radiology « UCSF Students

* Chest radiography
o The upright chest radiograph is the ideal primary diagnostic study in the evaluation of hemothorax.
o In the normal unscarred pleural space, a hemothorax is noted as a meniscus of fluid blunting the costophrenic angle or diaphragmatic surface and tracking up the pleural margins of the chest wall when viewed on the upright chest x-ray film. This is essentially the same chest radiographic appearance found with any pleural effusion.
o In cases in which pleural scarring or symphysis is present, the collection may not be free to occupy the most dependent position within the thorax, but will fill whatever free pleural space is available. This situation may not create the classic appearance of a fluid layer on a chest x-ray film.
o As much as 400-500 mL of blood is required to obliterate the costophrenic angle as seen on an upright chest radiograph.
o In the acute trauma setting, the portable supine chest radiograph may be the first and only view available from which to make definitive decisions regarding therapy. The presence and size of a hemothorax is much more difficult to evaluate on supine films. As much as 1000 mL of blood may be missed when viewing a portable supine chest x-ray film. Only a general haziness of the affected hemithorax may be noted.
o In blunt trauma cases, hemothorax is frequently associated with other chest injuries visible on the chest radiograph, such as rib fractures, pneumothorax, or a widening of the superior mediastinum.
o Additional studies such as ultrasonography or CT scan may sometimes be required for identification and quantification of a hemothorax noted on a plain chest radiograph.
* Ultrasonography
o Trauma ultrasonography is used at some trauma centers in the initial evaluation of patients for hemothorax.
o One drawback of ultrasonography for the identification of traumatic hemothorax is that associated injuries readily seen on chest radiographs in the trauma patient, such as bony injuries, widened mediastinum, and pneumothorax, are not readily identifiable on chest ultrasonograph images.
o Ultrasonography more likely plays a complementary role in specific cases in which the chest x-ray findings of hemothorax are equivocal.
* CT scan
o CT scan is a highly accurate diagnostic study for pleural fluid or blood.
o In the trauma setting, it does not hold a primary role in the diagnosis of hemothorax but is complementary to chest radiography. Because many victims of blunt trauma do undergo a chest and/or abdominal CT scan evaluation, hemothorax not considered based on initial chest radiographs might be identified and treated.
o Presently, CT scan is of greatest value later in the course of the chest trauma patient for localization and quantification of any retained collections of clot within the pleural space. (6)

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Pneumothorax on Wikiradiography

Filed under: Chest CT scan, Chest Tube Insertion, Pneumothorax, chest x-ray — Tags: Pneumothorax on Wikiradiography — admin @ 12:31 pm

Pneumothorax on Wikiradiography

http://www.wikiradiography.com/page/Pneumothoraces

- introduction
- causes of pneumothorax
- pneumothorax
- chest x-ray
- inspiration vs expiration films
- erect vs supine films
- signs of supine pneumothorax
- positioning of a chest tube
- “If the drain is intended to drain pleural fluid, the drain holes should be positioned posteriorly within the pleural space. If the intercostal darin is inserted to re-expand a lung in a patient with pneumothorax, the drain should be anterior”
- chest tube x-ray
- lateral chest x-ray
- loculated pneumothorax
- CT scan of loculated pneumothorax
- false pneumothorax from skin folds
- pneumothorax vs bullae
- iatrogenic pneumothorax
- apical lordotic view
-

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Pneumothorax Chest X-ray

Filed under: Pneumothorax, chest x-ray — Tags: Pneumothorax Chest X-ray — admin @ 9:33 am

Pneumothorax Chest X-ray

First, log on to the ucsf radiology learning module. Then click on the link below.

PNEUMOTHORAX

http://www.radiology2.ucsf.edu/academics/learning_ctr/syllabus/12/fig_html/10_18.html

TOPICS:
IMAGE 10.18 – This chest x-ray was obtained after a patient in a motor-vehicle accident experienced severe sudden chest pain. He has developed a pneumothorax on the left side. You can clearly see the margin of the collapsed lung. The sharp line represents the visceral pleural surface of the lung (arrows). No vessels are seen extending beyond this level.

