Emergency radiology
Dr .Raad Abdulrahman
hameed FIBMR –TUCOM
بسم هللا الرحمن الرحيم
Emergency Radiology
What to order, When
Emergency Radiology
What are the different
Radiological investigation
to order In different
Emergency situations
Emergency Radiology
Common Topics
•
CNS Emergencies
•
Face & Neck Emergencies.
•
Spinal Emergencies.
•
Chest Emergencies.
•
Cardiovascular Emergencies.
•
Abdominal Emergencies.
•
Gynecological & Obstetrical Emergencies.
•
Male Genitourinary Emergencies.
•
Pelvic Emergencies.
•
Extremities Emergencies.
•
Pediatric Emergencies
Emergency Radiology
CNS Emergencies:
Skull Fractures
Hemorrhage: (Traumatic–NonTraumatic)
• Extra-axial
• Parenchymal
Cerebral infarction.
Spinal trauma
Emergency Radiology
CNS Emergencies:
Skull Fractures:
What to order:
•
Plain X-ray of the skull (AP-lateral view)
•
Computed tomography of the Brain (Axial –
Coronal) (bone window)
When:
•
History of trauma – evident injury of the scalp
Emergency Radiology
Skull fractures (Plain X-ray)
Emergency Radiology
Skull Fractures (CT Scan)
Emergency Radiology
Skull Fractures (CT Scan)
Emergency Radiology
CNS Emergencies:
Hemorrhage: Traumatic and Non Traumatic
What to order:
Computed tomography (CT) of the Brain Plain.
When:
Head trauma – focal neurological defect.
Emergency Radiology
CNS Emergencies:
Hemorrhage: Traumatic
Findings in:
Extra Dural Blood
Sub dural Blood.
Cerebral contusion.
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
Intracerebral hematomas
Emergency Radiology
CNS Emergencies:
Hemorrhage: Non Traumatic
Findings in:
•
Subarachnoid Blood
•
Intraparenchymal Blood.
•
Intraventricular Blood
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
CNS Emergencies:
Cerebral Infarction:
What to order:
•
Computed tomography (CT) of the Brain
•
Magnetic Resonance Imaging (MRI) : DWI
When:
Focal neurological defect - Stroke
acute left side crebral infarction
Emergency Radiology
Acute right side cerebral
infarction
Emergency Radiology
Emergency Radiology
Facial Emergencies:
What to order?
Plain X-ray of the Skull (Lateral view – PA view)
Computed Tomography of the facial bones
Bone window–Axial & coronal–3D recon.)
When?
History of trauma to the face –
disfigurement – Severe facial contusions
Emergency Radiology
Fracture of left mandibular ramus
Emergency Radiology
Nasal bone fracture
Fracture right side orbital roof
Fracture right maxilla
Emergency Radiology
Emergency Radiology
Emergency Radiology
Orbital Injuries:
What to order?
•
Plain X-ray of the Skull (Lateral view – PA view)
•
Computed Tomography of the Orbit (Axial
Coronal - Bone & Soft tissue settings)
When?
History of trauma to the orbit –
History of FB to the eye
Coronal CT scan bone window ,fracture
floor of right orbit
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
Spinal Emergencies:
Trauma
•
Vertebral fracture (Varieties)
•
Spinal cord injuries.
Emergency Radiology
Spinal trauma:
What to order?
•
Plain X-ray of the spine (Lateral view – AP
view)
•
Computed Tomography of the Spine
(Bone & Soft tissue settings–3D recon.)
•
MRI of the spine. (for cord injury)
When?
•
History of trauma – Falling from height.
Odontoid fracture
Odontoid fracture
Anterior islocation of C5-6
vertebra
Traumatic spondylolisthesis of
C4-5
Emergency Radiology
Spinal cord injury .MRI
cervicaodorsal T2
MRI sagittal T2 .spinal cord
injury
Emergency Radiology
Chest Emergencies:
Chest Trauma
•
Rib fractures – Traumatic Hemothorax –
pneumothorax – pneumomediastinum –
pulmonary contusion, laceration &
hematoma – Esophageal injury –
diaphragmatic injury – etc.
•
Airway Foreign Body.
Emergency Radiology
Chest Emergencies:
What to order?
•
Plain X-ray of the Chest (PA view – Lateral
view)
•
Computed Tomography of the Chest
•
Angiography (Aortography)
When?
History of trauma – Difficulty of breathing.
