Unofficial Guide To Radiology

and Other Important Modalities
Mark Rodrigues and Zeshan Qureshi
Join Our Medical Book Writing Project (details inside)
Bonus Orthopaedic X-Rays
Core Radiology Curriculum Covered: 100 Annotated X-Rays (including how to present them), 300 Multiple Choice Questions (with detailed explanations)
Bonus Abdominal X-Rays
Orthopaedic X-Rays, plus CTs, MRIs
Radiology: Chest, Abdominal and
Bonus Chest X-Rays
The Unofficial Guide to
Fluoroscopy
Nuclear Medicine Scans
USS Scans
MRI Scans
CT Scans
Orthopaedic X-Rays
Abdominal X-Rays
Chest X-Rays
Introduction
THE UNOFFICIAL GuIDE tO RADIOLOgY

FIRST EDITION
MArK RodriGUes BSc (Hons) MBChB (Hons)
Radiology Registrar, Royal Inrmary of Edinburgh; Honorary Clinical Tutor, University of Edinburgh, UK
ZeshAn QUreshi BM BSc (Hons)

Academic Clinical Fellow (International Child Health) Great Ormond Street and Institute for Global Health, London; Honorary Clinical Tutor, University of Edinburgh, UK
INTRODUCTION
The Unofcial Guide to Radiology is the fth book in the Unofcial Guide to Medicine series. Almost every patient has some form of medical imaging performed during his or her investigations and management. The commonest form of imaging, and the modality which all doctors should be able to interpret, remains the X-ray. This important aspect of radiology is therefore the main focus of the book. Other imaging modalities are specialised investigations interpreted by radiologists. However, medical students, doctors, nurses, physicians associates, and surgeons need to understand what these tests involve, when they are indicated and contraindicated, and how to best request them. Therefore, these aspects are also covered in the book.
Despite its universal importance, X-ray interpretation is often an overlooked subject in the medical school curriculum, which many medical students and junior doctors nd difcult and daunting. I was no different when I started work as a junior doctor. However, since starting radiology training, I have realised X-ray interpretation should not be that way. The keys to interpreting X-rays are having a systematic method for assessing the X-ray and getting lots of practice at looking at and presenting X-rays. Occasionally, there may be a complex X-ray you nd difcult, or a subtle nding you overlook, but thats what keeps people like me in a job, so do not worry about it. The 4 Ds are a useful framework for X-ray interpretation which underpins the approach used in this book. First, you need to Detect and Describe the abnormalities on the X-ray. You then need to form a Differential diagnosis based on clinical and X-ray ndings before Deciding what further imaging and management is required. There are lots of radiology textbooks available, but I do not think there is one which is ideally suited for teaching medical students and junior doctors. Many have small, often poor quality images. Radiology is a visual subject and therefore such images are difcult to use to demonstrate key clinical ndings. This is confounded by the fact that the ndings are usually only described in a gure below the image, and it is often difcult to know exactly what part of the image corresponds to which nding! Another fundamental problem with many radiology textbooks is that they deal with X-rays in isolation. In reality, X-rays are part of the clinical assessment and management of patients, and thus they should be taught in a clinical context. The content, layout and approach used in this book are designed to make it as useful and clinically relevant as possible: Over 200 large, high quality radiological images are used throughout the book and important ndings are annotated on the images to highlight the key points and ndings to the reader. The chest, abdominal and orthopaedic X-ray chapters contain step-by-step approaches to interpreting and presenting X-rays. Each of these chapters also covers 20 common and important X-ray cases/diagnoses. They are labelled as Case X to not give away the diagnosis, but at the end of the book there is a list of all the diagnoses. The X-rays are presented in the context of a clinical scenario. The reader is asked to present their ndings before turning over the page to reveal a model X-ray report accompanied by a fully annotated version of the X-ray. This encourages the reader to look at the X-ray thoroughly, as if working on a ward, and come to their own conclusions about the X-ray ndings and any further management required before seeing the answers. To further enhance the clinical relevance, each case has 5 clinical and radiology-related multiplechoice questions with detailed answers. These are aimed to test core knowledge needed for exams and working life, and illustrate how the X-ray ndings will inuence patient management.
The bonus X-ray chapter provides over 50 further X-ray cases to help consolidate the readers knowledge and provide an opportunity to practice the skills they have learnt. Five chapters are devoted to other important imaging investigations: computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (USS), nuclear medicine, and uoroscopy. These cover the details of what the examinations entail, their common indications, contraindications and key imaging ndings. The content is in line with the Royal College of Radiologists Undergraduate Radiology Curriculum 2012, making it up to date and relevant to todays students and junior doctors.
With this textbook, we hope you will become more condent and competent in these radiology competencies, both in exams and in clinical practice, and we also hope that this is just the beginning. We want you to get involved, this textbook has been a collaboration with junior doctors and students just like you. You have the power to contribute something valuable to medicine; we welcome your suggestions and would love for you to get in touch. A good starting point is our Facebook page, which is growing into a forum for medical education: Search for The Unofcial Guide to Medicine or enter the hyperlink below into your web browser.
Please get in touch and be part of the medical education project.

Mark Rodrigues, mark.a.rodrigues@gmail.com Zeshan Qureshi, zeshanqureshi@doctors.org.uk, @DrZeshanQureshi
Facebook: http://www.facebook.com/TheUnofcialGuideToMedicine
FOREWORD
Radiology is encountered every day by medical students. From the wards to OSCEs, from theatre to outpatient clinics, radiology is everywhere at the undergraduate level and beyond. The importance of understanding the principles of imaging, radiation doses and the clinical interpretation of results is paramount. Radiology is a key diagnostic and monitoring tool in modern medicine, so the ability to assess an X-ray in a systematic order is a vital skill. The vast range of techniques, and the complexity of the human body, means this is not a subject that can be learnt overnight, and this book aims to provide you with a grounding in this mammoth specialty. The authors have ensured they have included the basic scientic principles underlying radiology. The book covers many imaging modalities and presents them in a systematic James Brookes, order to give you a clear approach to interpreting what you see. Detailed pictures along Medical Student, University of Southampton the way point out normal anatomical features as well as deformities and anomalies. Perhaps one of the biggest strengths of this book is the cases section, which allows you to practice not only interpreting high quality images but also to link them to a case history. The questions that follow not only test your radiology knowledge, but also your understanding of signs, symptoms, underlying pathophysiology and management of the condition. As well as providing detailed answers in each section, the book also shows you the best way to present each case, whether in an OSCE situation or on a ward round. The Unofcial Guide to OSCEs has quickly become established as one of the most useful undergraduate books. The ease of use, detailed pictures and emphasis on key points of this title should cement it as the number one undergraduate book for radiology. I hope you nd it invaluable throughout your studies and it brings you success in all of your exams!
James Brookes
Which radiographs from each system are most likely to be presented in exams? This excellent book presents the classics, and at one level this makes it a high-yield textbook that will be extremely valuable to medical students and junior doctors. But it is much more than that. Not only does it teach pattern recognition, it also clearly and simply explains the underlying concepts which make such images easier to interpret and answers all those tricky questions that return to haunt clinicians on a regular basis. For example, when should I use CT and when would magnetic resonance imaging be more appropriate?
Bob Clarke, Associate Dean, Professional Development, London. Director, Ask Doctor Clarke Ltd.
This book also teaches a systematic approach to reporting, with the bonus cases particularly useful in enabling readers to check that they have learnt from the core cases that have gone before. This interactivity is essential to its success and the skills acquired will transfer to life beyond the exams. What is especially striking is the denition and clarity of the illustrations, with onimage labelling enabling one to be absolutely certain of which is the endotracheal tube, the nasogastric tube and the central line, for example.
Mark Rodrigues and Zeshan Qureshi are to be congratulated on producing this excellent volume. As with the other books in this series, the multi-author collaborative approach works exceptionally well and the democratisation of the reviewing process ensures that this will meet the needs of medical students and junior doctors, both in their exams and in their day to day work. In summary, this is another classic in the Unofcial Guide series.
Bob Clarke
ABBreViationS
A&E AAA ACE ACJ ADEM ADH AIN AMT ANCA AP ATLS AV AVN AXR BTS CABG CBD CCAM cm COPD CPAP CRP CSF CT CTPA DDH DEXA DHS DIPJ DMSA DTPA DVT DWI ECG accident and emergency abdominal aortic aneurysm angiotensin converting enzyme acromio-clavicular joint acute disseminated encephalomyelitis anti-diuretic hormone anterior interosseous nerve abbreviated mental test anti-neutrophil cytoplasmic antibodies anterior to posterior Advanced Trauma Life Support arteriovenous avascular necrosis abdominal X-ray British Thoracic Society coronary artery bypass graft common bile duct congenital cystic adenoid malformation centimetre chronic obstructive pulmonary disease continuous positive airway pressure ventilation C-reactive protein cerebrospinal uid computer tomography computer tomography pulmonary angiogram developmental dysplasia of the hip dual energy X-ray absorptiometry dynamic hip screw distal interphalangeal joint dimercaptosuccinic acid diethylenetriaminepentaacetic acid deep venous thrombosis diffusion weighted image electrocardiogram ENT ERCP ESR ESWL ET EVAR FAST FDL FDP FDS FLAIR FOOSH G g/L G&S GCS GI GTN HAS HIDA HIP HLA HPOA HRCT HRT HU ear, nose and throat endoscopic retrograde cholangiopancreatogram erythrocyte sedimentation rate extracorporeal shock wave lithotripsy endo-tracheal endovascular aneurysm repair focused assessment with sonography in trauma exor pollicis longus exor digitorum profundus exor digitorum supercialis uid attenuation inversion recovery falls onto an outstretched hand gauge grams per litre group and save Glasgow coma scale gastrointestinal glyceryl trinitrate human serum albumin hepatobiliary iminodiacetic acid heparin-induced thrombocytopaenia human leukocyte antigen hypertrophic pulmonary osteoarthropathy high resolution CT hormone replacement therapy Hounseld unit
IRMER ionising radiation [medical exposure] regulations ITP ITU IU IUCD IV IVC idiopathic thrombocytopenic purpura intensive treatment unit international unit intrauterine contraceptive device intra-venous inferior vena cava
ABBreViationS
IVU JVP kg KUB LDH LIF LLL LUL m MAG3 MCPJ MDP MDT MIRP mm mmHg intravenous urogram jugular venous pressure kilogram kidneys, urethra, bladder lactate dehydrogenase left iliac fossa left lower lobe left upper lobe metre methyl-acetyl-gly-gly-gly metacarpophalangeal joint methylene disphosphonate multi-disciplinary team minimally invasive retroperitoneal pancreatic necrosectomy millimetre millimetres of mercury SLE SMA SMV SP STIR SUFE TB THR TNF TNM U&Es USS VQ VTE -HCG PET PFO PICC PIN PIPJ PR RLL RML RUL RUQ positron emission tomography patent foramen ovale peripherally inserted central catheter posterior interosseous nerve proximal interphalangeal joint per rectum right lower lobe right middle lobe right upper lobe right upper quadrant
SCIWORA spinal cord injury without radiological abnormality SHO SI SiADH senior house ofcer sacroiliac syndrome of inappropriate anti-diuretic hormone systemic lupus erythematosus superior mesenteric artery superior mesenteric vein spinous process short tau inversion recovery slipped upper femoral epiphysis tuberculosis total hip replacement tumour necrosis factor tumour, nodes, metastases urea and electrolytes ultrasound scan ventilation/perfusion venous thromboembolism beta human chorionic gonadotrophin
mmol/L millimoles per litre MRA MRCP MRI MRSA mSv MTPJ NAI NG NSAID OA PA PaCO2 PaO2 PE PEA PEG magnetic resonance angiography magnetic resonance cholangiopancreatogram magnetic resonance imaging methicillin resistant Staphylococcus aureus milliSieverts metatarsophalangeal joint non-accidental injury naso-gastric non-steroidal anti-inammatory drug osteoarthritis posterior to anterior partial pressure of carbon dioxide partial pressure of oxygen pulmonary embolus pulseless electrical activity percuntaneous endoscopic gastrostomy
ContriButorS
Editors
M.Rodrigues
Mark Rodrigues Zeshan Qureshi
Radiology Registrar, Edinburgh Royal Inrmary, Edinburgh, UK Academic Clinical Fellow, Great Ormond Street and Institute of Global Health, London, UK
Authors
J.Rodrigues B.Hedayati K.Varghese A.Cheng C.Gee
Jonathan Rodrigues Chest X-rays Abdominal X-rays Mark Rodrigues Introduction Chest X-rays Abdominal X-rays CT MRI Ultrasound Nuclear Medicine Scans Fluroscopy Bijan Hedayati Chest X-rays Chris Gee Orthopaedic X-rays Amanda Cheng Bonus X-rays Kabir Varghese Bonus X-rays
Radiology Registrar (Bristol Royal Inrmary, Bristol) Radiology Registrar (Edinburgh Royal Inrmary, Edinburgh)
Radiology Consultant (Lewisham Hospital, London) Orthopaedic Registrar, Trauma and Orthopaedics (Western Sussex Hospitals, Sussex) Radiology Registrar (Western General Hospital and Edinburgh Royal Inrmary, Edinburgh) Radiology Registrar (Chelsea and Westminster, London)
Reviewers
Brendan Kelly Chloe Thomson Marianna Christodoulou Madelaine Gimzewska Katherine Lattey Jessica Spiteri Paris University College Dublin University of Leicester University of Manchester University of Edinburgh Brighton and Sussex Medical School University of Malta
Z.Qureshi
ConTENTS
Introduction........................................................... 11
What are X-rays?........................................................................ 11 How are X-rays used to produce images?......................... 12 The main densities on X-ray. .................................................. 12 Magnication. ............................................................................. 12 The hazards of using X-rays................................................... 13 Relevant legislation................................................................... 13 Pregnancy and X-rays............................................................... 14 How to request radiology examinations........................... 14 When and how to discuss a patient with radiology...... 15
MRI Scans......................................................... 543