TENSION PNEUMOTHORAX

http://www.radiology2.ucsf.edu/academics/learning_ctr/syllabus/12/fig_html/10_12.html

TOPICS
IMAGE 10.12 – Tension Pneumothorax A pneumothorax is present here, with air between the chest wall and the visceral pleural surface (arrows) of the partially collapsed right lung. This air is under considerable tension and it expands the right hemithorax (compared to the left) and pushes the heart and mediastinum to the left. Also, the right hemidiaphragm is depressed and the right intercostal spaces are wider than on the left.

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Angiograms of the Abdomen

Filed under: Abdominal Aorta, Aorta Angiogram, Celiac Trunk, Inferior Mesenteric Artery, Superior Mesenteric Artery, Umbilical Plane — Tags: Angiograms of the Abdomen — admin @ 5:12 am

Angiograms of the Abdomen

http://info.med.yale.edu/surgery/anatomy/radiology/abdominal_angiogram_content.php

SLIDE 1
Angiograms of the abdomen
- is a composite of angiograms taken from different patients.
- The position of the transumbilical plane is approximated by the red line.
- The three images on the right are standard x-ray films with reverse contrast (a positive was made from the x-ray negative)
- The image on the left was reconstructed from a CT study
- The individual images with labels can be viewed on the following pages

- celiac trunk
- superior mesenteric artery
- inferior mesenteric artery
- abdominal aorta with branches of the celiac trunk deleted

SLIDE 2
SUMMARY
1. The celiac and SMA originate close to each other, which the IMA originated more distally close to the transumbilical plane
2. Note the gross differences in the distribution of the vessels
3. The celiac branches are superior and on both sides of the midline
4. The SMA branches are widely distributed, through heavily in the upper left quadrant
5. The IMA branches are entirely on the left
6. In your further studies you should be able to identify what organs the major branches are supplying and where the vessels are located (i.e. in mesenteries or retroperitoneal)

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Diverticulitis on CT scan

Filed under: Colon CT Scan, Diverticulitis, Mesenteries Mesentery, Sigmoid Colon, Stranding — Tags: Diverticulitis on CT scan — admin @ 4:55 am

Diverticulitis on CT scan

http://info.med.yale.edu/surgery/anatomy/radiology/diverticulitis_content.php

SLIDE 1
Goals
To examine how diverticulitis affects the:
1. Wall of the colon
2. Lumen of the colon
3. Fat in the mesentery of the colon

SLIDE
Normal and diseases sigmoid colon are shown for comparison. The sigmoid colon is filled with contrast.
Compare:
- In the sigmoid colon: width of the colon, width of the lumen
- In the neighboring fat: stranding due to inflammatory response, normal fat

SLIDE 2
SUMMARY
1. Inflammation causes a thickening of the colon wall that narrows the lumen
2. Stranding is the radiographic appearance of an inflammatory response by the fat in the mesentery

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March 26, 2010

Abdomen and pelvis X-ray part 2

Filed under: Acetabulum, Femur, KUB, Obturator Foramen, Pelvis Anatomy, Sacroiliac Joint — Tags: Abdomen and pelvis X-ray part 2 — admin @ 6:15 pm

Abdomen and pelvis X-ray part 2

http://info.med.yale.edu/surgery/anatomy/radiology/plain_pelvis_2_content.php

TOPICS
SLIDE 1
Goals
- Be able to identify the major bony landmarks on a plain film of the pelvis

SLIDE 2
- T12 (it’s the inferior-most vertebra with a rib)
- L4 (Draw a line across the iliac cress, or count down from T12)
- Umbilicus (roughly at the L3/L4 junction)
- Pubic symphysis (first bony landmark superior to the genitalia)

SLIDE 3
- sacroiliac joint
- neck of the femur
- head of the femur
- greater trochanter
- lesser trochanter
- acetabulum
- obturator foramen
- head of femur & acetabulum
- pelvic brim (pelvic inlet)
- ischial tuberocities

SLIDE 4
SUMMARY
- You should be familiar with the bony landmarks and start to become aware of the major soft structures that lie close to them

