic anatomy and
disease entities
 Radiographs:

– The Chest Radiograph
– The Abdominal Radiograph
– Miscellaneous Radiographs…
The Chest Radiograph
1.
2.
Anatomy
Cases (3)
trachea
Anatomy
clavicle
SVC
aortic arch
aortopulmonary window
main pulmonary artery
right atrium
left atrial
appendage
left ventricle
right
hemidiaphragm
left
hemidiaphragm
Anatomy
trachea
retrosternal
airspace
left pulmonary artery
right pulmonary
artery
right heart
chambers
left heart chambers
IVC
Case 1

69 y.o. female presents with shortness of
breath
Case 1
Case 1
Kerley B lines
peribronchial cuffing
Pulmonary edema

Radiographic signs of pulmonary edema?
(5)
– Enlarged cardiac silhouette
– Kerley B lines (fluid in the interlobular septae)
– Peribronchial cuffing
– Indistinctness of the pulmonary vessels
– Pleural effusion
Case 2

69 y.o. with fever and cough
Case 2
Case 2
Air bronchograms
Case 2

Findings of pneumonia on radiograph?
– Consolidation (white) and air bronchograms

How are pneumonia and atelectasis similar
on radiograph?
– Both are white

How are pneumonia and atelectasis
different on radiograph?
– Look for air bronchograms
– Atelectasis will have signs of volume loss
Case 3

69 y.o. with chest pain
Case 3
Case 3
Visceral pleura
Case 3

Causes of pneumothorax?
– Numerous!

Treatment?
– Urgent
– Chest tube
– 25 G needle 2nd intercostal space
Companion Case
Case 3

Deep sulcus sign?
– pneumothorax on supine films
– especially seen in ICU patients
The Abdominal
Radiograph
1.
2.
Anatomy
Cases (3)
Anatomy
Right kidney
Hepatic
angle
Left kidney
Left psoas
Properitoneal
fat
Air in
descending
colon
Case 1

69 y.o. with abdominal pain
Case 1
Case 1

What films are obtained in a conventional
abdominal series?
– Supine and upright abdomen, chest radiograph

What are the 4 cardinal symptoms of small
bowel obstruction?
– Nausea, vomiting, abdominal distension, obstipation

What are the causes of SBO?
– Adhesions, hernia, stricture, neoplasm, gallstone ileus
Companion Case
Case 1

What are the signs of SBO on radiograph?
– Dilated and fluid filled loops, “step-ladder”
appearance

What is the difference between ileus and
SBO?
– SBO indicates mechanical obstruction
– Ileus is an adynamic state (“bowel shuts
down”)
Case 2

69 y.o. with abdominal pain
Case 2
Case 2
Cupola sign
Football sign
Case 2

Signs of free intraperitoneal air on upright
radiograph?
– Air under the diaphragm

Signs of free intraperitoneal air on supine
radiograph?
– “football sign”, football shaped lucency central
abdomen
– “cupola sign”, free air in the mid-subphrenic space

What is Rigler’s sign?
– Free air outlining both sides of bowel
Companion case
Companion case
Rigler’s sign
Case 2

What are the 2 most common reasons to
see free intraperitoneal air?
– Post-operative or perforated duodenal ulcer

Is free air commonly seen on radiograph
from perforated diverticulitis?
– No.
– Why?
 the omenteum usually contains the air, and is not
seen on radiograph
Case 3

69 y.o. with abdominal pain
Case 3
Case 3

What are the signs of large bowel
obstruction?
– Dilated large bowel proximal to the site of
obstruction
– Paucity of air distal to obstruction

What are the most common causes of
large bowel obstruction?
– Colon Ca, stricture (post-inflammatory
diverticulitis or IBD), volvulus
The Miscellaneous
Radiograph
Cases (4)
Case 1

69 y.o. in a fight
Case 1
Case 1

What is a Boxer’s fracture?
– Fracture of the 5th metacarpal

Potential complications of a Boxer’s
fracture?
– Metacarpal shortening
– Usually the distal fragment is rotated in a
radial direction, and may heal with deformity
Wrist and hand anatomy
Distal phalynx
DIP joint
Middle
phalynx
PIP joint
Proximal
phalynx
MCP joint
Metacarpal
Sesamoid
CMC
joint
Distal
ulna
Distal radius
Wrist anatomy
hamate
lunate
trapezoid
trapezium
capitate
scaphoid
pisiform
triquetrum
Companion case
Case 2

69 y.o. who fell
Case 2
Case 2
Case 2

What is the classic clinical presentation for
a hip fracture?
– Shortened lower extremity and external
rotation
Pelvic anatomy
Iliac crest
SI joint
Sacral ala
Femoral head
Iliopectineal
line
Superior pubic
ramus
Femoral neck
Ischial tuberosity
Obturator foramen
Greater
trochanter
Lesser
trochanter
Inferior pubic ramus
Pubic symphysis
Case 3

69 y.o. who fell
Case 3
Case 3

What are the 3 radiographs that are
obtained with an ankle series?
– AP, lateral, ankle mortice view

How is the ankle mortice view obtained?
– Internal rotation 15 degrees

What does the ankle mortice view tell you
clinically?
– Ankle joint stability!
Ankle and foot anatomy
Proximal
phalynx
Sesamoid
metatarsal
3rd cuneiform
Cuboid
2nd cuneiform
Talus
Calcaneus
1st cuneiform
Navicular
Case 4

69 y.o. who fell
Case 4
Case 4

Where is the position of the humerus in an
anterior dislocation?
– Anterior!, and inferior

What is a Bankart lesion?
– Impaction fracture at inferior glenoid rim

What is a Hill-Sachs lesion?
– Impaction fracture at the superolateral aspect
of the humeral head
Case 4

Which is more common, anterior or
posterior dislocations?
– Anterior (90%)

What are the causes of posterior shoulder
dislocations?
– Ethanol, epilepsy, electrocution
Shoulder anatomy
AC joint
Acromium
Clavicle
Anatomical
neck
Greater
tuberosity
Surgical
neck of
humerus
Coracoid
Glenoid
Scapula
End!

Questions?

Email:
– [email protected]