MRI Head....................................................................................544 ...................................................................................549 MRI Spine. MRCP............................................................................................553 MRI Small Bowel......................................................................554 MRI Knee & Other Joints.......................................................555
Ultrasound Scan.............................................. 557

Neck USS.....................................................................................558 Chest USS...................................................................................558 Abdominal USS.........................................................................560 Pelvic USS...................................................................................562 FAST Scanning...........................................................................563 Vascular USS..............................................................................563 Musculoskeletal USS..............................................................564 Ultrasound Guided Procedures...........................................564
Chest X-Rays* .....................................................17

Introduction................................................................................. 17 20 Clinical Cases. ........................................................................ 29
Abdominal X-Rays*......................................... 181

Introduction...............................................................................181 20 Clinical Cases. ......................................................................189
Nuclear Medicine Scans................................. 565

VQ scan. .......................................................................................566 Myocardial perfusion scan...................................................567 Genitourinary scan. .................................................................567 Bone imaging............................................................................568 PET/CT..........................................................................................569
Orthopaedic X-Rays*....................................... 335

Introduction...............................................................................335 Spine X-Ray Cases ...................................................................367 Shoulder X-Ray Cases ............................................................391 Elbow X-Ray Cases...................................................................399 Wrist X-Ray Cases ...................................................................407 Hip X-Ray Cases .......................................................................429 Knee X-Ray Cases ....................................................................473 Tibia/Fibular X-Ray Cases . ...................................................497 Ankle X-Ray Cases . .................................................................513
Fluoroscopy...................................................... 571
Contrast Swallow.....................................................................572 Barium Follow Through.........................................................576 Contrast Enema........................................................................576 Tubogram...................................................................................576
CT Scans............................................................ 521
CT Head.......................................................................................525 CT Cervical Spine......................................................................530 CT in Orthopaedics..................................................................530 CT Chest......................................................................................531 CT Abdomen and Pelvis.........................................................535
Bonus Cases*.................................................... 579

Bonus Chest X-Rays. ................................................................579 Advanced Chest X-Rays.........................................................603 Bonus Abdominal X-Rays......................................................613 Advanced Abdominal X-Rays...............................................625 Bonus Orthopaedic X-Rays...................................................637 Advanced Orthopaedic X-Rays............................................671
* For Chest X-Rays, Abdominal X-Rays, Orthopaedic X-Rays and the Bonus Cases, all cases have been labelled Case X to mimic real life clinical situations/assessment. For reference, the X-rays are also all listed by diagnosis and clinical signs on p695.
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18 Chest X-Rays - Introduction
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Figure 6: These three X-rays show how difcult it can be to diagnose free subdiaphragmatic gas. Image A: Is a normal chest X-ray with gas in the stomach. We know the gas is within the stomach, as it is under the left hemidiaphragm, and the soft tissue rim overlying the gas is a few millimetres thick, as it consists of the stomach wall and adjacent diaphragm. hi i s eshi resh u ursoft Q Qurea large pneumoperionteum. In this case, Q Image B: Contrast that appearance to the centre X-ray, which shows the n n n a a a h h sh f Zes tissue rim between the lung and abdomen f Zeis f Zes very thin, as it solely represents the diaphragm. o o o t t t h h h g g g ri ri pyri the right hemidiaphragm below Copy Image C: Is a mimic of free subdiaphragmatic Copy gas. In this case, inspection of the area Co reveals bowel markings. These appearances are due to interposition of a loop of bowel between the liver and right hemidiaphragm, and is known as Chilaiditis sign.
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Technical Aspects
Chest X-Rays
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Chest X Rays - Case 1 29
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C C pneumothorax. IN SUMMARY This chest X-ray shows a large right There is no evidence of associated tension. hi shi this X-ray, suggesting ureshi There is no underlying cause discernible ures ureon Q Q n n nQ esha esha esha Z Z Z f f f o o o ht spontaneous pneumothorax. that this is a o primary ight ight pyrig opyr opyr C C resh i righ Copy t of Z e resh i righ Copy t of Z e resh i
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cardiac diseases, and systemic problems. It is important to be able to formulate an appropriate differential diagnosis from the history and examination to guide suitable investigations and initial management. Establishing the time frame of the onset of breathlessness is very helpful in formulating your differential hi hi eshi refers to breathlessness that develops diagnosis. Sudden onset ur uresover seconds and includes pulmonary ures Q Q Q n n n a ha ha embolus, inhaled pneumonia, Zesh f Zespneumothorax, anaphylaxis, and f Zesforeign bodies. Dyspnoea associated f with o o o t t t h h h rig rig rig and exacerbations of asthma or COPD tend more slowly, over pydevelop opy Copy heart failure, metabolic acidosis,C Coto minutes to hours. Other conditions, such as interstitial lung disease and anaemia, have a much more chronic onset.
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4. Which of the following is the most appropriate initial imaging investigation in a patient hi hi hi ures a simple pneumothorax? ures ures suspected of having Q Q Q n n n a a a
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be a clearly discernible lung edge as seen in an erect accurate and reliable assessment for a pneumothorax. X-ray. Supine chest X-rays are thus not performed A well inspired PA X-ray allows a better assessment of routinely. Instead they are reserved for trauma patients the lungs and cardiac contours compared to an AP or i i shi on a chest X-ray is shsafely e who cannot moved. Features suggestive ofQ a uresh r expiratory X-ray. The key nding u urebe Q Q n n n halung edge (visceral pleura) away ha pneumothorax on a supine chest X-ray include aa sharply displacement of the es Zesh fZ f Zes fdeep o o o t t t h h h outlined dome of the hemidiaphragm, a lateral from the chest wall, with no lung markings visible ig rig pyrig opyr Coperipheral Copy C costophrenic sulcus, and a hyperlucent upper quadrant to this. of the abdomen (due to the lucent gas within the B) PA and lateral chest X-rays Incorrect. The lateral chest pleural space overlying the upper abdomen). X-ray can provide helpful information if a pneumothorax i Whilst CT is the most sensitive and E) CT Incorrect. hi shi sh is not visible on the PA X-ray. However, it is not part of ure urefor ures Q Q Q n n n specic test a pneumothorax, its high radiation dose routine practice. ha ha ha f Zes f Zes f Zes and the (approximately equivalent to 400 chest X-rays!) o o o t t t h h h rig rig C) o Expiratory X-rays pyrig chest X-ray Incorrect. Expiratory satisfactory accuracy of standard C may Copy Copy PA chest X-rays mean make a subtle pneumothorax more readily visible. CT is not the rst line imaging modality for suspected However, there are not performed in the rst instance. pneumothoraces; instead, it is reserved for patients in Additionally, they can limit the assessment of the lungs whom there is continued suspicion of a pneumothorax and cardiac shadow. hi hi hi but no evidence s e r ures on a chest X-ray, or for assessing n Qures Qu Q n n a a a trauma patients. CT also provides the most e reliable h h h f Zes f Zes fZ s o o o t t t assessment of pneumothorax size. h h h g g g i i i
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Chest X-Rays
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Case 1...................189 Case 2...................195

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ABDOMINaL X-RaYS
Case 6...................225 Case hi 7...................233
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Case 16.................299 Case 17.................305 hi

Abdominal X-Rays
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Abdominal X-Rays - Introduction 181

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Abdominal X-Rays - Case 11 263
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264 Abdominal X-Rays - Case 11
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A) Pain B) Nausea and vomiting C) Dysuria shi Qure D) Haematuria n a esh f ZAll o t of the above E) h g yri
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A) Uric acid ureshi Q shan oxalate e B) Calcium Z f o right C) Calcium phosphate Copy D) Struvite E) Cysteine
3. Which type of renal stone is least likely to be visible on an X-ray?