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CT reconstruction of the kidneys and renal arteries and 3-D reconstruction of kidneys and SMA vasculature

Filed under: 12th Rib, Abdominal Aorta, Aorta, CT Reconstruction and 3-D reconstruction, Inferior Mesenteric Artery, Inferior Vena Cava, Kidney Anatomy, Lumbar Segmental Arteries, Renal Arteries, Renal Vein, Subcostal Plane, Superior Mesenteric Artery, Transpyloric Plane, Ureters — Tags: CT reconstruction of the kidneys and renal arteries and 3-D reconstruction of kidneys and SMA vasculature — admin @ 1:41 pm

CT reconstruction of the kidneys and renal arteries and 3-D reconstruction of kidneys and SMA vasculature

http://info.med.yale.edu/surgery/anatomy/radiology/CT_kidney_content.php

TOPICS

SLIDE 1
Goals
1. Be able to identify the renal vessels, aorta and ureters as these structures are rotated in 3-D
2. Be able to explain the relative position of important nearby structures that are not shown such as the 12th rib and IVC

SLIDE 2
- CT reconstruction of the kidneys and renal arteries
- Rib 12 is colored blue, the abdominal aorta is pink and the renal arteries are red
- Transpyloric plane
- Subcostal plane

SLIDE 3
[...]

SLIDE 4
3-D reconstruction of kidneys and SMA vasculature
- aorta
- left renal artery
- left renal vein
- right renal artery
- left ureter
(and questions)
- right ureter
- SMA (superior mesenteric artery)
- IMA (inferior mesenteric artery)

SLIDE 5
- lumbar segmental arteries
(question)

SUMMARY
1. The renal vessels are at the subcostal plane
2. The left renal artery is posterior to the left renal vein
3. The kidneys are posterior to the aorta and IVC, so the vessels course posteriorly from the midline to reach their targets

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Pancoast Tumor Chest X-ray and Chest CT

Filed under: Chest CT scan, Pancoast Tumors, chest x-ray — Tags: Pancost Tumor Chest X-ray and Chest CT — admin @ 9:58 am

Pancoast Tumor Chest X-ray and Chest CT

http://info.med.yale.edu/surgery/anatomy/radiology/pancoast_tumor_content.php

SLIDE 1
Goals
- Locate a tumor by applying the surface anatomy (that you’ve learned)
- Use CT to investigate a radio-opacity (high attenuation signal) that appears on the:
- anterior chest wall
- posterior chest wall and lung
- Relate the tumor and normal anatomical features to the sympathetic chain
- learn relations in the hilum of the lung

SLIDE 2
- Pancoast tumor in cross section
- [...]
Question 1
- arch of the aorta (aortic knob)
- border of right atrium
- border of left ventricle
- 2nd rib (angle of louis)
- clavicle (sternal notch)
- hilum of left lung

Question 2a
[...]
- chamberlain procedure (medial thorocostomy)
- 3rd rib
- arch of the aorta (aortic knob)
- trachea
- hilum
- heart
- angle of louis

Question 2b
- Using bilateral symmetry, try to find two radio-opacities (regions that are whiter than the mirror image region on the opposite side of the midline). DO NOT INCLUDE THE HEART.
[...]
-

SLIDE 3
- Pancoast tumor in cross section
[...]

LOTS MORE QUESTIONS AND EXERCISES!

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Widening of the Superior Mediastinum on Chest X-ray

Filed under: Mediastinum, chest x-ray — admin @ 8:37 am

Widening of the Superior Mediastinum on Chest X-ray

http://info.med.yale.edu/surgery/anatomy/radiology/mediastinum_1_content.php

Yale school of medicine

SLIDE 1
- aorta
- mediastinum
[...]

