Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Abnormalities of the Pharynx

Functional Abnormalities AGING Age-related change in the muscles, tendons, ligaments, cartilages, and nerves that participate in pharyngeal function may alter swallowing dynamics, causing a swallowing disorder. The type of normal swallowing in young patients is found in only about 15% of people over age 80 years. , For example, loss of sensors at the palatoglossal isthmus and base of the tongue with aging results in poor…

Pharynx: Normal Anatomy and Function and Examination Techniques

The pharynx is the crossroads of respiration, speech, and swallowing. During respiration, the pharynx is an active conduit for the passage of air from the nasopharynx to the laryngeal aditus. During speech, the pharynx functions as a resonating chamber, changing size and shape to alter sounds. During swallowing, the pharynx directs the bolus into the esophagus and prevents the bolus from entering the tracheobronchial tree. Disorders…

Abdominal Calcifications

Physiology Precipitation of calcareous substances requires an alkaline medium and high local concentrations of ionic calcium. The term metastatic calcification refers to deposition of calcium salts in normal tissues secondary to hypercalcemia and an elevated pH. Although the stomach and kidneys are the most frequent sites of metastatic calcification, the degree of opacification in these organs is usually too faint to be detected on abdominal radiographs.…

Abnormal Bowel Gas Patterns and Extraluminal Gas in Abdomen

Even with the widespread availability of cross-sectional imaging studies, abdominal radiography remains a common imaging test in modern radiology practice. Although computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound provide more information about acute abdominal conditions, abdominal radiographs (previously known as abdominal plain films before the advent of digital radiography) have the advantages of relatively low cost and ease of acquisition and can be readily…

Abdomen: Normal Anatomy and Examination Techniques

From the 1970s to 1990s, the abdominal radiograph traditionally served as the initial radiologic means of evaluating patients with suspected abdominal pathology. Since the early 2000s, however, computed tomography (CT) has become the major imaging procedure in patients with acute abdominal signs and symptoms. As a screening test, abdominal radiographs have a low diagnostic yield, especially in patients with mild or nonspecific symptoms. Nevertheless, abdominal radiographs…

The Foot

Foot Checklists 1 Radiographic examination AP Oblique Lateral Axial view of calcaneus 2 Common sites of injury in adults Metatarsals Neck, base, shaft Fifth MT – tuberosity, Jones’ fracture Phalanges Metatarsal/tarsal fracture-dislocation (Lisfranc) Calcaneus – compression fracture Talus Neck Lateral process (snowboarder’s fracture) Subtalar fracture-dislocation Chopart’s fracture-dislocation Navicular Body Proximal pole Tarsal avulsion Lateral view Head of talus Anterior cortex navicular Posterior tuberosity of talus Dorsal…

The Ankle

Ankle Checklists 1 Radiographic examination AP view Lateral view Internal oblique view 2 Common sites of injury in adults Lateral malleolus fibula Medial malleolus tibia Posterior malleolus tibia Pilon fracture of the tibial plafond Fractures of tarsus and midfoot mimicking ankle fractures Tarsal avulsion Lateral view Head of talus Anterior cortex navicular Posterior tuberosity of talus Dorsal surface of calcaneal tuberosity Anterior process of calcaneus Tuberosity…

The Knee

Knee Checklists 1 Radiographic examination AP Obliques (internal and external) Cross-table lateral Sunrise view of patella 2 Hemarthrosis/lipohemarthrosis – distention of suprapatellar bursa Important clue to Underlying obscure fractures Cruciate and collateral ligament and meniscal injuries Most commonly ACL tear 3 Common sites of injury in adults Patella Tibial plateau Distal femur Metaphysis/intercondylar Proximal fibula Head Neck Flake/avulsions Osteochondral fractures Joint surface patella or femoral condyles…

The Hip

Hip Checklists 1 Radiographic examination Hip AP pelvis AP hip Frog leg-view hip Groin lateral hip Femur AP hip AP femoral shaft and condyles Lateral femoral shaft and condyles Oblique femoral shaft 2 Common sites of injury in adults Elderly – low-impact trauma (fall from standing height) Femoral neck Intertrochanteric Greater trochanter Pelvic fractures presenting as hip fractures Pubic rami Iliac wing Adult – R/O pathologic…

The Pelvis

Pelvis Checklists 1 Imaging assessment Radiographic examination AP Oblique views Internal oblique (obturator view) External oblique (iliac view) Inlet view Outlet view Computed tomography (CT) Axial Reformatted images Coronal Sagittal 3-D Volume-rendered semitransparent three-dimensional images to simulate radiographic views AP, inlet, outlet, iliac oblique, obturator oblique Lateral view of high quality Not possible to obtain radiographically 2 Anatomic features Pelvic ring Composed of two innominate bones…