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f The ght o gas pattern is normal. ibowel r y p CoNo plain lm evidence of bowel obstruction, perforation or mucosal oedema. sh Fixation screws are projected Qure over n a h es joint. There is the left sacro-iliac t of Z h g i r an abnormal area of bone on the Copy left side of the L5 vertebral body which is in keeping with partial sacralisation of the L5 vertebra hi (a congenital anomaly, which ures is Q n esha signicance, usually ofo no clinical fZ t h rig the transverse process of where Copy the L5 vertebral body fuses onto the sacrum). Otherwise, there is no signicant abnormality of the shi imaged skeleton. Qure righ Copy t of Z e shan i
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A) Abdominal X-ray/KUB (Kidney, Ureter, Bladder) B) Intravenous urogram C) Ultrasound hi i res resh u u Q Q D) Non-contrast CT KUB han han f Zes f Zes o o t t h h abdomen and pelvis rig pyrig E) Contrast enhanced CT of the py
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5. What is the most appropriate initial management of a well patient with renal colic and a small hi shi calculus at the left (<5 mm) left sided ure ures Q Q n n a ha eshKUB? junction identied on f Zes f ZCT t ovesicoureteric to
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B) Urgent extracorporeal shock wave lithotripsy (ESWL) C) Urgent percutaneous nephrostomy hi hi D) Conservative approach (supportive treatment with ures ures Q Q n n ha X-ray and anti-emetics and follow up with esha es f Zanalgesia fZ o o t t h h ig until the stone rig KUBs [if the stone is visible on r X-ray] Copy Copy has passed) E) Percutaneous nephrolithotomy
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PRESENT Qureshi n esha Z f o YOUR right Copy FINDINGS...
hi hi A) Hypercalcaemia ures ures Q Q n n ha B) esha tubular acidosis f ZRenal f Zes o o t t h h rig C) Over hydration rig Copy Copy D) Inammatory bowel disease E) Recurrent urinary tract infections
1. Which of the following is/are risk factors for developing renal calculi?
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Renal calculi are common, occurring in 5-10% of the population. They typically occur in middle age (30-60 years) and affect men more commonly than women. There are several risk factors for developing renal calculi.
A) Hypercalcaemia Correct. Calcium is a component of Normally, calcium within the lumen of the GI tract binds i hi of calcium h sform shi and the resultant calcium oxalate is poorly e e r r most renal calculi, in the oxalate or to oxalate u u ures Q Q Q n n n ha absorbed from the GI tract. Fat malabsorption ha occurs in sha calcium phosphate. There is increased risk of developing f Ze f Zes f Zes o o o t t t h h h patients who have hadp small igbowel resections or Crohns rig calcium containing renal calculi with conditions rig that cause o yr Copy hypercalcaemia, such as primary hyperparathyroidism, Copy disease (due to the C disruption of the enterohepatic malignancy, sarcoidosis, Addisons disease and circulation of bile acids). Unabsorbed fats preferentially medications (thiazides, vitamin D analogues, lithium). bind with luminal calcium. This results in oxalate binding with sodium B) Renal tubular acidosise s Correct. There is an increased risk hi hi in the GI tract. Sodium oxalate is absorbed hi es r r u u ures in the colon and results in high serum oxalate levels, Q Q Q of developing calcium renal stones in type 1 renal tubular n n n a a a h sh esh formation. increasing the risk of calcium oxalate f Ze f Zes f Zstone acidosis. This is due to alkaline urine, hypercalciuria and o o o t t t h h h g g g ri yri yri this E) Recurrent urinary tract infections Correct. Struvite stones opcondition. Copy low citrate which are associated withC Cop (magnesium ammonium phosphate) form in alkaline C) Over hydration Incorrect. Renal calculi are more common urine which contains ammonia. These conditions can in hot climates due to dehydration. Dehydration results occur in the presence of urease producing bacteria, such as in concentrated urine, which can become supersaturated i i i Proteus, and Enterobacter (urease metabolises h shKlebsiella with substances that es in stone formation. resh ure u Qurresult Q Q n n n urea into ammonia and carbon dioxide). Struvite stones a a a h sh bowel disease Correct. Calcium oxalate sh esmultiple D) Inammatory typically occur in patients who have had urinary of Ze of Ze of Z t t t h h h g g g i i i disease r stones are more common in patients with yr yr with vesicoureteric reux, pCrohns p tract infections such as those o Copy or those who have had a previous small Co C bowel resection. neurogenic bladder and obstructive uropathies.
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2. Which of the following are symptoms associated with renal calculi?

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Many patients with renal calculi are asymptomatic; however, renal calculi can cause a variety of symptoms.
A) Pain Incorrect. Renal colic is the classic symptom C) Dysuria Incorrect. Dysuria can occur with urinary tract i shi calculi. It is caused by a associated with urinary tract calculi. Itiis also commonly seen in cystitis (bladder e r resh resh u u u Q Q Q an calculus e becoming to infection). han lodged in a ureter, with resultant hyperhan inammation, which is often secondary h fZ s f Zes f Zes o o o t t t peristalsis of the ureter in an attempt to overcome the h h h D) Haematuria Incorrect.y Haematuria is another classic rig rig yrig calculi typically Copy blockage. The 3 anatomical sites at which Cop Cop with renal calculi. It is often clinical nding in patients become obstructed are a) the pelvi-ureteric junction, b) microscopic and is related to inammation and trauma where the ureter crosses over the iliac vessels, and c) at caused by the calculus. However, the absence of the vesico-ureteric junction. Additionally, any pathological haematuria on urinalysis does not exclude renal calculi. hi shi can cause stone impaction. shi e e narrowing, such as a stricture, r r u u ures Q Q Q E) All of the above Correct. As the previous answers n n n a ha The pain usually to sha starts acutely, spreads from the loin f Ze Zesh suggest, renal calculi can cause a variety f and f Zes of symptoms. o o o t t t groin comes in waves. In contrast to peritonitis, patients h h h ig rig rig They can also cause fever pyrin Copy with renal colic usually writhe around the Cobed Copy and rigors if there is superagony. added infection, acute kidney injury secondary to B) Nausea and vomiting Incorrect. Nausea and vomiting ureteral obstruction, as well as being asymptomatic. is common. It is mediated via an autonomic response to the pain. The ganglion which i receives pain signals from i i sh e r resh resh u the kidneys also supplies the stomach. nQ n Qu n Qu
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C cause loin pain similar in Dissecting or C leaking abdominal aortic aneurysms can nature to renal colic. In addition, if the aneurysm is adjacent to a ureter, there may be haematuria. Therefore, it is important to consider this serious differential i i years presenting with renal colic eshi particularly in patients agedu over 65 resh resh r udiagnosis Q Q n n n Qu a a a h h h for the rst time. s s s Ze Ze Ze r Copy ight o f r Copy ight o f
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A) Uric acid Correct. Uric acid stones are the least radioopaque stones out of the listed options. They are typically hi radiolucent on X-ray butQ usually ures visible on CT. They form n in patients with increased sha levels of uric acid, such as those f Ze f who o o t h with gout or are being treated for myeloproliferative rig right y y p p o o C disorders. They account for approximately 10% C of renal calculi. Xanthine stones are also typically radiolucent but are a rare cause of renal calculi. B) Calcium oxalate Incorrect. Calcium shi containing renal Quretype of stone, accounting calculi are the mosta common n h for approximately f Zes 75%. They are the most radio-opaque f o t h g ight o pyri calculi. orenal opyr
C) Calcium phosphate Incorrect. See B. D) Struvite Incorrect. Struvite calculi form in the presence hi shi bacteria (see Question 1) and account e r u ures of urease producing Q Q n n a ha esh for approximately 15% of renal stones. They generally Zes f Zare o t h g radio-opaque, and are the second type of renal pyridensest Coare calculi. Most staghorn calculi composed of struvite. E) Cysteine Incorrect. Cysteine stones are rare. They occur in patients with cystinuria, an uncommon autosomalrrecessive hi condition. Cysteine stones are shi u es Q Qure n n usually radio-opaque on plain X-ray but less dense than a a h h Zes f Zes calcium containing or struvite stones. ght o
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4. What is the diagnostic modality of choice for identifying renal calculi?

