Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Ultrasound/echocardiography

2.1 Introduction The traditional echocardiographic techniques are widely used and form a routine complete echocardiographic examination: – M-mode recordings, guided by two-dimensional (2D) echocardiographic images, are used for quantification of cardiac dimension and timing of rapid cardiac motions [ ]. It is recommended that left ventricular (LV) internal diameters and wall thickness are measured by M-mode since they show excellent temporal resolution and may complement 2D…

Advanced cardiac imaging

1.1 Introduction One cannot cure without knowing what is wrong, which is why diagnostic techniques are essential to practice medicine. The heart is a mechanical organ, a pump consisting of moving structures, directed flow, electric controls, and an efficient oxygen and nutrient supply system. These physical phenomena can be investigated in many ways, externally by physical examination, auscultation, or electrocardiogram; invasively using catheters; and more recently…

Swallowed foreign bodies

Dangerous injuries ▪ Coins may lodge in the oesophagus—slightly dangerous. □ The CXR must include the neck. ▪ Button batteries may lodge in the oesophagus—highly dangerous. □ The halo sign is important. ▪ Two magnets in the bowel—highly dangerous. □ Use of a compass may be crucial. Useful tools ▪ X-ray machine. ▪ Hand held metal detector. ▪ A compass. ▪ CT Scanner. Abbreviations AXR, abdominal…

Penetrating foreign bodies

The standard radiographs Foreign body in soft tissue ▪ Two radiographs—angulated so that bone does not obscure the injured site. Orbital foreign bodies ▪ Two frontal projections: upward and downward gaze. Alternative imaging to consider Soft tissue foreign bodies ▪ Superficial: sonography. ▪ Deeply penetrating: CT or MRI. Orbital foreign bodies ▪ CT or MRI. Regularly overlooked foreign bodies ▪ Glass hidden by bone. ▪ Deeply…

Abdominal pain & abdominal trauma

Appropriate imaging ▪ CT is frequently the optimum first line investigation. ▪ US is sometimes the optimum first line test. ▪ The AXR has a limited, occasionally useful, role. Abbreviations AXR, abdominal X-ray examination; CT, computed tomography; CT KUB, computer tomographic examination of the renal tract; CXR, chest radiograph; ED, Emergency Department, Emergency Room; FAST, focussed abdominal sonography for trauma; IVU, intravenous urogram; US, diagnostic ultrasound…

Chest

The chest X-ray (CXR) A comprehensive description of the information that can be provided by the CXR requires a textbook all of its own. Our companion book The Chest X-Ray : A Survival Guide will assist you to get the very best from this, the commonest radiological investigation in an Emergency Department (ED). In this chapter we focus on the ten most common clinical questions that…

Midfoot & forefoot

Regularly overlooked injuries ▪ Lisfranc subluxations. ▪ Fatigue fractures involving the 2nd or 3rd metatarsals. ▪ Avulsion fracture of the base of the 5th metatarsal—overlooked on ankle radiographs. The standard radiographs Protocols vary. In the UK a two view series is commonplace: AP and Oblique. Elsewhere, and in the USA, a three view series is common practice : AP, Oblique , and a Lateral . Abbreviations…

Ankle & hindfoot

Regularly overlooked injuries Talus : talar dome osteochondral lesion; neck of talus fracture; medial or lateral process fractures. Calcaneum : acute fracture; stress fracture. Syndesmotic widening (tear of tibiofibular membrane). Base of 5th metatarsal fracture. The standard radiographs Ankle : AP mortice (20° internal rotation) and Lateral . Sometimes a Straight AP . Calcaneal injury : an additional Axial . Abbreviations AP, anterior-posterior; AVN, avascular necrosis;…

Knee

The standard radiographs AP and Lateral. Suspected patella fracture, but AP & lateral are equivocal: Skyline view . Occasionally, a Tunnel view to evaluate the intercondylar area. Regularly overlooked injuries ▪ Plateau fracture. ▪ Segond fracture. ▪ Small fragments in the joint. ▪ Vertical fracture of the patella . Abbreviations ACL, anterior cruciate ligament; AP, anteroposterior; FFL, fat–fluid level; LCL, lateral capsular ligament; MCL, medial capsular…

