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Clinical radiology slide share

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Clinical radiology slide share

  1. 1. WHEN WHAT AND WHICH IMAGING MODALITY?? __ ACUTE INDICATION CLINICAL RADIOLOGY EMERGENCY ROOM
  2. 2. UPPER AIR WAY PROBLEMS  Inhaled Foreign Body : X-ray neck AP & LAT  Retropharyngeal Abscess: X-ray neck LAT ( look for widened pre vertebral space )  Acute Epiglottis: Clinical diagnosis
  3. 3. Emergency Foreign Body on chest PA
  4. 4. Emergency Foreign Body on chest Lateral
  5. 5. Emergency Retropharyngeal abscess
  6. 6. RESPIRATORY PROBLEMS Infection: To exclude Pneumonia _Chest PA Inhaled Foreign Body: Needs film PA View in full inspiration & expiration to see air trapping Chest Trauma: Air leak/ Hemothorax or wide Mediastinum or any rib fracture _Chest PA & or Plain CT Chest
  7. 7. Emergency Pneumonia/ consolidation
  8. 8. Emergency Chest Trauma Pneumothorax
  9. 9. Emergency Chest trauma
  10. 10. CONTD: Pneumothorax : Full inspiratory film Asthma/ Brochiolitis : If diagnosis is not clear or severe attack not responding to standard medication or focal sign +/_ fever due to mucus plug & viral infection _ Chest PA view
  11. 11. CARDIAC PROBLEMS  Cardiomyopathy or Cardiac Failure_Chest PA ( normal CT ratio 0.5 in adult, 0.6 in infant ) Cardiac murmur: To see cardiac chamber Hypertension : Chest is seldom useful
  12. 12. Emergency Cardiomyopathy
  13. 13. Emergency Pericardial effusion
  14. 14. NEONATAL CHEST_ CHEST PA VIEW Respiratory Distress : To exclude CCM or CCF Septic screen : Chest indicated unless focus else where
  15. 15. BONE PROBLEM__ AP & LAT VIEW  Trauma : X-ray of suspected fracture as well as joint above & below  Non accidental injury: If Child is more than 2yr Ask X-ray of clinically suspected injury If Child is less than 2yr Ask Skeletal survey
  16. 16. Emergency Trauma/ Fracture
  17. 17. SUSPECT NON ACCIDENTAL INJURY  If : Metaphyseal fracture Marked or unusual epiphysis Fracture Spine or Rib seperation
  18. 18. NON ACCIDENTAL INJURY Acute painful Hip: Plain X-ray AP& Frog Leg Lat For Slipped Femoral Epiphysis & Perthes Disease U/S Bone Scan may be indicated
  19. 19. NAI CONTD…..  Acute Swollen Joint  Osteomyelitis : Early X-ray _ soft tissue swelling Bone scan /MRI _ changes earlier than X-ray
  20. 20. NAI CONTD…..  Septic Arthritis: Normal X-ray or Bone scan does not exclude septic arthritis U/S for joint effusion and soft tissue swelling
  21. 21. Emergency Osteomyelitis
  22. 22. Emergency Pyogenic arthritis
  23. 23. NAI CONTD……  Metabolic disorder: X-ray of one wrist or knee enough for Ricketes  Pulled elbow : if Radial head subluxated X-ray is unnecessary
  24. 24. Emergency Ricketes
  25. 25. Emergency Ricketes
  26. 26. SPINAL PROBLEM  Trauma : Xray spine AP & LAT If neurological deficit with trauma CT or MRI  Scoliosis : Plain film of whole spine Potential Cord Compression: MRI Suspected focal vertebral pathology : MRI
  27. 27. Emergency Spinal trauma
  28. 28. Emergency Spinal cord compression
  29. 29. SKULL & INTRACRANIAL PROBLEM  Specific indication for Skull X-ray: Craniostenosis- Premature fusion of suture NO OTHER ROUTINE INDICATION
  30. 30. INDICATION FOR CT HEAD  Head trauma  Headache  Depressed consciousness level  Abnormal neurological sign  Marked change in behaviour Unexplained decrease in visual activity Enlarging head
  31. 31. CT SCAN CONTD…..  Symptoms of increased ICT: Seizure Abnormal size & shape Unexplained headache
  32. 32. Emergency Head inury
  33. 33. Emergency Head Injury
  34. 34. Emergency Head injury
  35. 35. Emergency Seizure Tuberculoma
  36. 36. Emergency Tuberculoma on MRI
  37. 37. Emergency Headache
  38. 38. INDICATION FOR CRANIAL U/S  Large Head: Hydrocephalus Cerebral Palsy Encephalomalacia Mass  Neuorological concerns in neonatal infants
  39. 39. Emergency Big Head
  40. 40. ABDOMINAL PROBLEMS  Suspected bowel obstruction/ Perforation Supine Abd. X-ray_ to see dilated bowel Erect Abdomen_ Air under Rt dome of diaphragm for perforation
  41. 41. Abdominal pain Intestinal perforation
  42. 42. Abdominal pain Small bowel obstruction on supine x-ray Abdomen
  43. 43. Abdominal pain Small bowel obstruction on x-ray
  44. 44. Abdominal pain Small bowel obstruction on CT scan
  45. 45. CONTD……  Foreign Body: Single AP view Mouth to Anus  Suspected Abdominal mass : Plain X-ray & or Ultrasound & or CT scan
  46. 46. Emergency Foreign body
  47. 47. Abdominal mass Hepatic mass
  48. 48. ABDOMINAL PROBLEMS  Don’t ask X-ray for following : vague central abdominal pain gastroenteritis chronic constipation uncomplicated appendicitis
  49. 49. ABDOMINAL PROBLEMS SPECIFIC INDICATION U/S  Suspected Intussuseption  Suspected Pyloric Stenosis  Abdominal pain_ Iliac or pelvic pain or renal tract obstruction
  50. 50. Abdominal pain Intussuseption
  51. 51. Acute abdomen Pyloric stenosis on Barium meal x-ray
  52. 52. Acute abdomen Pyloric stenosis on U/S scan
  53. 53. DR REKHA KHARE MD RADIOLOGY THANK YOU HAVE A NICE DAY

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