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Imaging is used to conrm the diagnosis of renal/urinary tract calculi, exclude differential diagnoses, such as appendicitis and diverticulitis, and identify any complications, such as hydronephrosis. All the options listed can help diagnose urinary hi tract calculi. hi hi ures ures ures
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C) Ultrasound Incorrect. Ultrasound can occasionally identify renal calculi. However, this modality is not as sensitive as CT. Additionally, it is usually impossible to image the entire hi ureter due to overlying bowel hi ures ultrasound has a low sensitivity for ures Q Q gas. Therefore, n n ha sha egood Zes f Zis detecting urinary tract calculi. Ultrasound at o t h rig which may be y p identifying urinary tract obstruction o C caused by calculi. Furthermore, it can identify other causes of loin pain and haematuria such as renal tumours, as well as gynaecological pathology, such as hi hi ovarian cysts, ureswhich can present in a similar manner. ures
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higher specicity than IVU. It is readily available and quick to perform. As it is a non-contrast examination, it can be safely in patients with renal i hi shperformed ure(which ures Q Q impairment may be secondary to urinary tract n n ha ha Zes Zescan calculi). As well as identifying calculi, of KUB t CT
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i shi Different types of renalucalculi approximately 75-90% of renal calculi ureshi resh have varying X-ray density. Overall, ure Q Q Q n n hastones are radio-opaque on CT. The are radio-opaque (i.e. visible) on plain X-rays, and almost exception shan esha esall e Z Z Z f f f o o o ht is calculi treated ght stones are ithese right that form in HIV patients beingo py pyrig with the protease inhibitor indinavir; opyr Co C C classically radiolucent even on CT.
helping to identify or exclude other differential diagnoses, such as appendicitis and diverticulitis (although the accuracy for this is limited by the low i dose nature of the examination and the lack of resh u Q n a h intravenous contrast). As discussed in Question 3, Zeshan s e Z f o t of atsmall proportion of urinary tract calculi ighnot righ rare y y p p o o C C be secondary visible on CT; however, there may still signs of urinary tract calculi, such as perinephric and peri-ureteral stranding.
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than CT KUB and requires intravenous contrast. Therefore, non contrast scans are preferred. It does, however, provide a better assessment of the abdominal i shi organs. Additionally, a delayed phase u and pelvic scan, resh ure Q Q n ha where the patient is imaged when the contrast is being Zes f urogram) o t h excreted into the urinary tract (CT , would help rig Copy calculi as these would appear identify non-radio-opaque as lling defects in the urinary tracts.
Abdominal X-Rays
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The management of urinary tract calculi depends on the size and site of the stone and whether there is evidence of associated infection.
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IMPORTAnT LEARninG POinTs: Renal ca i lculi ar
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Orthopaedic X-Rays
hi hi hi ures ures ures Q Q Q n n n a chapter is aimed at providing a systematic ha framework for approaching orthopaedic ha X-rays. This introduction to the sh f Ze f Zes f Zes o o o t t t h h h g Further and examples of the specic X-rays igndings discussed below are coveredpmore ridetails rig extensively in the opyr Copy cases later in the chapter and theC Co y example bonus X-ray chapter. hi shi shi ures Qure Qure Q n n n a a a h h h f Zes Systematic approach to orthopaedic f Zes X-rays f Zes o o o t t t h h h g g g ri ri ri Copy Copy Copy 4. Obvious abnormalities 1. Projection
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Assessment of any bone or joint in general requires eshiis one too few! These at least two views one view Qur Q Q n a sh shan normally consist of AP and lateral X-rays (gure 1). f Zeshan e e Z Z f f fractured it is o If the shaft of a long bone isig ht o ight o right pyrsome pyr above and below imperative to X-ray the joint sites, such as the scaphoid, where CoFor Copy Co because of the potential for additional injuries fractures are difcult to detect, it is routine to (fracture or dislocation) at these sites. obtain more than two views.
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Orthopaedic X-Rays - Introduction 335
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The Gartland classication system is useful for categorising the severity of supracondylar fractures, and the X-ray features are summarised in Table 1. It relates to extension type supracondylar injury, where the hi hi hi s s e e r r u u ures distal fragment is displaced 5% of supracondylar fractures, and Q posteriorly. Flexion type injuries comprise Q Q n n n a a a sh sh are classied separately. Zesh of of Ze of Ze
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Orthopaedic X-Rays - Introduction 353
Orthopaedic X-Rays
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Orthopaedic X-Rays - Hip Case 5 457
Orthopaedic X-Rays
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e of Ze a displaced left intracapsular IN SUMMARY This X-ray tshows t of Z h h g g i i r r C Copy Copy fracture of the neck of femur. I would want to see a lateral X-ray of the hip to complete my radiological assessment of the fracture. hi hi hi ures changes of the hips and ures are evident and theren Qures Q Q Degenerative spine n n ha ha ha f Zes f Zes f Zes o o o t t t h h h ig vascular calcification. rig rig is C marked opyr Copy Copy ight opyr resh i righ Copy t of Z e resh i righ Copy t of Z e resh i
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This is an AP X-ray of the pelvis of hi a skeletally mature patient. ures
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Intracapsular fractures often need surgery to have the femoral head replaced, but in certain cases this is not necessary, and in some cases conservative management might hi be considered. The Garden hi shi sintracapsular e e r r u u ures Classication is used to categorise the degree of displacement of an femoral neck fracture, Q Q Q n n n a sha to the femoral head has been fdisrupted. eshdenes esha and as such, also how likely it is that the tblood supply of Ze t of Z to Z
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D) Traction and bed rest Incorrect. This is not appropriate for patients in this age group with this fracture.
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Orthopaedic X-Rays
C E) None of the above Correct. Although not absolutely necessary, these should all be done for the standard patient with a neck of femur fracture. ight opyr of Ze Qu shan resh i
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CASE INDEX
Orthopaedic X-Rays
Lumbar degenerative changes (case about cauda equina syndrome)............367 Anterior wedge compression fracture............375 Cervical spine fracture.........................................383 Anterior shoulder dislocation............................391 Supracondylar fracture........................................399 Salter Harris fracture............................................407 Scaphoid fracture..................................................415 Colles fracture........................................................423 Hip joint osteoarthritis........................................429 Perthes disease......................................................435 Pelvic fracture.........................................................443 Slipped upper femoral epiphysis......................451 Intracapsular fracture of the neck of femur....................................................................457 Extracapsular fracture of the neck of femur....................................................................465 Paediatric aggressive bone lesion....................473 Lipohaemarthrosis/Tibial plateau fracture/Fibular fracture.....................................481 Knee joint osteoarthritis.....................................489 Tibial and bular shaft fractures......................497 Osteomyelitis/Periosteal reaction...................505 Bimalleolar fracture/Dislocation of the ankle joint.........................................................513
Chest X-Rays
Primary spontaneous pneumothorax.............. 29 Tension pneumothorax......................................... 37 Normal CXR. ............................................................... 45 Collapsed right upper lobe................................... 53 Pleural effusion........................................................ 61 Hilar mass.................................................................. 69 Apical lung mass with rib destruction............. 77 Multiple pulmonary metastases........................ 85 Sarcoidosis................................................................. 91 Ingested foreign body............................................ 97 Left lower lobe consolidation............................105 Possible pulmonary embolism..........................113 Congestive cardiac failure. ..................................121 Free subdiaphragmatic gas................................129 Mediastinal mass..................................................137 Lung abscess and pneumonia...........................145 Left lower lobe collapse and humeral fracture......................................................................153 Incorrectly placed NG tube.................................161 Pericardial effusion...............................................169 Calcied pleural plaques.....................................175
Abdominal X-Rays
Normal AXR.............................................................189 Small bowel obstruction.....................................195 Large bowel obstruction.....................................203 Sigmoid volvulus....................................................211 Pneumoperitoneum.............................................217 Thumbprinting.......................................................225 Pneumatosis intestinalis and pneumoperitoneum.............................................233 Constipation............................................................241 Splenomegaly.........................................................247 Gallstones................................................................255 Renal calculi.............................................................263 Chronic pancreatitis. .............................................269 Uterine broid........................................................277 Splenic artery aneurysm.....................................285 Abdominal aortic aneurysm..............................293 Sclerotic bone metastases..................................299 Ankylosing spondylitis.........................................305 Ingested foreign bodies.......................................313 Duodenal atresia/Double-bubble sign. ..........321 Pneumatosis intestinalis.....................................327
Bonus Chest X-Rays

Apical pneumothorax..........................................579 Normal CXR. .............................................................581 Free subdiaphragmatic gas................................583 Pleural effusion......................................................585 Misplaced NG tube...............................................587 Left lower lobe collapse.......................................589 Pericardial effusion...............................................591 Misplaced NG tube and dilated small bowel loops under the diaphragm........................................................593 Left lower lobe consolidation............................595 Right middle lobe consolidation. ......................597 Right upper lobe collapse...................................599 Right upper lobe consolidation/Basal atelectasis................................................................601 Right lower lobe consolidation.........................603 Free subdiaphragmatic gas................................605 Lingula consolidation...........................................607 Left upper lobe collapse. ......................................609 Pneumomediastinum..........................................611
Bonus Abdominal X-Rays

Gallstones................................................................613 Migrated IUCD........................................................615 Large bowel obstruction.....................................617 Normal AXR.............................................................619 Small bowel obstruction/ Pneumoperitoneum.............................................621 Thumbprinting/Toxic dilatation of the transverse colon.............................................623 Bilateral nephrostomies......................................625 Thumbprinting.......................................................627 Necrotising enterocolitis.....................................629 Pagets disease........................................................631 Splenomegaly.........................................................633 Intra-abdominal surgical swab/ Small bowel obstruction.....................................635
Bonus Orthopaedic X-Rays

