Transcript shoulder - Radiology

Abdomen case #1
Patient came to the ER with new onset of
abdominal pain.
Diagnosis: Free air under
hemidiaphragm bilaterally
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confirm the diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal structures
Your Interpretation here.
RADIOLOGY EXAM: Upright abdomen
CLINICAL INDICATION: Abdominal pain
HEART
REPORT The patient has free air under both
sides of the diaphragm. The possibility of a GI
tract perforation has to be considered most
likely.
FREE AIR
L1
VERTEBRA
COLON GAS
CONCLUSION: Pneumoperitoneum – likely GI
perforation
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
•Air under hemidiaphragm bilaterally could be
caused by many conditions such as perforated
peptic ulcer, perforated diverticulum, or
abdominal trauma.
•This condition may require surgery to treat the
condition that caused the free air to be under the
diaphragm.
• The longer treatment (generally surgery) is
delayed the more serious the patient’s health
status may become with peritonitis and sepsis.
Abdominal case #2
Abdomen pain increasing over past 4days.
History of previous abdominal surgery 6yrs
ago.
Diagnosis: Small bowel obstruction
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confirm the diagnosis and /or other abnormalities.
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Your Interpretation here.
RADIOLOGY EXAM: Abdominal X-ray -Supine
DISTENDED
SMALL BOWEL
CLINICAL INDICATION: Increasing abdominal
pain over past 4 days—prior surgery
ILIAC CREST
REPORT: There is distended small bowel filling
of the mid abdomen with no significant colon
gas. This is likely due to post of adhesions
from prior surgery.
LUMBAR
VERTEBRAE
LT. PUBIC RAMUS
CONCLUSION: Small bowel obstruction
• GI suction tube inserted nasally may be used
to clear the obstruction; patient put on
restricted NPO diet
•Surgical intervention to lyse t post-operative
adhesion
•Electrolytes, fluids, and nutrients should be
administered intravenously to replace fluids &
compensate for malabsorption
Abdomen case #3
Complaints of decreasing caliber stool and
straining.
Diagnosis: Large bowel obstruction
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diagnosis and /or other abnormalities.
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Your Interpretation here.
RADIOLOGY EXAM: Supine abdomen
radiograph
TRANSVERSE
COLON
CLINICAL INDICATION: Complaints of
decreasing caliber stool and straining
DISTENDED/
OBSTRUCTED
RIGHT COLON
REPORT: The right colon, Transverse colon and
Lt. colon are distended. The femoral head,
symphysis pubis and inferior pubic ramus are
unremarkable.
FEMORAL HEAD
SYMPHYSIS
PUBIS
CONCLUSION: Distal colon obstruction
possibly due to malignancy. Colonoscopy is
suggested.
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
Management of Large Bowel Obstruction:
•IV fluids and medicine to manage
symptoms
•If obstruction persists, colonoscopy and
surgical may be necessary. Antibiotics and
IV fluids given to avoid infection.
•Other nonsurgical treatments such as
enemas may be used to clear large bowel
obstruction due to fecal impaction.
Abdomen case #4
Patient with positive hem occult and
incomplete colonoscopy
Diagnosis: Colon cancer
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diagnosis and /or other abnormalities.
Your Interpretation here.
Use blue arrows to indicate 3 normal
structures.
RADIOLOGY EXAM: Barium Enema
DESTINED
DESCENDING COLON
CLINICAL INDICATION: Positive hem occult
and incomplete colonoscopy.
12TH RIB
LUMBAR
VERTEBRAE
COLON
STRICTURE
REPORT: Distended descending colon with
short segment stricture indicated by the
narrowing of contrast in the column. Distally
there is a normal sized sigmoid colon and
rectum.
CONCLUSION: Partial obstruction of the Lt.
colon most typical for colon cancer.
Recommend colonoscopy for evaluation.
HIP JOINT
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
Suggestions for management:
• Surgical resection of the cancerous portion
of the colon
•Biopsy of sentinel lymph nodes to determine
if metastasis has occurred.
• Chemotherapy for possible tumor reduction
and treatment of residual microscopic tumor.
•Annual colonoscopies to monitor for
recurrent of new colon malignancy
developing.
Abdomen case # 5
Abdomen pain and weight loss
Diagnosis: Metastatic cancer of the liver.
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diagnosis and /or other abnormalities.
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Your Interpretation here.
structures.
RADIOLOGY EXAM: CT scan
2 LOW DENSITY
MASSES IN THE LIVER
STOMACH
CLINICAL INDICATION: Abdomen pain and
weight loss.
REPORT: Abnormal low density masses
present in the Rt. & Lt. lobes of the liver are
seen on this IV contrast enhanced CT scan.
CONCLUSION: Multiple hepatic masses most
typical for metastatic disease probably from a
GI source. Colon evaluation may be helpful.