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Barium Swallow

Filed under: Barium Swallow — admin @ 8:26 am

Barium Swallow

http://info.med.yale.edu/surgery/anatomy/radiology/barium_swallow_1_content.php

SLIDE 1
Goals
1. To understand how barium and air can be used as contrast agents in the upper GI tract
2. Identify normal anatomic impressions on the esophagus and relationship to chambers of the heart to the surface anatomy of the thorax
3. Relate the surface anatomy such as the angle of Louis and various vertebrae and how they relate to the position of the esophagus and the GI junction
4. Understand which portions of the stomach (fundus, body, antrum) and duodenum will pool barium in prone, supine and upright positions
5. Appreciate the different fold patters of the stomach, duodenum, and jejunum

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Barium Swallow vs Upper GI Series

Filed under: Barium Swallow, Upper GI Series — Tags: Barium Swallow vs Upper GI Series — admin @ 8:21 am

Barium Swallow vs Upper GI Series

What is Upper Gastrointestinal (GI) Tract Radiography?
Also called an upper gastrointestinal (GI) series or simply an upper GI, upper gastrointestinal tract radiography is an x-ray examination of the esophagus, stomach and first part of the small intestine. However, in order for the anatomy to show up on radiographic images, the upper gastrointestinal tract must be coated or filled with a contrast material called barium, an element that appears bright white on radiographs. The barium is given to the patient to drink. This procedure is called upper gastrointestinal tract radiography when the esophagus, stomach, and duodenum are evaluated, or a barium swallow when only the pharynx and esophagus are evaluated. Additionally, some patients are asked to swallow baking-soda crystals to create gas and further improve the images; this procedure has the modified name of air-contrast or double-contrast upper GI.

source: http://www.fmh.org/body.cfm?id=181

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Pulmonary arteries and veins

Filed under: Pulmonary Artery, Pulmonary Trunk, Pulmonary Veins, chest x-ray — admin @ 6:06 am

Pulmonary arteries and veins

http://info.med.yale.edu/surgery/anatomy/radiology/pulmonary_arteries_content.php

TOPICS
GOALS
1. To understand the spacial relationships of structures that enter and exit the hilum of the lung
2. To relate structures of the hilum of the sternal angle of Louis and other bony landmarks
3. To relate structures of the hilum to the chambers of the heart and the aorta
4. To trace flow of blood in the pulmonary circulation
5. To relate the lungs to the clavicle and diaphragm

SLIDE 1
- Left pulmonary artery: AP view

Section 1
- Locate regions of the cathether
- inferior vena cava (IVC)
- right atrium
- right ventricle
- pulmonary trunk
- Relate the tip of the catheter to the:
- clavicle
- second rib
- sternal angle of louis
[...]
- pulmonary valve
Section 2
[...]
- bifurcation of the trachea
- clavicle (inferred from the first image)
- dome of the diaphragm
Section 3
- [...]
Section 4
- [...]
Section 5
- [...]
- Relate the angle of louis (catheter tip) to:
- pulmonary artery (contains catheter tip)
- arch of aorta
- pulmonary veins
- left atrium

SLIDE 2
- [...]
- Locate regions of the catheter
- inferior vena cava
- right atrium
- right ventricle
- pulmonary trunk

SLIDE 3
- Right pulmonary artery: AP view

Section 1
- Locate regions of the catheter
- inferior vena cava (IVC)
- right atrium
- right ventricle
- pulmonary trunk
- right pulmonary trunk
- right pulmonary artery

- Relate the tip of the catheter to the:
- clavicle
- second rib
- sternal angle of louis
- bifurcation of the trachea
[...]
- aortic valve

Section 2
[...]
- bifurcation of the trachea
- clavicle
- dome of the diaphragm

Section 3
- [...]

Section 4
- [...]
- Relate the angle of louis (catheter tip) to:
- pulmonary artery (contains catheter tip)
- arch of aorta
- pulmonary veins
- left atrium

SLIDE 4
- Right pulmonary artery: right
- [...]

Section 1
- Locate regions of the catheter:
- inferior vena cava (IVC)
- right atrium
- right ventricle
- pulmonary trunk
- right pulmonary artery

Section 2-5
- [...]
- Relate the angle of louis (catheter tip) to:
- pulmonary artery (contains catheter tip)
- arch of aorta
- left atrium
- ascending aorta
- descending aorta

SUMMARY
1. The pulmonary arteries and mainstem bronchi are located superiorly in the hilum; the pulmonary veins are inferior, to enter the left atrium of the heart
2. The pulmonary arteries and mainstem bronchi are in the plane of the sternal angle of Louis inferior to the arch of the aorta (which in turn is inferior to the clavicular heads).