5th metacarpal fracture......................................637 Normal foot X-ray..................................................639 Healed fractures (rib/clavicle/coracoid)/ Pneumothorax........................................................641 Normal elbow X-ray..............................................643 Slipped upper femoral epiphysis......................645 Lisfranc injury..........................................................647 Distal radial (with dorsal angulation) fracture......................................................................649 Weber C ankle fracture........................................651 5th metatarsal fracture.......................................653 Lipohaemarthosis..................................................655 Anterior shoulder dislocation............................657 Comminuted mid shaft femoral fracture......659 Comminuted humeral surgical neck fracture......................................................................661 Monteggia fracture...............................................663 Posterior shoulder dislocation..........................665 Rheumatoid arthritis............................................667 Distal radial (minimally displaced) fracture......................................................................669 Pathological shaft of femur fracture...............671 Acromio-clavicular joint disruption................673 5th metatarsal fracture.......................................675 Enchondroma (lytic bone lesion). .....................677 Distal radial (buckle) fracture............................679 Intracapsular fracture of the femoral neck.... 681 Triquetral fracture.................................................683 Weber A ankle fracture........................................685 Radial head fracture.............................................687 Trimalleolar fracture.............................................689 Extracapsular (subtrochanteric) fracture of the femoral neck...............................................691 Supracondylar fracture........................................693
Case Index 695
INDEX
Page numbers followed by f indicate gures.
AAA, see Abdominal aortic aneurysm ABCDD mnemonic, chest X-ray assessment airway, 1920 breathing, 20 cardiac and mediastinum, 20, 21f delicates, 21 diaphragm, 2021, 22f ABCDE assessment, pelvic fracture, 446 ABCDEF mnemonic, pulmonary oedema chest X-ray assessment, 25 Abdominal aorta, abdominal X-ray assessment, 185f Abdominal aortic aneurysm (AAA) abdominal X-ray, 293f, 294f causes, 296 clinical ndings, 296 computed tomography angiography, . 542f diameter, 297 management, 297 rupture imaging, 298 Abdominal computed tomography colonoscopy, 539f haematuria, 541f haemorrhage, 537f indications, 535 renal tract calculi, 540f sepsis, 536f trauma, 535f tumour staging, 538f Abdominal ultrasound, 559f, 560f Abdominal X-ray adequacy, 181 case examples abdominal aortic aneurysm, 293f, . 294f, 295298 ankylosing spondylitis, 305f, 306f, 307312 bone metastasis, 299f, 300f, 301304 bowel ischaemia, 233f, 234f, 235240, 627f, 628f colitis, 225f, 226f, 227232 constipation, 241f, 242f, 243246 duodenal atresia, 321f, 322f, 323326 foreign body ingestion, 313f, 314f, 315320 gallstones, 255f, 256f, 257262, 613f, 614f inammatory bowel disease, 623f, 624f intrauterine contraceptive device migration, 615f, 616f large bowel obstruction, 203f, 204f, 205210, 617f, 618f necrotising enterocolitis, 327f, 328f, 331332, 629f, 630f nephrostomy complications, 625f, 626f Pagets disease, 631f, 632f pancreatitis, 269f, 270f, 271276 pneumoperitoneum, 217f, 218f, 219224, 234f, 621f, 622f renal calculi, 263f, 264f, 265268 sigmoid colon volvulus, 211f, 212f, 213216 small bowel obstruction, 195f, 196f, 197202, 635f, 636f splenic artery aneurysm, 285f, 286f, 287292 splenomegaly, 247f, 248f, 249254, 633f, 634f uterine broid, 277f, 278f, 279284 checklist, 186 dose, 192193, 523 indications, 192 normal ndings, 189f, 190f, 191194, 619f, 620f projection, 181 small/large bowel differences, 193 systematic review, 181185 Abscess, see Lung abscess; Pancreatic abscess Achilles tendon, rupture, 517 Acute pancreatitis causes, 273 complications, 276 management, 275 pleural effusion induction, 66 ultrasound for gallstones, 274 Adhesions, small bowel obstruction, 200 Advance Trauma Life Support (ATLS), 446447, 478 AIN, see Anterior interosseous nerve Alcoholism acute pancreatitis, 273 chronic pancreatitis, 272 lung abscess risk factor, 149 Allergy, contrast agents, 523 AMPLE assessment, 447 Anal ssure, constipation, 245 Anaphylaxis, breathlessness, 34 Anatomical snuff box, pain and scaphoid fracture, 418 Ankle medial clear space, 518 orthopaedic X-ray assessment, 362f, 363f fracture with talar shift, 651f, 652f malleolar fracture case examples, 513f, 514f, 515520, 685f, 686f, 689f, 690f Ottawa Ankle Rules, 516 Weber classication of lateral malleolus fractures, 363, 517 talar shift, 518519 triplane fracture, 414 Ankle jerk, spinal injury assessment, 380 Ankylosing spondylitis abdominal X-ray, 305f, 306f, 309 clinical presentation, 308 extra-spinal joint involvement, 310 hepatic brosis, 311 treatment, 311312 Anterior interosseous nerve (AIN) injury following supracondylar fracture, 404 testing, 427 Aortic dissection, chest computed tomography, 534f Appendicitis, foreign body ingestion, 430 Asbestos exposure, case example with chest X-ray of pleural plaques, 175f, 176f, 177180 Ascites, portal hypertension, 290 Aspirin, pericardial effusion management, 174 Atherosclerosis, abdominal aortic aneurysm, 296 ATLS, see Advance Trauma Life Support Avascular necrosis hip, see Perthes disease scaphoid, 419 Axillary nerve, injury in shoulder dislocation, 396 Babinski sign, 304 Back pain management, 374 red ags, 308 Bamboo spine, ankylosing spondylitis, 309 Barium follow-through, 576 Barium swallow constipation induction, 246 principles, 572 small bowel obstruction diagnosis, 202 views, 573f, 574f, 575f Bats wing consolidation, 122f Bell classication, necrotising enterocolitis, 332 Bennetts fracture, 364 Biliary colic, gallstone presentation, 259 Blood culture, necrotising enterocolitis, 331 Blood gas, venous central line, 167168 Bone metastasis abdominal X-ray, 299f, 300f causes, 302 clinical ndings, 302 spinal cord compression management, 304
696 Index
INDEX
Bone scan principles, 565, 568f, 569 prostate cancer staging, 302303 radiation dose, 566 Bony Bankart lesion, 397 Bowel ischaemia abdominal X-ray, 233f, 234f, 235240 acute versus chronic, 240 case examples with abdominal X-ray, 233f, 234f, 235240, 627f, 628f computed tomography, 237, 239 management of acute disease, 237 pneumatosis intestinalis, 236, 238 Bowel obstruction abdominal X-ray assessment, 182, 183f case examples with abdominal X-rays large bowel obstruction, 203f, 204f, 205210, 617f, 618f small bowel obstruction, 195f, 196f, 197202, 621f, 622f, 635f, 636f central loops in small bowel obstruction, 198 foreign body ingestion, 320 pseudo-obstruction versus mechanical large bowel obstruction, 206 small/large bowel differences on X-ray, 193 stenting of large bowel Breast cancer lobar lung collapse, 156 sclerotic bone metastasis, 302 Breathlessness, differential diagnosis, 34 Bronchiectasis, pneumonia complication, 111112 Bronchoscopy, foreign body retrieval, 104 Burst fracture, 364 placement verication, 167168 Chance fracture, 364, 379 Chest computed tomography, see also Computed tomography pulmonary angiography aortic dissection, 534f indications, 531 lobar lung collapse, 532 lung parenchyma assessment, 532f pulmonary nodule, 531f trauma, 533f Chest drain Seldinger technique, 68 tension pneumothorax, 44 Chest ultrasound, 558, 559f Chest X-ray abnormality assessment, 19 calcication causes, 180 case examples asbestos exposure and pleural plaques, 175f, 176f, 177180 foreign body ingestion, 97f, 98f, 99104 lobar collapse right upper lobe collapse, 53, 54f, 5560, 599f, 600f left lower lobe collapse, 153f, 154f, 155160, 589f, 590f lung abscess, 145f, 146f, 147152 lung cancer hilar mass, 69f, 70f, 7176 metastasis sites, 7475 Pancoast tumour, 77f, 78f, 7984 pulmonary metastases, 85f, 86f, 8790 mediastinal mass, 137f, 138f, 139141 normal ndings, 46f, 4752 Caecum, volvulus, 213214, 216 pericardial effusion, 169f, 170f, CAP, see Community acquired pneumonia 591f, 592f Cardiothoracic ratio pleural effusion, 61f, 62f, 6368, congestive cardiac failure, 125 585f, 586f measurement, 5051 pneumomediastinum, 611f, 612f Carotid artery, Doppler ultrasound, 558, pneumonia, 105f, 106f, 107112, 559f 595f, 596f, 597f, 598f, 601f, 602f, Carpal tunnel, anatomy, 422 603f, 604f, 607f, 608f Cauda equina syndrome pneumoperitoneum, 129f, 130f, clinical features, 370 131136, 583 f , 584 f decompression surgery, 373 pneumothorax lumbar spine X-ray, 367f, 368f primary spontaneous, 29f, 30f, magnetic resonance imaging, 372, 3136 550f small left apical pneumothorax, physical examination, 371 579f, 580f Cavitating tumour, lung, 148 tension pneumothorax, 37f, 38f, Central cord syndrome, 382 3944 Central line pulmonary embolism, 113f, 114f, chest X-ray, 22f 115120, 581f, 582f insertion, 166167 pulmonary oedema, 121f, 122f, 123128 sarcoidosis of lung, 91f, 92f, 9396 tube and line displacement, 161f, 162f, 163168, 587f, 588f, 593f, 594f checklist, 28 consolidation causes, 108, 117, 122f, 162f dose, 4849 indications, 48 inspiration during, 1819 lines and tubes, 22f lung collapse, see Lobar lung collapse lymphadenopathy, 94 patient details, 18 penetration assessment, 19 pleural effusion, 25f pneumonia, 23, 24f, 25 pneumothorax, 25f projection, 17f, 18 pulmonary oedema, 25f review ABCDD mnemonic airway, 1920 breathing, 20 cardiac and mediastinum, 20, 21f delicates, 21 diaphragm, 2021, 22f summarisation, 23 rotation, 18f Cholecystitis, gallstone presentation, 259 Chronic myeloid leukaemia, splenomegaly, 252 Chronic obstructive pulmonary disease (COPD), 20, 603f, 604f Chronic pancreatitis, abdominal X-ray, 269f, 270f Clavicle, see Shoulder Clips, see Sterilisation clips Cocksackie virus, pericardial effusion induction, 172 Coffee bean sign, sigmoid colon volvulus, 215 Colchicine, pericardial effusion management, 174 Colitis case example with abdominal X-ray, 225f, 226f, 227232 causes, 228 ulcerative colitis, see Inammatory bowel disease Colles fracture, 364, 423f, 424f, 425428 Colon cancer colonoscopy, 209 large bowel obstruction, 207 lobar lung collapse, 156 Colon, see Large bowel
Index 697
INDEX
Colonoscopy, 209, 539f Community acquired pneumonia (CAP) case examples, 595f, 596f, 601f, 602f pathogens, 110 scoring, 111 Compartment syndrome, 402, 486, 503 Computed tomography (CT) abdominal aortic aneurysm rupture imaging, 298 abdominal CT, 535f, 536f, 537f, 538f, 539f, 540f, 541f angiography, 542f bone tumour, 479 bowel ischaemia, 237, 239 cancer staging, 159 cervical spine, 344f, 388389, 530f chest CT, 531f, 532f, 533f, 534f contraindications, 524 contrast agents allergy, 523 metformin patient precautions, 524 nephropathy induction, 523524 types, 523 dose, 523 foreign body ingestion, 101 head CT, 525, 526f, 527f, 528f, 529f indications, 524 lung abscess, 150151 lung cancer, 75 orthopaedic CT, 530f, 531 pancreatic abscess, 276 pelvis fracture, 446 PET/CT, see Positron emission tomography pleural calcication, 179 pneumoperitoneum, 132133, 223224 principles, 521f pulmonary metastases, 90 scanner, 521f sigmoid colon volvulus, 216 tibial plateau fracture, 488 windowing, 522f, 523 Computed tomography pulmonary angiography (CTPA) pleural effusion, 67 pulmonary embolism, 531f Congestive cardiac failure assessment, 117 chest X-ray ndings, 114115 clinical features, 114 Constipation ankylosing spondylitis, 306f bone metastasis, 302 causes, 244245 complications, 246 imaging, 241f, 242f, 245246 management, 245 tenesmus, 244 Continuous positive airway pressure (CPAP), pulmonary oedema management, 128 Contrast agents computed tomography allergy, 523 metformin patient precautions, 524 nephropathy induction, 523524 types, 523 gadolinium for magnetic resonance imaging, 544 Contrast enema, 576f Contrast swallow, see Barium swallow COPD, see Chronic obstructive pulmonary disease Costophrenic angle, blunting, 30f, 62f CPAP, see Continuous positive airway pressure Cremasteric reex, spinal injury assessment, 380 CRITOE acronym, ossication centres, 351, 353f Crohns disease, see Inammatory bowel disease CTPA, see Computed tomography pulmonary angiography Cubitus varus, supracondylar fracture, 406 CURB 65, pneumonia scoring, 111 Danozol, uterine broid management, 283 Deep vein thrombosis (DVT) complications, 119120 pneumonia complication, 111112 prophylaxis in ulcerative colitis are management, 232 ultrasound, 118 Demyelination, magnetic resonance imaging, 547f Dermatome, spinal injury assessment, 380, 389390 Diarrhoea, bloody diarrhoea assessment, 229 Dislocation, 339, 340f Disseminated intravascular coagulation, necrotising enterocolitis, 334 Diverticulitis, stricture formation, 208 Docusate sodium, constipation management, 245 Double bubble sign, 322f Downs syndrome, duodenal atresia, 325 Duodenal atresia abdominal X-ray, 321f, 322f, 325 associated conditions, 325 case example with abdominal X-ray, 321f, 322f, 323326 double bubble sign, 322f management, 326 signs and symptoms, 324 stenosis similarity, 324 Duodenum, volvulus, 213 DVT, see Deep vein thrombosis Dysmenorrhoea, uterine broids, 281 ECG, see Electrocardiogram Elbow anatomy, 405 anterior interosseous nerve injury, 404 effusion X-ray, 337f, 687f, 688f, 693f, 694f orthopaedic X-ray assessment, 350, 351f, 352f, 353f, 403 normal ndings, 643f, 644f radial head fracture, 687f, 688f supracondylar fracture case examples, 399f, 400f, 401406, 693f, 694f deformities following, 405406 Gartland classication, 353, 403 ossication centres, 351, 353f Electrocardiogram (ECG), congestive cardiac failure, 127 Emergency surgery, prerequisites, 463464 Emphysema, lung abscess risk factor, 149 Empyema pleural calcication, 178 pneumonia complication, 111112 Enchondroma, location and age, 480 Endoscopic retrograde cholangiopancreatography (ERCP), acute pancreatitis, 273 Endoscopy battery stuck in mid-oesophagus, 319 complications, 320 Endotracheal tube (ET) chest X-ray, 22f positioning, 166 Enema, sigmoid colon volvulus management, 216 Enterocolic stulae, necrotising enterocolitis, 334 Epilepsy, magnetic resonance imaging, 548 ERCP, see Endoscopic retrograde cholangiopancreatography ET, see Endotracheal tube Ewings sarcoma differential diagnosis, 477 location and age, 480 Faecal loading, see Constipation FAST, see Focused assessment with sonography in trauma Femoral vein, ultrasound, 563f Femur neck fracture, see Hip shaft fracture X-rays, 339f, 659f, 660f, 671f, 672f
