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Atherosclerotic plaque

8.1 Introduction Atherosclerosis is a chronic inflammatory disease [ ]. Although great strides have been made in the diagnosis and management of atherosclerotic cardiovascular disease (CVD), overall mortality due to underlying atherosclerosis remains a leading cause of death in industrialized countries [ , ]. For example, more than one-third of all deaths in the United States are attributed to CVD, including atherosclerotic coronary disease and stroke…

Noninvasive coronary angiography

7.1 Introduction Invasive coronary angiography (ICA) is the gold standard for the identification of anatomically obstructive coronary artery disease (CAD). However at many centers, ICA is a limited resource that is expensive and has periprocedural risks (death, cerebrovascular accident, myocardial infarction, and vascular complications). Thus, ICA may not be appropriate for all patients and best reserved for those at highest risk and who likely require coronary…

Magnetic resonance imaging

Acknowledgments The authors of this chapter acknowledge BioMed Central as the original publisher of selected figures in this chapter as indicated by references to the original authors and publications. The authors also acknowledge Oxford University Press as the original publisher of Figure 6.16 reproduced with permission from Schroeder et al., hyperpolarized C-13 magnetic resonance reveals early- and late-onset changes to in vivo pyruvate metabolism in the…

Computed tomography

5.1 Development of cardiac CT In 1972, the first CT scanner was designed by the engineer Geoffrey N. Hounsfield at an English company named EMI Ltd. Together with Allan C. Cormack, a physicist from Cape Town who developed the mathematical foundation for the reconstruction of cross-sectional images from transmission measurements, Hounsfield was honored with the Nobel Prize for Physiology or Medicine in 1979. The first CT…

Single-photon emission computed tomography

3.1 Introduction Radionuclide imaging today is an active and growing branch of medical diagnostics. Over the past decades, radionuclide imaging has advanced to become a cornerstone for the accurate diagnosis and appropriate management of a variety of medical conditions. Interestingly, however, it has its origins in the cardiovascular field: it was in the late 1920s when Herrmann L. Blumgart published his “Studies on the velocity of…

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…