The pulmonary veins and left atrium are closer to the 3rd costocartilage eand intercostal space.

3. The pulmonary veins enter the posterior-most chamber of the heart (left atrium); the right pulmonary artery travels just inferior to the arch of the aorta (and anterior to the right mainstem bronchus)

4. The path of the catheter marked the flow of blood through the right side of the heart to the pulmonary trunk. Deoxygenated blood traveled via the pulmonary arteries to the lungs; oxygenated blood returned via the veins to the left atrium, then to the left ventricle and aorta

5. The lungs extend superior to the clavicle and inferior to the dome of the diaphragm

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Shoulder Angiogram Part 2

Filed under: Shoulder Angiogram — admin @ 4:10 am

Shoulder Angiogram Part 2

http://info.med.yale.edu/surgery/anatomy/radiology/shoulder_angiogram_1_content.php

TOPICS
SLIDE 1
- Related the subclavian and axillary artery to bony landmarks
- Identify branches of he subclavian artery
- Identify branches of hte axillary artery

Slide 2
[...]
Question 1 [...]
Question 2 [...]
- vertebral artery
- internal thoracic artery
Question 3 [...]
Question 4
- 1st rib
- 2nd rib
- internal thoracic artery
- vertebral artery
- suprascapular artery
- thoracoacromial arteries (very faint)
- lateral thoracic artery (very fain)
- anterior/posterior circumflex arteries

SUMMARY [...]

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Shoulder Angiogram Part 1

Filed under: Shoulder Angiogram, chest x-ray — Tags: Shoulder Angiogram — admin @ 4:00 am

Shoulder Angiogram

http://info.med.yale.edu/surgery/anatomy/radiology/shoulder_angiogram_1_content.php

TERMS
SLIDE 1
- clavicular heads
- vertebral bodies
- spinous processes
- trachea
- tip of the catheter
- subclavian artery
- axillary artery
- vertebral artery
- Branches of thyrocervical trunk
– ascending cervical artery
– suprascapular artery
Question 1
- Oblique view
- The heads of the clavicles are not centered over vertebral bodies
- The spinous processes of the vertebra are not centered on the vertebral body
- the trachea does not overlay the vertebral body
- the ribs are not symmetrical
Question 2
- assuming this is an anterior view, is the patient turned with his left side toward you or his right side toward you?
- the patient’s left side is toward you because anterior structures are to the viewers left of the vertebral column: clavicular heads, trachea; the left clavicle crosses the vertebral bodies
Question 3
- where is the tip of the catheter? why?
- [....]
- by contrast the early branches of the subclavian are evident:
– vertebral (important!)
– thyrocervical trunk branches
– ascending cervical
– suprascapular (important!)

Question 4
- where does the axillary artery begin?
- where the subclavian artery crosses the first rib
- note that the subclavian artery arches over the apex of the lung

SUMMARY
[...]

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March 25, 2010

Angiogram of the arch of the aorta

Filed under: Aorta Angiogram, chest x-ray — admin @ 9:04 pm

Angiogram of the arch of the aorta

http://info.med.yale.edu/surgery/anatomy/radiology/aortic_arch_2_content.php

TOPICS
SLIDE
- domes of the diaphragm
- spinous processes
- trachea
- heads of the clavicles
- vertebral body
- right common carotid
- right subclavian
- brachiocephalic and its branches
Question 1
- oblique view
Question 2
Question 3
Question 4
- the brachiocephalic and its branches
- the right common carotid
- right subclavian

SUMMARY
- In a right oblique view your line of sight is in the direction of the arch of the aorta. Consequently, the ascending aorta overlaps the descending aorta.
- The advantage of this view is the right common carotid artery no longer overlaps the right subclavian artery, which allows these branches of the brachiocephalic to be examined independently.
- The branches of the arch would be most spread out in the opposite oblique view (perpendicular to the arch)