698 Index
INDEX
Fibula, see also Knee shaft fracture case example, 497f, 498f, 499504 Finger, X-ray bone lesion in proximal phalanx, 677f, 678f lucent lesion, 338f subluxation versus dislocation, 339, 340f views, 335f Fish bone, X-ray ndings of ingestion, 103 Fistula, Crohns disease, 230 FLAIR, see Fluid attenuation recovery Fluid attenuation recovery (FLAIR), 547f Fluid resuscitation, ulcerative colitis are management, 232 Fluid therapy duodenal atresia, 26 necrotising enterocolitis, 332333 Fluoroscopy barium follow-through, 576 barium swallow, see also Barium swallow principles, 572 views, 573f, 574f, 575f contraindications, 572 contrast enema, 576f indications, 572 principles, 571 radiation dose, 572 tubogram, 576, 577f Focused assessment with sonography in trauma (FAST), 448, 563 Foot, metatarsal fracture, 639f, 640f, 647f, 648f, 653f, 654f, 675f, 676f Foreign body ingestion abdominal X-ray, 313f, 314f age groups, 316 battery stuck in mid-oesophagus, 319 case examples abdominal X-ray, 313f, 314f, 315320 chest X-ray, 97f, 98f, 99104 oropharynx trapping, 317 physical examination, 318 pneumoperitoneum induction, 135 Foreign body inhalation, lobar lung collapse, 157 Functional ileus, small bowel obstruction differentiation, 199 Gadolinium, precautions, 544 Galeazzi fracture, 364 Gallbladder, abdominal X-ray assessment, 185 Gallstones acute pancreatitis, 273 case examples with abdominal X-ray, 255f, 256f, 257262, 613f, 614f cholecystitis management, 262 clinical presentation, 259 risk factors, 258 ultrasound, 274, 560f, 561f Garden classication, hip fractures, 359, 461 Garlands triad (1, 2, 3 sign), 96 Gartland classication, supracondylar fracture, 353, 403 Gas, see also Pneumoperitoneum; Pneumothorax pneumatosis intestinalis, 236, 238 subdiaphragmatic, 22f, 129f, 130f, 131136, 605f, 606f Gastric tube, duodenal atresia, 326 Genitourinary scan principles, 565 radiation dose, 566 renal cortex assessment, 567568 Glenohumeral joint, see Shoulder Globular heart, pericardial effusion chest X-ray, 174 Glycerol suppository, constipation management, 245 Glyceryl trinitrate (GTN), pulmonary oedema management, 128 Goitre mediastinal mass differential diagnosis, 142 ultrasound, 558f Golden S sign, 26f, 54f, 59 Growth plate fracture growth disturbances, 412 management, 413 Salter Harris classication, 364, 408f, 411412 physis components, 410 GTN, see Glyceryl trinitrate Gunstock deformity, supracondylar fracture, 406 Gustilo classication, open fractures, 504 haemorrhage, 525, 526f, 527 hydrocephalus, 526f, 528 indications, 525, 527 mass effect, 527 space-occupying lesions, 527f Head magnetic resonance imaging congenital abnormalities, 549 demyelination, 547f epilepsy, 548 indications, 544 pituitary, 548 space occupying lesions, 548f stroke, 546f vascular abnormalities, 549 weighted images, 545f Heparin-induced thrombocytopaenia (HIP), 119 Hepatic brosis, ankylosing spondylitis, 311 Hereditary spherocytosis, splenectomy, 253 Hilar mass, case example, 69f, 70f, 7176 Hill Sachs lesion, 365, 397 Hilum overlay sign, mediastinal mass, 142 HIP, see Heparin-induced thrombocytopaenia Hip ankylosing spondylitis, 310311 avascular necrosis case example, 435f, 436f, 437442 femur neck fracture case examples extracapsular fracture, 465f, 466f, 691f, 692f intracapsular fracture, 457f, 458f, 459464, 681f, 682f Garden classication, 359, 461 management, 462463, 470471 mechanism of injury, 468 mortality, 471472 overview, 462 2 to 4 parts classication, 360, 470 indications, 433434 orthopaedic X-ray assessment, 357f, 358f, 359f, 360 Haematuria, abdominal computed osteoarthritis tomography, 541f case example, 336f, 429f, 430f, Haemolytic anaemia, gallstone risks, 258 431434 Haemoptysis, differential diagnosis, 72 X-ray, 336f Haemorrhoids, constipation association, parts classication of neck of femur 246 fractures, 360 Haemothorax, pleural calcication, 18 Perthes disease, 442 Hamptons hump, 117 septic arthritis distinguishing from Hand, see also Finger irritable hip, 512 erosive arthropathy, 667f, 668f slipped upper femoral epiphysis case metacarpal fracture, 637f, 638f examples, 451f, 452f, 453456, 645f, Hangmans fracture, 364 646f Hartmanns procedure, 210 surgical approaches, 434 Head computed tomography Trendelenburg sign, 432433 contrast enhanced imaging, 528, 529f Hippocratic method, shoulder dislocation grey-white matter differentiation, 528f reduction, 395
Index 699
INDEX
Holstein Lewis fracture, 365 Hormone replacement therapy (HRT), pulmonary embolism risks, 116 Horners syndrome, lung cancer, 8081 Hounsfeld unit (HU), 522 HPOA, see Hypertrophic pulmonary osteoarthropathy HRT, see Hormone replacement therapy HU, see Hounsfeld unit Hydronephrosis, abdominal aortic aneurysm, 296 Hypercalcaemia constipation, 244 renal calculi, 266 Hypertension, splenic artery aneurysm risks, 290 Hypertrophic pulmonary osteoarthropathy (HPOA), lung cancer, 74 Hypotension pericardial effusion, 173 tension pneumothorax, 41 Hypoxia, tension pneumothorax, 41 Hysterectomy, uterine broid management, 284 right upper lobe, 26, 53, 54f, 5560, 599f, 600f clinical presentation, 56 computed tomography, 532 foreign body induction, 102 Low-molecular-weight heparin, pulmonary embolism management, 119 Luftsichel sign, 26f Lumbar spine, see Cauda equina syndrome; Spine Lung parenchyma assessment with chest computed tomography, 532f X-ray, see Chest X-ray Lung abscess aetiology, 150151 chest X-ray ndings, 145f, 146f differential diagnosis, 148 risk factors, 149 treatment, 151152 Lactulose, constipation management, 245 Lung cancer Large bowel case examples with chest X-rays abdominal X-ray assessment, 182f hilar mass, 69f, 70f, 7176 abscess, 334 metastasis sites, 7475 constipation and perforation, 246 Pancoast tumour, 77f, 78f, 7984 Idiopathic thrombocytopaenic purpura, obstruction, 182, 183f, 617f, 618f pulmonary metastases, 85f, 86f, Splenectomy, 253 obstruction, see Bowel obstruction 8790 Inammatory bowel disease sigmoid colon volvulus, 211f, 212f, consolidation on chest X-ray, 108 abdominal X-ray ndings, 623f, 624f 213216 lobar lung collapse, 156 Crohns disease versus ulcerative small bowel differences on X-ray, 193 Lung collapse, see Lobar lung collapse colitis, 230 thumbprinting, 185f, 185 Lung ventilation/perfusion scan ares Laryngeal cancer, asbestos exposure, 179 principles, 565 toxic megacolon assessment, 231 Left lower lobe collapse, 26f, 153f, 154f, pulmonary embolism, 566, 567f ulcerative colitis management, 232 155160 radiation dose, 566 gallstone risks with Crohns disease, 258 Left upper lobe collapse, 26, 58, 609f, 610f Lymphadenopathy pneumoperitoneum induction, 135 Levonorgestrel intrauterine device, chest X-ray ndings, 94 renal calculi, 266 uterine broid management, 283 sarcoidosis of lung, 91f, 92f, 94 stricture formation, 208 Lipohaemarthrosis Lymph node, calcication in upper left Iniximab, ankylosing spondylitis fracture association, 484 quadrant of abdominal X-ray, 288 management, 312 tibial plateau fracture case studies, Lymphoma Interosseus nerve, testing, 427 481f, 482f, 483488, 655f, 656f hilar mass, 73 Interventional radiology, bowel Lisfranc injury, 365 mediastinal mass differential ischaemia, 237 Liver diagnosis, 142143 Intra-aortic balloon pump, pulmonary abdominal X-ray assessment, 185 splenomegaly, 252253 oedema management, 128 ultrasound, 560f, 561f Intrauterine contraceptive device (IUCD), Liver transplantation, splenic artery Magnetic resonance X-ray of migration, 615f, 616f aneurysm risks, 290 cholangiopancreatography (MRCP), 261, IUCD, see Intrauterine contraceptive Lobar lung collapse 553f device cancer association, 156 Magnetic resonance imaging (MRI) causes, 57 bone tumour of knee, 479 Jaundice, gallstone presentation, 259 chest physiotherapy, 60 cauda equina syndrome, 372 Jefferson fracture, 365, 388 chest X-ray cervical spine, 388389 Jones fracture, 365 left lower lobe, 26f, 153f, 154f, contraindications, 544 155160, 589f, 590f gadolinium contrast agent, 544 Kerley B lines, 25f left upper lobe, 26, 58, 609f, 610f head MRI Kidney right lower lobe, 27f congenital abnormalities, 549 abdominal X-ray assessment, 185 right middle lobe, 27f demyelination, 547f failure, see Renal failure stones, see Renal calculi ultrasound, 560, 561f Kleins line, 366 Knee aspiration, 487 bone tumour case study, 473f, 474f, 475480 magnetic resonance imaging, 555f orthopaedic X-ray assessment, 360, 361f osteoarthritis case example, 489f, 490f, 491496 tibial plateau fracture case studies, 481f, 482f, 483488, 655f, 656f X-ray features, 494495 Knee replacement, 496 Kochers method, shoulder dislocation reduction, 395
700 Index
INDEX
epilepsy, 548 indications, 544 pituitary, 548 space occupying lesions, 548f stroke, 546f vascular abnormalities, 549 weighted images, 545f indications, 544 knee, 555f osteomyelitis, 510 Pancoast tumour, 83 principles, 543 safety, 543 scanner, 543f small bowel, 554f spinal cord compression, 303 spine MRI cauda equina syndrome, 550f indications, 549 normal ndings, 549f spinal canal stenosis, 552f spinal cord compression, 550, 551f spinal cord trauma, 553f uterine broids, 282 weighted sequences, 544 Maissonneuve injury, 365 Malaria, splenomegaly, 252 Malleolus, see Ankle Malrotation, duodenal atresia, 325 Medial clear space, 518 Median nerve, injury in Colles fracture, 426427 Mediastinum chest X-ray assessment, 20, 21f, 140 gas, see Pneumomediastinum mass, case example with chest X-ray, 137f, 138f, 139141 mediastinitis and oesophagus foreign body induction, 100 Menorrhagia, uterine broids, 281 Mesothelioma, asbestos exposure, 179 Metacarpal, fracture, 637f, 638f Metal detector, ingested coin detection, 100 Metastasis, lung cancer, 7475 Metatarsal, fracture, 639f, 640f, 647f, 648f, 653f, 654f, 675f, 676f Mitral regurgitation calcication on X-ray, 180 pulmonary oedema, 126 Metformin, contrast agent precautions, 524 Monteggia fracture, 365 MRCP, see Magnetic resonance cholangiopancreatography MRI, see Magnetic resonance imaging Mucus plug, lobar lung collapse, 157 Multiple myeloma, 158, 480 Myasthenia, lung cancer, 74 Myelobrosis, splenomegaly, 252 Myocardial infarction, pericardial effusion induction, 172 Myocardial perfusion scan principles, 565, 567 radiation dose, 566 Myomectomy, uterine broid management, 284 Myotome, spinal injury assessment, 380, 390 fracture appearance, 336f descriptors, 338339 names, 364366 hip assessment, 357f, 358f, 359f, 360 knee assessment, 360, 361f pelvis assessment, 357f, 358f, 359f, 360 projection, 335f shoulder assessment, 348, 349f, 350f spine cervical spine assessment, 340341, Nasendoscopy, foreign body retrieval, 104 342f, 343f, 344f, 345f Nasogastric (NG) tube thoracolumbar spine assessment, acute pancreatitis, 275 345, 346f, 347f chest X-rays, 22f, 161f, 162f, 165, 587f, subluxation versus dislocation, 339, 340f 588f, 593f, 594f systematic review, 336f, 337f, 338f placement, 164 technical adequacy, 336 small bowel obstruction wrist assessment, 354f, 355f, 356f management, 201 Ossication centres, elbow, 351, 353f Necrotising enterocolitis Osteoarthritis abdominal X-ray, 327f, 328f, 331332, hip case example, 336f, 429f, 430f, 629f, 630f 431434 Bell classication system, 332 knee case example, 489f, 490f, 491496 complications, 333334 severity assessment, 433 management, 332333 X-ray features, 432 risk factors, 330 Osteomyelitis stricture formation, 208 clinical ndings, 508 Needle decompression, tension differential diagnosis, 477 pneumothorax, 38, 42, 44 magnetic resonance imaging, 510 Nephrostomy, complications, 625f, 626f management, 511 NG tube, see Nasogastric tube pathogens, 509 Nuclear medicine, see Bone scan; tibia case example, 505f, 506f, Genitourinary scan; Lung ventilation/ 507512 perfusion scan; Myocardial perfusion Osteophyte, knee arthritis, 494496 scan; Positron emission tomography Osteosarcoma location and age, 480 Obesity, gallstone risks, 258 pathological fracture, 158 Oesophageal varices, portal hypertension Ottawa Ankle Rules, 516 as cause, 291 Ovarian cyst, ultrasound, 562f Oesophagus battery stuck in mid-oesophagus, 319 stula from foreign body ingestion, 320 Pagets disease, X-ray ndings, 631f, 632f Pancoast tumour, see Lung cancer perforation from foreign body Pancreas ingestion, 320 abdominal X-ray assessment, 185 Open fracture annular pancreas, 324325 Gustilo classication, 504 ultrasound, 560 management, 501502 Pancreatic abscess, acute pancreatitis Opioids, constipation, 244 association, 276 Orthopaedic computed tomography, Pancreatitis, see Acute pancreatitis; 530531 Chronic pancreatitis Orthopaedic X-rays, see also specic Patella reex, spinal injury assessment, 380 bones and joints Pelvic ultrasound, 562f ankle assessment, 362f, 363f Pelvis checklist, 366 fracture elbow bladder and urethral injuries, 449 assessment, 350, 351f, 352f, 353f case example, 443f, 444f, 445450 Gartland classication of computed tomography, 446 supracondylar fracture, 353
