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…

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…

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;…

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…

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.…

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…

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…

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…

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…