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Angiogram of aortic arch

Filed under: Aorta Angiogram, chest x-ray — admin @ 3:04 pm

Angiogram of aortic arch

http://info.med.yale.edu/surgery/anatomy/radiology/aortic_arch_1_content.php

TOPICS
- brachiocephalic artery
- left common carotid artery
- left subclavian artery
- clavicular heads and spinous processes

Questions 1
- spinous process of the vertebrae
- clavicles
- ribs
- trachea
- vertebral column
- primary bronchi
- diaphragm
Question 2
- tip of the catheter
- sternal angle (angle of louis)
- bifurcation of the trachea
- aortic valve
Question 3
- brachiocephalic artery
- left common carotid artery
- left subclavian arteries

SUMMARY
- Blood flow through the aorta crosses the vertebral column from right to left. The arch of the aorta gives rise to large vessels to the head and upper limbs
- these are hard to distinguish on an AP view, because the aorta also travels from anterior to posterior. In an oblique view, overlap of these vessels would be minimized
- In an AP view:
– The spines of the vertebra should be in the midline of the vertebral bodies centered between the clavicular heads
– The trachea should overlie the vertebral bodies

- The arch of the aorta lies behind the manubrium, below the jugular notch. Look for the second rib to infer the position of the sternal angle of Louis. Confirm that the aorta lies superior to the sternal angle and the bifurcation of the trachea.

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Chest X-ray surface anatomy PA film

Filed under: 2nd Rib, 5th Intercostal Space, Aorta, Clavicle, Diaphragm, Heart Anatomy, Jugular Notch, Mediastinum, Sternal Angle, Xiphisternal Junction, chest x-ray — Tags: chest x-ray, Chest X-ray surface anatomy PA film — admin @ 2:15 pm

Chest X-ray surface anatomy PA film

http://info.med.yale.edu/surgery/anatomy/radiology/chest_xray_surface_anat_content.php

Yale school of medicine

CONTENTS

SLIDE 1
- jugular notch (follow the clavicles to the midline)
- sternal angle (angle of louis) (follow 2nd rib to the midline)
- xiphisternal junction (middle of a line that connects the 5th intercostal spaces at the midclavicular line)

SLIDE 2
- right done of diaphragm (the right dome is normally higher because of the liver)
- left dome of diaphragm
- mediastinum
- right border of heart (right atrium)
- left border of heart (left ventricle)
- ascending aorta
- arch of aorta
- descending aorta

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Heart Valves In Situ

Filed under: Aortic Valve, Heart Valves, Jugular Notch, Mitral Valve, Pericardial Sac, Pulmonic Valve, Sternal Angle, Sternum, T2 Vertebra, T5 Vertebra, Tricuspid Valve, Xiphisternal Junction, Xiphoid Process, chest x-ray — admin @ 10:01 am

Heart Valves In Situ

http://info.med.yale.edu/surgery/anatomy/graphics/heart_valves_insitu.htm

TERMS MENTIONED
- chest x-ray
- heart valves
- sternum
- sternal notch / jugular notch, T2 vertebra
- sternal angle / angle of louis , T5 vertebra
- pulmonic valve
- aortic valve
- mitral valve (bicupid valve)
- xiphisternal junction , T10 vertebra
- xiphoid process
- pericardial sac

- tricuspid valve

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CT scan introduction learning module

Filed under: CT Scan, Learning Modules — admin @ 9:26 am

CT scan introduction learning module

http://info.med.yale.edu/surgery/anatomy/webactivities/the_matrix_content.php

Yale School of Medicine

TOPICS
- The CT scan matrix
- How a CT scan is generated
- How it is different from a traditional x-ray
- three dimensional representation on CT scan
- How contrast is altered on CT

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Chest X-ray introduction learning module

Filed under: Learning Modules, chest x-ray — admin @ 9:14 am

Chest X-ray introduction module

http://info.med.yale.edu/surgery/anatomy/webactivities/x_ray_explained_content.php