AORTA
LT. KIDNEY
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
-A Liver biopsy should be taken to get histologic
diagnosis
-treatment will vary depending on extent and
nature of cancer
- A portion of the liver may be surgically excised
in patients who have a single isolated metastatic
lesion in addition to surgical resection of the
primary lesion.
Abdomen case #6
Recumbent film of the abdomen for patient
with acute abdomen pain.
Diagnosis: Gall stones
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diagnosis and /or other abnormalities.
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Your Interpretation here.
RADIOLOGY EXAM: AP abdomen x-ray
CLINICAL INDICATION: Acute abdominal pain
GALL STONES
COLON
GAS
ILIAC CREST
REPORT: Multiple radiopaque densities in the
patient right upper quadrant. These are
rounded and are less than 1cm in diameter.
Most typical for calcified gallstones.
CONCLUSION: Cholelithiasis
FEMORAL
HEAD
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
• A gallstone is a concretion in the gallbladder,
cystic duct or bile duct composed chiefly of
cholesterol crystals.
• Gallstones are more common in women and
their incidence increases with age.
•For gallstones to cause clinical symptoms,
they must obtain a size sufficient to produce
mechanical injury to the gallbladder or
obstruction of the biliary tract.
Abdomen case #7
Ultrasound for right upper quadrant pain.
Diagnosis: Gall stones
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diagnosis and /or other abnormalities.
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Your Interpretation here.
Gallstone
RADIOLOGY EXAM:
• Ultrasound of liver and gallbladder
Shadow
CLINICAL INDICATION:
•Acute pain in the RUQ
LIVER
GALL
BLADDER
REPORT:
•Liver ultrasound shows echogenic mass
in gallbladder typical for cholelithiasis
•Prominent acoustic shadow displayed
deep to the calculi
CONCLUSION:
•Cholelithiasis
KIDNEY
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
•Some risk factors for gallstones include
obesity, advanced age (over forty), being
female, having a family history, diabetes,
and using cholesterol lowering drugs
•Symptoms include: intense pain to right
upper quadrant and referred pain to
shoulder and/or between should blades
•Gallstones are caused by too much bilirubin
or cholesterol in bile
•Gallstones can block the hepatic, common
bile, or cystic ducts
Sources:
http://www.mayoclinic.com/health/gallstone
s/DS00165/DSECTION=causes
http://digestive.niddk.nih.gov/ddiseases/pu
bs/gallstones/
Abdomen case #8
Contrast enhanced CT scan performed for
abdominal mass palpated at physical exam.
Diagnosis: AAA
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diagnosis and /or other abnormalities.
Your Interpretation here.
Use blue arrows to indicate 3 normal
structures.
RADIOLOGY EXAM: Contrast enhanced CT
scan of the abdomen.
AORTIC ANEURYSM
BLOOD
CLOT
REPORT: The CT indicates an enlarged
abdominal aorta with low density clot at the
margin of the aneurysm.
RT. PSOAS
MUSCLE
LUMBAR VERTEBRAL
BODY
CLINICAL INDICATION: An abdominal mass
was detected during physical exam
palpations. A CT was ordered to determine
the origin.
LT. FACET JOINT
CONCLUSION: Abdominal Aortic Aneurysm
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
Risk factors include smoking, high blood
pressure, high cholesterol, male gender,
advanced age (60+), emphysema, genetic
factors, and obesity.
Surgery is only recommended to repair the
unruptured aneurysm if it is larger than 5 cm
and if the risk of surgery is less than the risk of
the aneurysm rupturing.
The two surgical options are a traditional
(open) repair and an endovascular stent
grafting.
Abdomen case # 9
Arteriogram of abdominal aorta performed
due to abnormal renal nuclear medicine
study.
Diagnosis: Stenosis of the Lt. Renal Artery
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diagnosis and /or other abnormalities.
RADIOLOGY EXAM: Arteriogram of the
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abdomen.
structures.
CLINICAL INDICATION: Abnormal nuclear
medicine renal scan.
ABDOMINAL AORTA
RIGHT RENAL ARTERY
CATHETER
LEFT RENAL
ARTERY. STENOSIS
REPORT: The image shows the aorta and Rt. &
Lt. renal arteries. The aorta demonstrates
normal filling with the contrast material. The
Rt. renal artery also shows normal filling and
configuration. The Left renal artery shows a
high grade stenosis at it’s junction with the
aorta.
CONCLUSION: Left Renal Artery Stenosis
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
Patients with stenosis of a renal artery can
exhibit the following symptoms:
• High blood pressure
• Mild to moderate renal failure
• Heart failure
Abdomen case #10
Horse stepped on patient
Diagnosis: Fracture of the Rt. Kidney
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and /or other abnormalities.
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Your Interpretation here.