Hip & proximal femur

Regularly overlooked injuries ▪ Femoral neck fracture—minimally displaced. ▪ Femoral neck fracture—inadequate assessment of the lateral radiograph. ▪ Pubic ramus fracture. ▪ Apophyseal injuries in the young. The standard radiographs AP of whole pelvis. Lateral projection of the painful hip. Abbreviations AIIS, anterior inferior iliac spine; ASIS, anterior superior iliac spine; CT, computed tomography; MRI, magnetic resonance imaging; RTA, road traffic accident; THR, total hip replacement.…

Pelvis

Regularly overlooked injuries ▪ Undisplaced acetabular fracture. ▪ Detached acetabular fragment in a patient with a dislocated hip. ▪ Sacral fractures. ▪ Avulsed apophysis from the proximal femur or from the innominate bone. The standard radiograph AP view . Abbreviations AIIS, anterior inferior iliac spine; AP, anterior-posterior; ASIS, anterior superior iliac spine; RTA, road traffic accident; SI joint, sacro-iliac joint. Normal anatomy Normal AP view The…

Thoracic & lumbar spine

Regularly overlooked injuries ▪ Transverse process fractures. The standard radiographs Lateral and AP views. Abbreviations AP, anterior-posterior; L1, the 1st lumbar vertebra; T6, the 6th thoracic vertebra. Normal anatomy Lateral view—thoracic and lumbar vertebrae ▪ The vertical contour of the lumbar spine is a smooth unbroken arc. ▪ The vertebral bodies are the same height anteriorly and posteriorly. ▪ The posterior margin of each vertebral body…

Cervical spine

Regularly overlooked injuries The most common causes of a missed C-spine abnormality are failure to adequately visualise the injured region and inadequate understanding of the C1/C2 anatomy. Therefore errors commonly relate to: ▪ C1/C2 fractures or subluxations. ▪ Low C-spine fractures , frequently involving the C7 vertebra. The standard radiographs Three-view trauma series . Abbreviations AP, anterior-posterior projection; C-spine, cervical spine; C1, Atlas vertebra; C2, Axis…

Hand & fingers

The standard radiographs Depends on site of injury: ▪ Injury to a metacarpal or several phalanges: PA of hand and oblique of entire hand and wrist . ▪ Injury to the thumb or to a single digit: PA and lateral of the digit . Regularly overlooked injuries ▪ Dislocations at 4th & 5th CMC joints. ▪ Fractures at base of 4th or 5th MCs. ▪ Fracture…

Wrist & distal forearm

Regularly overlooked injuries ▪ Undisplaced fracture of distal radius. ▪ Dislocation involving the lunate. ▪ Greenstick fracture. ▪ Triquetral fracture. The standard radiographs PA , Lateral , Scaphoid series . Abbreviations AVN, avascular necrosis; C, capitate; L, lunate; PA, posterior-anterior (view); R, radius. Normal anatomy PA projection: bones and joints The articular surface of the radius lies distal to that of the ulna in 90% of…

Adult elbow

A child's developing skeleton is vulnerable to specific elbow injuries unlike those that affect an adult. Paediatric elbow injuries are dealt with separately in Chapter 7 . The standard radiographs ▪ AP view in full extension. ▪ Lateral with 90° flexion. ▪ Routine in some departments : the radial head–capitellum view ( p. 121 ). Regularly overlooked injuries ▪ Fracture of the radial head or neck.…

Paediatric elbow

Regularly overlooked injuries ▪ Undisplaced supracondylar fracture. ▪ Fracture, lateral condyle of humerus. ▪ Monteggia injury . The standard radiographs AP in full extension. Lateral with 90 degrees of flexion. Abbreviations CRITOL: C apitellum, R adial head, I nternal epicondyle, T rochlea, O lecranon, L ateral epicondyle. Anatomy AP view—child age 9 or 10 years Lateral view—child age 9 or 10 years Elbow fat pads There…

Shoulder

Regularly overlooked injuries ▪ Dislocations/subluxations: ACJ subluxation; complete rupture of the CC ligaments; posterior dislocation of humeral head. ▪ Fractures: scapula blade; glenoid rim or humeral head as a complication of an anterior dislocation at the GH joint. The standard radiographs AP view and a second view (see p. 74 ). Abbreviations ACJ, acromioclavicular joint; AP, anterior-posterior; CC, coracoclavicular; GH, glenohumeral; SC, sternoclavicular; Y projection (view),…