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…
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…
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.…
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…
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),…
The standard radiographs Midface and Orbit: one or two OM views ; occasionally with a lateral view . Mandible: OPG , preferably with a PA view. Regularly overlooked injuries ▪ Tripod fracture. ▪ Blow-out fracture. ▪ TMJ dislocation. ▪ Mandibular condyle fracture. Abbreviations CT, computed tomography; OM, occipitomental view; OM15/OM30, OM views with 15° or 30° of angulation of the X-ray beam; OPG, orthopantomogram; PA, posterior-anterior;…
Following a head injury the imaging examination of choice is CT . Plain film skull radiography (SXR) has in the main been abandoned or its use radically reduced as a first line imaging test both in children and in adults . A SXR is now limited to: ▪ where national or local guidelines indicate a role within a patient management algorithm; ▪ locations where imaging resources…
A skull X-ray (SXR) continues to have an important role when there is suspicion of non-accidental injury (NAI) in an infant or a toddler . The primary indication for a SXR in these patients is forensic . Be careful: ▪ Accessory sutures are common. ▪ Calling an accessory suture a fracture may lead to an incorrect suggestion of NAI. ▪ Dismissing a fracture as an accessory…
Paediatric Points addressed in other chapters Chapter 3 , pp. 35–46 : Skull—suspected NAI. Chapter 6 , pp. 92–93 : Shoulder. Chapter 7 , pp. 95–114 : Elbow. Chapter 13 , pp. 214–215, 224–226 : Pelvis. Chapter 17 , pp. 298, 304–305 : Foot. Chapter 21 , pp. 350–351, 358–359 : Swallowed foreign bodies. Bones in children are different “A child is not a small adult…
Introduction Patients with traumatic injuries can be placed into one of three major groups. The imaging approach will differ between these groups. Polytrauma (in which one injury may be life threatening) ▪ Imaging: Strict local protocols and algorithms utilising early ultrasound (US) and/or multidetector computed tomography (CT). The use of plain film radiology in the Emergency Department (ED) is generally limited . Multiple injuries (none of…
Increasing emphasis on tailoring of cancer treatment strategies to individual patients (i.e., personalized medicine) has enabled development of multiple therapeutic options in the management of malignant diseases of the abdomen and pelvis. In particular, in patients with malignant hepatic and renal tumors, organ-directed treatment such as percutaneous ablation, intra-arterial embolic therapies, and targeted radiation therapy have shown considerable promise in improving patient outcome. Although surgical resection…
Monitoring the response of tumors to treatment has become an integral component of oncologic imaging. Imaging studies play a vital role in objective assessment by quantifying tumor response to a variety of physical and pharmaceutical treatments. Traditionally, therapeutic response has been assessed by conventional methods that involve serial tumor burden measurements according to the World Health Organization (WHO) and Response Evaluation Criteria in Solid Tumors (RECIST)…
Etiology Abdominal wall hernias, or external hernias (where abdominal contents protrude beyond the abdominal cavity), include inguinal, femoral, umbilical, incisional, spigelian, epigastric, lumbar, and obturator hernias. All abdominal wall hernias consist of a peritoneal sac that protrudes through a weakness or defect in the muscular layers of the abdomen. The defect may be congenital or acquired. Weakness of the transversalis fascia, which is the layer immediately…
Cross-sectional imaging modalities including ultrasonography, computed tomography (CT), and magnetic resonancy imaging (MRI) provide good anatomic detail of the abdominal wall and allow evaluation of pathologic processes in this area. Ultrasonography is frequently used as the first imaging modality to explore a palpable abdominal mass. Non-neoplastic Conditions Abdominal Wall InflamMation, Infection, and Fluid Collection Etiology Inflammatory processes involving the abdominal wall include diffuse edema ( Figure…
Non-neoplastic Conditions of the Peritoneum In many of the diseases discussed in this chapter the diagnosis is often initially raised on computed tomography (CT) or magnetic resonance imaging (MRI). However, in most cases, it is not possible to make a categorical diagnosis based on the imaging findings alone and it is necessary to correlate with clinical findings and laboratory tests. In this section we discuss peritoneal…
Peritoneal Fluid Collections Etiology Ascites is the abnormal accumulation of fluid in the peritoneal cavity. There are numerous causes of ascites, including congenital, infective, inflammatory, and neoplastic diseases. In the United States the most common causes are liver disease and malignancy. In many parts of the world, tuberculosis is an important cause. The main causes of ascites and their frequency in the United States are listed…
Trauma Etiology Urethral trauma may result from blunt, penetrating, or iatrogenic injury. The spectrum of urethral injuries includes contusion, partial or complete disruption, and urethral injury and may involve either the anterior or posterior urethral segment. Blunt anterior urethral injuries are commonly associated with perineal straddle injury, whereas posterior urethral injuries are usually a consequence of the shearing forces involved with a pelvic fracture. Penetrating injuries,…
Urethral Diverticulum Etiology A urethral diverticulum is a focal outpouching of urethral tissue into the urethrovaginal space. It is thought to be due to postinflammatory dilatation and rupture of the periurethral glands (of Skene) into the urethra. Most urethral diverticula are acquired and occur in women between their third and sixth decades in age. The estimated prevalence of urethral diverticula is 0.6% to 6% of adult…
Benign Testicular Lesions Etiology and Clinical Presentation Benign scrotal or testicular swellings and masses have many etiologies and different clinical presentations, as listed in Tables 78-1 and 78-2 . Of palpable nodules, 31% to 47% are benign at surgery. TABLE 78-1 Causes of Acute Scrotal Swelling Condition Symptoms Signs Comments Torsion Acute onset of severe pain, usually postpubertal Pain not relieved by scrotal elevation, high-riding testis,…
Technical Aspects Scrotal imaging has been one of the undeniable success stories of modern radiology. The scrotum is predominantly imaged for two clinical indications: the painless scrotal mass and the acute scrotum. Both conditions predominantly affect young men in the second through fourth decades of life. Rapid and accurate diagnosis is the goal of all imaging. Among several imaging modalities available, ultrasonography and magnetic resonance imaging…