Index 701
INDEX
management, 450 mortality, 449 types, 448449 orthopaedic X-ray assessment, 357f, 358f, 359f, 360 tumour staging with computed tomography, 538f Pericardial effusion, case examples with chest X-ray, 169f, 170f, 591f, 592f Periosteal reaction aggressive bone lesion, 476 osteomyelitis, 505f, 506f Peritonitis, pneumoperitoneum induction, 136 Perthes disease differential diagnosis, 440 severity assessment, 441 treatment, 441442 X-ray case example, 435f, 436f, 437442 PET, see Positron emission tomography Phlebolith, 278f Physis, see Growth plate Pituitary, magnetic resonance imaging, 548 Pleural calcication causes, 178 imaging, 177f, 179 Pleural effusion case examples with chest X-ray, 61f, 62f, 6368, 585f, 586f chest X-ray ndings, 25f clinical signs and symptoms, 64 congestive cardiac failure, 125 draining, 68 exudate analysis, 6465 exudative effusion aetiology, 6566 pneumonia complication, 111112 transudate versus exudate effusions, 66 ultrasound, 559f Pneumatosis intestinalis, differential diagnosis, 236, 238 Pneumomediastinum, case example, 611f, 612f Pneumonia case examples with chest X-rays, 105f, 106f, 107112, 595f, 596f, 597, 598f, 601f, 602f, 603f, 604f, 607f, 608f chest X-ray ndings, 23, 24f, 25 community acquired pneumonia case examples, 595f, 596f, 601f, 602f pathogens, 110 scoring, 111 complications, 111112 consolidation on chest X-ray, 108109 pleural effusion induction, 65 Pneumoperitoneum abdominal X-ray assessment, 184f, 185f case examples with abdominal X-ray, 217f, 218f, 219224, 234f, 583f, 584f, 621f, 622f causes, 134135, 220 chest X-ray ndings, 129f, 130f, 131136 post-operative, 136 Pneumothorax breathlessness, 34 case examples with chest X-rays primary spontaneous, 29f, 30f, 3136 small left apical pneumothorax, 579f, 580f tension pneumothorax, 37f, 38f, 3944 chest X-ray ndings, 25f evolution from simple pneumothorax, 40 pneumonia complication, 111112 shoulder X-ray, 641f, 642f tension pneumothorax, 20 Portal hypertension, 290291, 560 Positron emission tomography (PET) indications, 420 PET/CT principles, 565 radiation dose, 566 tumours, 569f Posterior interosseus nerve, testing, 427 Pregnancy pulmonary embolism evaluation, 118 splenic artery aneurysm risks, 290 X-ray safety, 14 Premature infants, necrotising enterocolitis, 330 Prostate cancer bone metastasis, 299f, 300f, 301304 staging, 302303 Pulmonary artery hypertension hilar mass, 73 pulmonary embolism complication, 119120 Pulmonary embolism breathlessness, 34 case examples with chest X-ray, 113f, . 114f, 115120, 581f, 582f complications, 119120 lung ventilation/perfusion scan, 566, 567f pregnant patient evaluation, 118 risk factors, 116 treatment, 119 Pulmonary brosis, 96, 179 Pulmonary oedema case example with chest X-ray, 121f, 122f, 123128 causes, 126 chest X-ray ndings, 25f, 108 treatment, 128 Pulmory infarction haemoptysis, 72 lung abscess differential diagnosis, 148 pleural effusion induction, 66 Radial inclination, 355 Radial nerve, testing, 427 Radius, see Elbow; Wrist Renal artery stenosis, pulmonary oedema, 126 Renal calculi abdominal X-ray, 263f, 264f calcication in upper left quadrant of abdominal X-ray, 288 computed tomography, 267268, 540f management, 268 risk factors, 266 symptoms, 266 uric acid stones, 267 Renal failure contrast agent nephropathy induction, 523524 pericardial effusion induction, 172 pulmonary oedema, 126 Renal tubular acidosis, renal calculi, 266 Retroperitoneal brosis, abdominal aortic aneurysm, 296 Rheumatoid arthritis, hand X-ray, 667f, 668f Right lower lobe collapse, 27f Right middle lobe collapse, 27f Right upper lobe collapse, 26, 53, 54f, 5560, 599f, 600f Riglers sign, 234f Rolandos fracture, 365 Round atelectasis, asbestos exposure, 179 Sacroiliac joint, abdominal X-ray, 194 Saddle anaesthesia, cauda equina syndrome, 371 Sail sign, 26, 27f, 154f Salter Harris classication, growth plate fractures, 364, 408f, 411412 Sarcoidosis clinical presentation, 9596 differential diagnosis in lung, 78 hilar mass, 73 lung, 91f, 92f, 9396 risk factors, 9495 Scaphoid, see Wrist SCIWORA, see Spinal cord injury without radiological abnormality Segond fracture, 365 Seldinger technique, 68 Senna, constipation management, 245 Septic arthritis, distinguishing from irritable hip, 512
702 Index
INDEX
Shentons line, 366 Short bowel syndrome, necrotising enterocolitis, 334 Shoulder ankylosing spondylitis, 310 dislocation axillary nerve injury, 396 bony abnormalities with anterior dislocations, 397 instability following injury, 397398 reduction, 395 types, 394 orthopaedic X-ray acromio-clavicular joint disruption, 673f, 674f assessment, 348, 349f, 350f glenohumeral joint dislocation, 391f, 392f, 393398, 657f, 658f humeral neck fracture, 661f, 662f posterior dislocation, 665f, 666f SiADH, see Syndrome of inappropriate antidiuretic hormone secretion Sickle cell anaemia, calcication in upper left quadrant of abdominal X-ray, 288 Sigmoid colon volvulus abdominal X-ray, 211f, 212f, 213216 contrast enema, 576f Sigmoidoscopy, sigmoid colon volvulus management, 216 Silhouette sign mediastinal mass, 142 pneumonia chest X-ray, 24f, 109 Silicosis, calcication on X-ray, 180 Slipped upper femoral epiphysis (SUFE) case examples, 451f, 452f, 453456, 645f, 646f clinical presentation, 454 contralateral slippage incidence, 455 management, 456 pathology, 454 Trethowans sign, 455 Small bowel abdominal X-ray assessment, 182f barium follow-through, 576 dilation in necrotising enterocolitis, 331332 large bowel differences on X-ray, 193 magnetic resonance imaging, 554f obstruction, see Bowel obstruction ultrasound, 561f Smiths fracture, 365, 427428 Spinal canal stenosis, magnetic resonance imaging, 552f Spinal cord compression bone metastasis, 302304 cauda equina syndrome decompression surgery, 373 magnetic resonance imaging, 550, 551f Spinal cord injury without radiological abnormality (SCIWORA), 384 Spinal cord trauma, magnetic resonance imaging, 553f Spinal shock, 381 Spine, see also Cauda equina syndrome back pain management, 374 cauda equina syndrome decompression surgery, 373 cervical spine computed tomography, 530f computed tomography of cervical spine, 388389 magnetic resonance imaging of cervical spine, 388389 orthopaedic X-ray central cord syndrome, 382 cervical spine assessment, 340341, 342f, 343f, 344f, 345f case example of fracture without trauma, 382f, 383f, 384390 lines for lateral X-ray assessment, 387 Chance fracture-associated injuries, 379 Jefferson fracture, 388 L1 fracture, 375f, 376f level of sensation and fracture location, 380, 389390 stable fracture, 376 thoracolumbar spine assessment, 345, 346f, 347f Spine magnetic resonance imaging cauda equina syndrome, 550f indications, 549 normal ndings, 549f spinal canal stenosis, 552f spinal cord compression, 550, 551f spinal cord trauma, 553f Spleen abdominal X-ray assessment, 185f congenital asplenia, 251 erythrocytes, 251 lymphocyte production, 251 size, 251 Splenectomy indications, 253 management in post-operative period, 254 splenic artery aneurysm, 292 Splenic artery aneurysm abdominal X-ray of calcication, 285f, 286f, 288 pseudoaneurysm differentiation, 289 risk factors, 290 treatment, 292 Splenomegaly case examples with abdominal X-ray, 247f, 248f, 249254, 633f, 634f causes, 252 physical examination, 250 portal hypertension, 290 splenic artery aneurysm, 286f ultrasound, 560 Staphylococcus aureus, osteomyelitis association, 509 Sterilisation clips abdominal X-ray assessment, 186 displacement, 248f Stomach, volvulus, 213 Streptococcus pneumoniae, community acquired pneumonia, 110 Stroke computed tomography of haemorrhage, 525, 526f, 527 magnetic resonance imaging, 546f Subluxation, 339, 340f SUFE, see Slipped upper femoral epiphysis Superior vena cava, stenting in Pancoast tumour, 84 Supracondylar fracture, see Elbow Syndrome of inappropriate antidiuretic hormone secretion (SiADH), lung cancer, 74 Tachycardia, tension pneumothorax, 41 Talus, shift, 518519 TB, see Tuberculosis Tenesmus, constipation, 244 Teratoma, mediastinal mass differential diagnosis, 142143 Thrombolysis, pulmonary embolism management, 119 Thumbprinting, colitis, 218 Thurstand Holland fragment, 365 Thymoma, mediastinal mass differential diagnosis, 142143 Thyroid cancer, lobar lung collapse, 156 Tibia, see also Knee osteomyelitis case example, 505f, 506f, 507512 shaft fracture case example, 497f, 498f, 499504 Toxic megacolon, 231 Tranexamic acid, uterine broid management, 283 Trauma, initial series X-rays, 447 Trendelenburg sign, 432433 Trethowans sign, 366, 455 Triplane fracture, 414 Triquetral bone, see Wrist Tuberculosis (TB) differential diagnosis, 89
Index 703
INDEX
hilar mass, 73 pleural effusion induction, 66 Tubogram, 576, 577f Ulcerative colitis, see Inammatory bowel disease Ulna distal fracture, see Wrist shaft fracture, 663f, 664f Ulna variance, 355 Ultrasound scans abdominal aortic aneurysm, 297 abdominal ultrasound, 559f, 560f B-mode, 557 chest ultrasound, 558, 559f colour ow imaging, 557, 563f congestive cardiac failure echocardiogram, 127 contraindications, 558 deep vein thrombosis, 118 Doppler imaging, 557558, 559f focused assessment with sonography in trauma, 448, 563 gallstones, 260, 274 guided procedures, 564 indications, 557 musculoskeletal ultrasound, 564 neck, 558f, 559f pelvic ultrasound, 562f pleural effusion, 6768 principles, 557 reection of waves, 558 safety, 557 vascular ultrasound, 563f Ultrasound therapy, uterine broid management, 284 Urinary incontinence, cauda equina syndrome, 370 Urinary tract infection, renal calculi, 266 Uterine broid abdominal X-ray of calcication, 277f, 278f case example with abdominal X-ray, 277f, 278f, 279284 magnetic resonance imaging, 282 management, 283284 sites, 281 symptoms, 280 VACTERL, duodenal atresia, 325 Varicella pneumonia, calcication on X-ray, 180 Veil sign, 26f Ventilation/perfusion scan, see Lung ventilation/perfusion scan Vertebral body osteitis, ankylosing spondylitis, 309 Volar angulation, 355 Volar Bartons fracture, 365 Volvulus sigmoid colon volvulus, 211f, 212f, 213216 sites, 213 Wackenheims line, 366 Wall test, 308 Warfarin initial prothrombotic effects, 119 pulmonary embolism management, 119 Water skiing, pneumoperitoneum induction, 135 Weber classication, malleolus fractures, 363, 517, 686f Wegeners granulomatosis, 148 Westermarks sign, 114f Wilms tumour, 89 Wrist carpal tunnel anatomy, 422 orthopaedic X-ray assessment, 354f, 355f, 356f case examples Colles fracture, 423f, 424f, 425428 distal radius fracture, 407f, 408f, 409414, 649f, 650f, 669f, 670f, 679f, 680f scaphoid fracture, 415f, 416f triquetral fracture, 356f, 683f, 684f distal radius radiological measurements, 428 radial inclination, 355 radius fracture, 356f Smiths fracture, 365, 427428 ulna variance, 355 volar angulation, 355 X-ray, see also specic areas and structures densities, 12f dose, 192193, 523 generation, 11f hazards, 13 image production, 12 magnication of anteroposterior view, 12, 13f pregnancy, 14 regulatory legislation, 1314 requesting form, 1415 radiology team interactions, 1516
704 Index
Introduction Chest X-Rays Abdominal X-Rays Orthopaedic X-Rays CT Scans MRI Scans USS Scans Nuclear Medicine Scans Fluoroscopy Bonus Chest X-Rays Bonus Abdominal X-Rays Bonus Orthopaedic X-Rays
The Unofficial Guide to Radiology