Yale School of Medicine

The goals of this exercise are to
1. Begin to develop an understanding of the role that the shape of structure plays in the absorption of X-rays that pass through its various parts
2. Appreciate that a radiograph can discriminate among only four levels of tissue density
3. Begin to understand the importance of contrast in identifying the boundaries between tissues

SUMMARY
- A radiograph can discriminate four densities: air, fat, water and bone. Most soft tissues including muscle have the density of water
- These properties have implications for visualizing the boundaries of organs
- For example, if the lungs (mostly air) are normal, the boundary of the heart will be clear
- However, if a lung is filled with fluid (water), the boundary of the heart will be lost, since muscle has the same radiographic density as water

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Chest X-ray surface landmarks

Filed under: 1st Rib, 2nd Rib, 3rd Intercostal Space, 5th Intercostal Space, Clavicle, Great Vessels, Heart Anatomy, Jugular Notch, L1 Vertebra, Manubrium, Mediastinum, Renal Arteries, Sternal Angle, Sternum, Subcostal Plane, T10 Vertebra, T3 Vertebra, T5 Vertebra, T9 vertebra, Transpyloric Plane, Xiphisternal Junction, chest x-ray — Tags: Chest X-ray surface landmarks — admin @ 7:35 am

Chest X-ray surface landmarks

http://info.med.yale.edu/surgery/anatomy/radiology/surface_landmarks_content.php

Yale school of medicine

Topics covered
SLIDE 1
- introduction
- chest x-ray
- sternum
- mediastinum
- heart
SLIDE 2
- directions
SLIDE 3
- sternal notch (jugular notch); T3 vertebral level
- 1st rib
- 2nd rib
- sternal angle (angle of louis); T5 vertebral level
- sternum and 3rd intercostal space; great vessels enter and leave the heart
- xiphisternal junction ; T9 vertebral/T10 vertebral level
- 5th intercostal space (region of apex of heart)
- transpyloric plane (L1 vertebral level)
- subcostal plane (renal arteries)

Summary
- The two most important ribs are ribs 1 and 2.
- On palpation, you can palpate the sternal angle of louis to locate rib 2 and count ribs to locate other structures

- on x-ray, you can locate rib 1 articulating with the manubrium right next to the clavicle, and count ribs to locate other structures

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March 24, 2010

ETT placement x-ray

Filed under: chest x-ray — Tags: ETT placement x-ray — admin @ 6:41 pm

ETT placement x-ray

CXR Interp. ETT placement

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Chest X-ray Interpretation video

Filed under: chest x-ray — Tags: Chest x-ray interpretation video — admin @ 6:16 pm

Chest X-ray Interpretation video

CXR – How to read the chest x ray – Part I: Concepts and Quality

Terms: coming soon….

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Chest x-ray interpretation video

Filed under: chest x-ray — Tags: Chest x-ray interpretation video — admin @ 3:02 pm

Chest x-ray interpretation video

5 Steps to Chest X-ray Interpretation

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Chest X-ray Interpretation Videos