Chest trauma ,contusion right ling
,rib fracture ,surgical emphysema
Emergency Radiology
Pneumothorax
Emergency Radiology
Emergency Radiology
Tension
pneumothorax
pneumothorax
pneumothorax
Emergency Radiology
hydropneumothorax
Emergency Radiology
Emergency Radiology
pneuomediastinum
Emergency Radiology
pneumomediastinum
Emergency Radiology
Chest Emergencies:
FB of the Airway:
What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Computed Tomography of the Chest
When?
Children – difficulty in breathing – Unconscious
patient
Hyperinflation rt lung
Emergency Radiology
Emergency Radiology
Cardiovascular Emergencies:
•
CHF
•
Pericardial effusion
•
Aortic dissection, trauma.
•
Pulmonary Edema
•
Pulmonary Embolism.
•
Peripheral ischemia (acute)
•
DVT.
Emergency Radiology
Cardiovascular Emergencies:
CHF:
What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Echocardiography
When?
Dyspnea – signs of low cardiac output
HF
HF radiological findings?
Emergency Radiology
Cardiovascular Emergencies:
Aortic dissection:
PULMONARY EMBOLISM
What to order?
•
Plain X-ray of the Chest (PA view–Lat. view)
•
CT scan with contrast.
•
MRI
•
Aortography
When?
Sudden severe tearing substernal chest pain
Dissecting aortic aneurism
DISSECTING AORTIC ANEURISM
Emergency Radiology
Emergency Radiology
Pulmonary embolism
Emergency Radiology
Cardiovascular Emergencies:
Acute peripheral ischemia:
What to order?
•
Arteriography
•
Color doppler Ultrasound
When?
Sudden onset of severe pain, coldness,
numbness or pallor in a portion of an extremity
.
Emergency Radiology
Emergency Radiology
Emergency Radiology
Cardiovascular Emergencies:
DVT (Deep Vein Thrombosis):
What to order?
•
Color Doppler Ultrasound.
•
Venography
When?
Asymptomatic –
pain – edema – skin
discoloration
.
DVT Thrombus
Emergency Radiology
Emergency Radiology
Emergency Radiology
Abdominal Emergencies:
Abdominal Trauma
•
Hemoperitonium
•
Visceral injuries (Liver, Spleen, Kidney, UB,
etc.)
Non-Traumatic emergencies.
•
Intestinal obstruction, Appendicitis, GUT
perforation,
•
Ascites, Jaundice, peritonitis, GI bleeding
Emergency Radiology
Abdominal Emergencies:
Abdominal trauma:
What to order?
•
Chest & Abdominal radiographs.
•
Ultrasound (FAST)
•
CT scan
•
Arteriorgraphy.
When?
History of trauma to the abdomen – Motor
vehicle accidents
Emergency Radiology
Emergency Radiology
Liver injury
Emergency Radiology
Spleen injury
Spleenic laceration
Pancreas laceration
(fracture pancreas)
Fragmented kidney and perinephric
hematoma
Perinephric hematoma
Emergency Radiology
Emergency Radiology
Abdominal Emergencies:
Intestinal Obstruction
What to order?
Abdominal radiograph.
CT scan
When?
Crampy abdominal pain – nausea &
vomiting – abdominal tenderness
.
Small bowel obstruction
Small bowel obstruction
Emergency Radiology
Emergency Radiology
Large bowel obstruction.ca colon
Emergency Radiology
Emergency Radiology
Abdominal Emergencies:
Gut Perforation (e.g. Perforated DU)
What to order?
Abdominal radiograph (Erect).
US
CT scan
When?
History of peptic ulceration – signs of
peritonitis
Air under diaphragm
pneumoperitoneum
Emergency Radiology
Emergency Radiology
Emergency Radiology
Pneumoperitoneum
Emergency Radiology
Abdominal Emergencies:
Jaundice
What to order?
Ultrasound
CT scan
PTHC
ERCP
When?
Yellowish discoloration of the skin – dark urine –
pale stools
ERCP
CBD stones ,IHBD
Emergency Radiology
MRCP STONE
Emergency Radiology
PANCRATITIS
Emergency Radiology
Abdominal Emergencies:
Appendicitis
What to order?
Abdominal radiograph.
Ultrasound
CT scan
When?
Sudden onset of RIQ pain – rebound tenderness.
APPENDICITIS ,
Appendecolith
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
appendicitis
Emergency Radiology
Emergency Radiology
Abdominal Emergencies:
Cholecystitis
What to order?
Ultrasound (Gold standard)
When?
Sudden onset of epigastric pain – rebound
tenderness
Calculus cholycystitis
Cholycystitis
Emergency Radiology
Emergency Radiology
Emergency Radiology
Genitourinary Emergencies:
•
UT stones
•
Hematuria
•
Urinary tract trauma.