The Unofficial Guide to Radiology follows on from the The Unofficial Guide to Passing OSCEs. This book teaches systematic analysis of the three main types of X-rays: chest, abdominal and orthopaedic, with additional chapters looking at all the other main radiology tests such as CT and MRI. The layout is designed to make the book as relevant to clinical practice as possible; the X-rays are presented in the context of a real life scenario. The reader is asked to interpret the X-ray before turning over the page to reveal a model report accompanied by a fully annotated version of the X-ray. To further enhance the clinical relevance, each case has 5 clinical and radiology-related multiple-choice questions with detailed answers. These test core knowledge for exams and working life, and illustrate how the X-ray findings will influence patient management.
This book is suitable for:

Medical Students Radiographers Nursing Students Junior Doctors Physicians Associates Nurses Advanced Nurse Practitioners
Radiology is a constant challenge for students and doctors in busy clinical units: having a good command of the essentials is a real advantage. This book is well-presented and very accessible. The annotated examples provide realistic challenges with immediate feedback. It didnt take long before I felt better prepared for my next ward round!
Simon Maxwell, Professor of Student Learning, University of Edinburgh

Perhaps one of the biggest strengths of this book is the cases section, allowing you to practice not only interpreting high quality images but also to link them to a case history. The questions that follow not only test your radiology, but also your understanding of signs, symptoms, underlying pathophysiology and management of the condition. As well as detailed answers in each section, the book also shows you the best way to present each case, whether in an OSCE situation or on a ward round. The ease of use, detailed pictures and emphasis on key points of this one should cement it as the number one undergraduate book for radiology.
James Brookes, Medical Student

Which radiographs from each system are most likely to be presented in exams? This excellent book presents the classics, and at one level this makes it a high-yield textbook that will be extremely valuable to medical students and junior doctors. What is especially striking is the definition and clarity of the illustrations, with on-image labelling enabling one to be absolutely certain of which is the endotracheal tube, the nasogastric tube and the central line, for example.
Bob Clarke, Associate Dean, Professional Development, London. Director, Ask Doctor Clarke Ltd.
ISBN: 978 0 9571499 4 6
RRP 39.99
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Bonus Orthopaedic X-Rays

Bonus Abdominal X-Rays

Orthopaedic X-Rays, plus CTs, MRIs

Radiology: Chest, Abdominal and

Bonus Chest X-Rays

The Unofficial Guide to

Nuclear Medicine Scans

THE UNOFFICIAL GuIDE tO RADIOLOgY

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Mark Rodrigues Zeshan Qureshi

MRI Scans......................................................... 543

Ultrasound Scan.............................................. 557

Chest X-Rays* .....................................................17

Abdominal X-Rays*......................................... 181

Nuclear Medicine Scans................................. 565

Orthopaedic X-Rays*....................................... 335

Bonus Cases*.................................................... 579

Case 1................. 29 Case 2................. 37

Case 6................. 69 Case hi 7................. 77 Case 8................. 85 Case 10............... 97

Case 11.............105 ............121 esha 13. ZCase Case 12.............113 hi

Case 14.............129 Case 15.............137

Case 20............. 175

Chest X-Rays - Introduction 17

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18 Chest X-Rays - Introduction

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Chest X-Rays - Introduction 21

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24 Chest X-Rays - Introduction

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