The Thoracolumbar Spine

Thoracolumbar Spine Checklists 1 Imaging assessment Radiographic examination AP Lateral views Computed tomography (CT) Axial Reformatted images Coronal Sagittal 3-D 2 Anatomic features, biomechanics, and forces of injury Anatomy Biomechanics Denis three-column concept Forces of injury Flexion Extension Compression Distraction Shearing Rotation 3 Common forms of fracture and fracture-dislocations in adults Fracture Vertebral body Anterior wedged compression Burst Chance (seat-belt) Flexion-distraction Extension Vertebral appendage Transverse process…

The Cervical Spine

Cervical Spine Checklists 1 Radiographic examination Minimum necessary views Lateral cervical spine to include T1 AP cervical spine AP open-mouth odontoid CT examination: minimum necessary Axial, sagittal, and coronal noncontrast images in bone algorithm Extending through at least the level of T1 Axial and sagittal images in soft tissue algorithm 2 Common sites of injury in adults Craniocervical junction (Skull base – C2) Fractures Occipital condyle…

The Hand

Hand Checklists 1 Radiographic examination PA Pronation oblique Lateral 2 Common sites of injury in adults Fractures Phalanges (55% of hand injuries) Distal (50+% of fractures of the phalanx) Ungual tuft, base, shaft, baseball finger avulsion Proximal (15% of fractures of the phalanx) Shaft, base, condyles, volar plate avulsion Middle (10+% of fractures of the phalanx) Shaft, base, condyles, volar plate avulsion Metacarpals (36% of hand…

Treating venous disease

Percutaneous placement of inferior vena cava (IVC) filters and treatment of superior vena cava obstruction (SVCO) ( Ch. 44 ) are the cornerstones of venous intervention. Venous angioplasty, stenting and thrombolysis are sometimes performed but remain controversial techniques, except in the management of haemodialysis access ( Ch. 50 ). The principles of negotiating and treating venous stenoses and occlusions are exactly the same as in the…

Treating haemodialysis access

Referrals for management of vascular access problems are among the most common requests for vascular intervention in centres where haemodialysis is performed. Tip Embrace the dialysis patients; they will be one of the most important training grounds for vascular access, catheter and wire manipulation, angiography, angioplasty/stenting and thrombolysis! For patients on haemodialysis, their fistula, graft or dialysis catheter is a lifeline. Unfortunately, problems are common and…

Treating haemorrhage

If you practice vascular intervention you will find yourself called to stop haemorrhage. This is one of the most challenging and rewarding aspects of practice and frequently life-saving. There are three ways you can help: Inflow occlusion balloon: this is the ‘radiological tourniquet’ and is used to buy time in severe haemorrhage by controlling bleeding until definitive treatment is provided. Stent grafting: this is used to…

Treating aneurysmal disease

Aneurysms can affect vessels of any size. Clearly, not every aneurysm requires immediate treatment but, when indicated, successful endovascular management requires exclusion of the aneurysm from the circulation. The main options can broadly be thought of as: Embolization techniques which sacrifice the target vessels: This is only used when it is safe to occlude part of the circulation, i.e. there is a collateral pathway or the…

Treating acute limb ischaemia

Acute limb ischaemia describes a sudden reduction in perfusion of <3 days' duration. The ischaemia is usually due to thrombosis in native arteries or bypass grafts secondary to an underlying stenotic lesion. The severity of ischaemia is categorized using the Rutherford classification ( Table 47.1 ). Patients with rest pain without neuromuscular complications (Rutherford grade IIa) are the optimal candidates for thrombolysis in terms of time…

Treating arterial occlusive disease

Angioplasty and stenting are cornerstone techniques in interventional radiology and have widespread non-vascular and vascular applications. The key skills and equipment choices remain largely the same, regardless of the site. This chapter assumes that you have already mastered the theory and techniques for getting to and crossing the lesion. Basic principles Refer back to the sections on equipment and the basic principles for further guidance on…

Achieving angiographic diagnosis

Having a high-quality route map of the target vascular bed and, if necessary, the access to it are the keys to successful vascular intervention. They determine the choice of approach, the best equipment to use and the suitability for intervention. A preliminary diagnostic angiogram is seldom now required and non-invasive diagnostic imaging using ultrasound (US), magnetic resonance angiography (MRA) and computed tomography angiography (CTA) is the…