RADIOLOGY EXAM: CT of Abdomen @ the
level of the kidney
Liver
CLINICAL INDICATION: Trauma- Horse
stepped on the patient.
REPORT: CT through the kidney shows a
normal left kidney with a low density
laceration extending though the mid
portion of the right kidney,. Fluid in
peritoneum is likely blood or unopacified
urine.
CONCLUSION: Fractured Rt. Kidney
Rt. Kidney
IVC
Erector
Spinae mm.
.
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
The patient will need evaluation by
trauma surgery with fluid replacement
and likely surgery to repair or remove
the damaged kidney. The CT scan has
evolved into a critical trauma imaging
tool as the entire body can be
evaluated rapidly to aid in
management decisions.
Abdomen case #11
Abdominal distention and shifting dullness
on exam. CT scan with oral contrast and
abdomen x-ray after CT scan.
Diagnosis: ASCITES
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diagnosis and /or other abnormalities.
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L1
VERTEBRAE
FLUID & SHIFT
RADIOLOGY EXAM: CT scan
CLINICAL INDICATION: Abdominal distension
and shifting dullness
CONTRAST
IN COLON
REPORT: Fluid filled areas indicated by red
arrows causing shift in abdominal viscera
most notably in ascending colon shifted
AIR IN
SMALL BOWEL medially.
CONCLUSION: Radiological exam and clinical
indications (shifting dullness, abdominal
distension) confirm classical signs of ascites
(fluid in peritoneal space).
FLUID
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
1.) By definition, ascites is excess fluid in the
peritoneal cavity.
2.) Causes of ascites include portal
hypertension due to liver disease, CHF, portal
vein thrombosis.
3.) Treatment of ascites includes decrease
sodium in diet, decrease alcohol
consumption, diuretics, and antibiotics if
infection develops.
Abdomen case #12
Ultrasound exam performed at FAST exam
for patient in a MVC.
Diagnosis:
Hemoperitoneum
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diagnosis and /or other abnormalities.
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structures.
RADIOLOGY EXAM: Ultrasound FAST exam for
MVC patient.
LIVER
FLUID IN
MORISON’S POUCH
KIDNEY
DIAPHRAGM
CLINICAL INDICATION: Abdominal pain, recent
trauma
REPORT: Liver and right kidney are seen with
anechoic fluid separating the structures and
extending into Morrison’s pouch.
CONCLUSION: Fluid in Morrison’s Pouch
(Hemoperitoneum)
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less.
Evaluation of volume status- IV fluid
replacement as necessary.
Emergent laparotomy
•Surgical ligation or repair of bleeding vessel.
Interventional Radiology can embolize
bleeding vessel for hemostasis
Abdomen case #13
Left upper quadrant palpable mass and fullness.
Diagnosis: Splenomegaly
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diagnosis and /or other abnormalities.
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Your Interpretation here.
RADIOLOGY EXAM: AP Abdomen
CLINICAL INDICATION: Lt upper quadrant
palpable mass & fullness
LIVER
BOWEL GAS
ENLARGED
SPLEEN
REPORT: A markedly enlarged spleen is
prominent in the patient’s upper left
quadrant. Inage shows a normal amount of
diffuse gas in the distal small bowel as well as
the colon.
CONCLUSION: Splenomegaly Hematology
evaluation is indicated as initial step.
BLADDER
Three bullet points about pathology
identified OR
Management of the identified
process
•Splenic enlargement can be caused by
infections, abnormal blood cell counts,
cancer, and lymphatic problems.
• Symptoms may include:
• Inability to eat a large meal due
to discomfort and fullness.
• Pain in upper left quadrant of
abdomen
• Fatigue, weight loss, infections,
easy bleeding.
Abdomen case #14
Pt. with jaundice with CT scan and ERCP
Diagnosis: Stone in the Common bile duct
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diagnosis and /or other abnormalities.
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LIVER
RADIOLOGY EXAM:
DILATED BILE
DUCTS
AORTA
CT (computed tomography) and ERCP (endoscopic
retrograde cholangiopancreatography)
CLINICAL INDICATION: Patient with jaundice
and CT scan and ERCP.
REPORT:
Low density dilated bile ducts are seen on the CT
scan. ERCP indicated gallstone that obstructs
bilirubin flow to the intestines through the common
bile duct, causing jaundice.
RT. KIDNEY
`
`
`
`
`
BLOCKAGE
`
IN THE `
COMMON
`
BILE DUCT
`
`
`
CONCLUSION: Intraluminal calculus causing
Biliary dilation. Jaundice in patient was due to
blockage causing dilation of the duct.
Choledocholithiasis.
Management of the identified process
Treatment of jaundice in this patient
requires the removal of the gallstone.
Laparoscopic surgery to remove the bile
duct obstruction could be performed. The
patient could also be given medications
that would dissolve the gallstone. This
may be useful in patients who can not
tolerate surgery.