Filed under: chest x-ray — Tags: chest x-ray — admin @ 2:46 pm

Chest X-ray Interpretation

Chest x-ray interpretation

Terms:
- normal chest x-ray, blood vessels passing through lung parenchyma and branching off, branch of the pulmonary artery, trachea, right main bronchus, left main bronchus, carina
- right and left heart borders, right and left hemidiaphragms, mediastinum, heart size, if the maximum transverse diameter of heart is bigger than the hemidiaphragm, then the heart is considered enlarged
- posterior-anterior view, PA view, (x-rays came from the back side of the patient), traditionally radiologists will not comment on cardiac size on an AP view,
- In a number of x-rays you won’t be able to see the horizontal fissure, but very often you will see an opaque flat horizontal line (on the right of the patient) which is known as the horizontal fissure, which separates the right superior lobe and right middle lobe.
- Oblique fissure is only visible on the lateral view
- Costophrenic angles, If there is a small pleura effusion, this is the area (that will be affected) and you won’t be able to see either the right or left costophrenic angles, depending upon which lung the pleural effusion is in
- mediastinum, cardiac size
- consolidation in right superior lobe, you can see air bronchogram, which means that the bronchial branches are filled with air, and the background is opaque; you can see these branches clearly
- horizontal fissure, the consolidation is limited to one lobe, and this is a very good example of lobar pneumonia. Consolidation means the area is filled with exudates, and exudates can be blood, fibrin, fluid, and pus. Both right and left costophrenic angles are again clearly visible, cardiac size is not bigger than hemidiaphragm, so it’s normal. Trachea is not shift toward right or left, and mediastinum is normal.
- another chest x-ray, that shows consolidation in the left lingualal region; the left cardiac border is not visible,
- another chest x-ray shows massive consolidation in the right middle lobe and right inferior lobe; also left inferior lobe is consolidated, the patient is rotated toward the left hand side, and it is probably an AP view, so it is not a good idea to comment on cardiac size here.
- another chest x-ray shows massive pleural effusion. The right lung is normal; more than half of the left lung is not visible here, left heart border is not visible here, the left hemidiaphragm is not visible, the left costophrenic angle is not visible. There is a gap between rib cage and lung here, and this is fluid density. So this is a massive pleural effusion,

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March 10, 2010

Barium swallow demonstrating achalasia

Filed under: Achalasia, Barium Swallow — Tags: Barium swallow demonstrating achalasia — admin @ 11:07 am

Barium swallow demonstrating achalasia

Barium Swallow

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March 8, 2010

Free Intraperitoneal Air

Filed under: Free Intraperitoneal Air, KUB — admin @ 3:34 am

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cecal volvulus discussion [PT HAS FREE INTRAPERITONEAL AIR ALSO]

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March 7, 2010

Gallbladder Polyps on EUS

Filed under: EUS, Gallbladder Polyps — Tags: Gallbladder Polyps on EUS — admin @ 4:27 pm

Gallbladder Polyps on EUS

GALLBLADDER POLYPS EUS CHRISTOS KARALIS MD.wmv

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March 3, 2010

Esophageal varices

Filed under: Barium Swallow, Esophageal Varices — Tags: absite, Esophageal Varices — admin @ 1:26 pm

Esophageal varices

Esophageal varices, gross [ENDOSCOPY]

Esophageal varices, low power microscopic

Esophageal varices, high power microscopic

Esophageal varices as seen on barium swallow [mentioned by dr. managi in radiology elective]

http://emedicine.medscape.com/article/367986-imaging

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January 27, 2010

Search engine for medical students and residents

Filed under: 0 Multiple Choice Questions, 3 medical students, 3a Physical Exam, 4 USMLE, 4a Absite, 5 Clinical Rotations, 6 Residency, 7 Procedures, Anatomy, Antibiotics, Cardiovascular, Critical Care, Dermatology, ENT Otolaryngology, Electrolytes, Endocrinology, Environmental Exposures, Gastrointestinal, General Surgery, Genitourinary, Hematology, Histology, Internal Medicine, Learning Modules, Neurology, Neurosurgery, OBGYN, Oncology, Opthalmology, Orthopedic Surgery, Palliative Care, Pediatric Surgery, Pharmacology, Pulmonary, Radiation Oncology, Renal, Rheumatology, Surgical Oncology, Thoracic Surgery, Toxicology, Transplantation, Trauma, USMLE Step 2 CK, USMLE Step 2 CS, USMLE Step 3, Urology, Vascular Surgery, anesthesiology, cell biology, embryology, immunology, infectious diseases, pediatrics, plastic surgery, psychiatry, radiology — admin @ 1:19 pm

Search engine for medical students and residents

Below is a search engine designed by medical students and residents. Websites included in the engine include top ranked schools of medicine sites (eg. learning modules from UCSF, Yale, Harvard, Dartmouth, etc), pubmed, wikipedia, student doctor network, and top anatomy, radiology, and pathology sites. The results will also include pertinent videos and images.

If you have a good website/learning module (especially from your school) that you want us to include, please post it in the comments section below.

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