•
Urethral Injuries, stones (male)
•
Scrotal injuries, swellings, testicular
torsion, epididymitis (male)
Emergency Radiology
Genitourinary Emergencies:
Ureteric Stones (Renal Colic):
What to order?
•
Plain X-ray of the urinary tract (PUT)
•
Ultrasound
•
Intravenous Urography (IVU)
•
CT of the abdomen
When?
Sudden onset of loin pain radiating to the
groin.
Ureteric stone
Emergency Radiology
Ureteric stone
Ureteric stone
Lt ureteric stone
Emergency Radiology
Emergency Radiology
Emergency Radiology
Genitourinary Emergencies:
Hematuria (Painful-Painless):
What to order?
•
Plain X-ray of the urinary tract (PUT).
•
Ultrasound.
•
Intravenous Urography (IVU).
•
CT of the abdomen.
•
Cystogram.
When?
Passage of blood or blood clots with urination
(either painful or painless).
Renal cell carcinoma
RCC
CA BLADDER
Ca bladder
Emergency Radiology
Clot urinary bladder versus ca?
Ca bladder ?clot?
Emergency Radiology
Genitourinary Emergencies:
Urinary tract trauma (Renal Bladder male urethra):
What to order?
•
Plain X-ray of the urinary tract (PUT)
•
Ultrasound
•
Intravenous Urography (IVU)
•
CT of the abdomen
•
Ascending urethrocystography
When?
History of blunt trauma to the abdomen – Falling
astride.
Urinary bladder injury
Emergency Radiology
Emergency Radiology
Urethral injury
Emergency Radiology
Genitourinary Emergencies:
Scrotal emergencies:
What to order?
•
Ultrasound with color Doppler.
When?
Acute scrotal pain – trauma to testis
.
Testicular tortion
Emergency Radiology
Testicular tortion
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
Epidedymitis
Emergency Radiology
Gyncological & Obstetric Emergencies:
•
Ovarian Torsion
•
PID
•
Abortion
•
Ectopic pregnancy
•
Placenta Previa
Emergency Radiology
Gyncological & Obstetric Emergencies:
What to order?
Ultrasound (Color Doppler)
When?
Lower abdominal pain – fever – vaginal
discharge
Emergency Radiology
Ovarian tortion
Emergency Radiology
Emergency Radiology
Emergency Radiology
Obstetric Emergencies:
What to order?
Ultrasound (Color Doppler)
When?
Bleeding in early / late pregnancy
Emergency Radiology
Emergency Radiology
Emergency Radiology
Emergency Radiology
Blighted ovum
Emergency Radiology
Blighted ovum
Emergency Radiology
Placenta previa
Emergency Radiology
Emergency Radiology
Emergency Radiology
Muscloskeletal Emergencies:
•
Upper & lower extremities Fractures &
dislocations
•
Pelvic Fractures.
•
Joint injuries
•
Ligaments and tendons injuries
.
Emergency Radiology
Muscloskeletal Emergencies:
What to order?
•
Plain X-ray.
•
CT scan.
•
MRI
When?
History of trauma
.
Fracture left humerus
Emergency radiology
Emergency Radiology
Emergency Radiology
Coles fracture
Scaphoid fracture
Pelvis fracture
Emergency Radiology
Emergency Radiology
Emergency Radiology
Shoulder dislocation
Emergency Radiology
Pediatric Emergencies:
•
Neonatal emergencies (intestinal obstruction,
Intussception.)
•
Foreign body aspiration.
•
Bone injuries.
intusseption
Emergency Radiology
Emergency Radiology
Emergency Radiology
Intusseption us
Emergency Radiology
UNFORTUNATELY
most of doctors
don’t write proper history.
Please provide us with proper history to
get proper diagnosis.
In important cases, please don’t
hesitate to come to radiology
department and discuss the case with
the radiologist.
According to ACR regulation assessment
of renal function by doing creatinine
level before administration of CM is
crucial, however many center depend
on GFR.
Still there is conflict about the
save
creatinine level.
CIN :
Unfortunately CM has toxic effect on the
kidney.
With the use of new CM adverse effect
become less but still we face significant
morbidity.
According to ACR regulation CM should
be use consciously in patient with
impaired renal function.
In case of allergy like asthmatic patient,
the patient should be prepared with
prednisolone tab.
Unfortunately there is no effective way
to prevent severe allergic reaction (
anaphylactic shock ) but fortunately this
severe reaction is very rare nowaday
especially with the new generation of
CM.
THE END