Lecture 7 - Imaging Anatomy and Pathology PDF

Lecture 7- Imaging Anatomy and Pathology Unit convener-Justin Farrugia [email protected] 12B12  Objectives Introduce fundamental concepts of imaging anatomy with a focus on general radiography...

Lecture 7- Imaging Anatomy and Pathology Unit convener-Justin Farrugia [email protected] 12B12  Objectives Introduce fundamental concepts of imaging anatomy with a focus on general radiography images Discuss imaging pathology appearances for general X-ray examinations Introduce a range of useful resources to increase understanding of both anatomy and pathology Recommended Reading/Useful resources Radiopaedia Radiology masterclass Biodigital Human Bontrager- basic X-ray anatomy by region  Radiopaedia https://radiopaedia.org/articles/labelled-imaging- anatomy-cases Biodigital Human https://human.biodigital.com/explore Imaging Anatomy Key concepts Importance of being specific you need to alway state left or right (step 1) LEFT RIGHT As appropriate.. Side medial or lateral Structure anatomy Level the number rib , like left 4th rib Aspect eg: posterior or anterior , left 4th rib posterior aspect Spelling is important Importance of using correct terms Importance of using correct need to be specific terms  Imaging Anatomy Identify both bony and soft tissue structures Chest sternum or sternal notch to find were you are on the patient acromion midshaft inferior angle of scapula centre to T7  hypodense visually you can’t see the fissure right cardiophrenic angle right hemidiaphragm left hemidiaphragm  anterior posterior  apice more than 1 T1 more prominent here collection of vessels left cardiophrenic angle right cardiophrenic angle  trachea left apex carina left hemodiaphragm right costophrenic angle  Ribs Have a posterior and anterior aspect  posterior ribs = more “flattened” how many ribs you see , indicate the breath they took 10 posterior ribs before the diaphragm patient has taken a good inspiration anterior curves “inward” = 7 anterior ribs  trachea 3rd thoracic vertabrae 5th posterior rib aortic knuckle or aortic arch carina ( little bit below the aortic arch) left costophrenic angle Abdomen gas in bowel  superior border - diaphragm right upper quadrant left upper quadrant right lower quadrant left lower quadrant  these muscles can be seen on the x-ray liver stomach can see if there is gas inside kidney these lines are the psoas muscle  spinous process ureter right iliac wing SI - sacroiliac joint left iliac wing bladder Soft tissue signs  A great page to follow on Instagram bottle appearance , looks like a bottle liver will be very dense vertebral body L4 transverse process SI joint obturator foramen , lots of vessels pass it erect Clavicle  Midshaft of left clavicle Acromioclavicular joint lateral portion Sternoclavicular joint medial portion  middle phalanx of the 3rd digit Wrist/Hand smallest one interphalnageal joint MCP joint  trapezoid trapezium hamtate capitate scaphoid triquetrim and pisiform lunate Imaging Pathology  Imaging pathology if more radiolucent or radiopaque , then you know pathology A KEY CONCEPT WHEN IDENTIFYING PATHOLOGY IS BEING WE WILL COVER SOME BASICS ABLE TO DEFINE APPEARANCES RADIOGRAPHICALLY AND RELATE THIS TO A POTENTIAL PATHOLOGY Chest  you would rather first comment on the density color first , rather than just immediately go to pathology radioluscent area there is a radiopaque area in the left lung Left sided Pneumothorax Left sided Pleural effusion  Pneumothorax something that is caused medically patient here has taken an expiration Rib fractures (traumatic pneumothorax) has multiple rib fractures Absence of lung markings (radiolucent) collapsed portion of the lungs Compressed portion of lung Pleural Effusion can be confident some sort of trauma thorax has accumulated blood  if it were for surgery reasons, you would not see pressure or things pushed to the side Mediastinal shift to large left sided effusion the right due to pressure Left sided effusion Tracheal deviation Complete “white out” alot of fluid on the left so will move trachea blunting of costophrenic angles means there would be fluid Treatment consolidation is a sign of pathology you don’t have consolidation , you just say as a sign on an x-ray Pneumonia usually has a hypodense appearance  not effusion as you can see the costophrenic angles and lungs this is an area of consolidation , patchy area here , “enlargement” , indicates pneumonia Abdomen  Kidney (Renal) stones calcification nephro refers to the kidney ureter don’t really use an x-ray mostly dense kidney stone ( looks like it’s sitting in the psoas muscle)  kidney kidney stone psoas muscle Staghorn calculus looks like a deer Gallstones cholec ….refers to the gallbladder  gallstones liver Bowel Obstruction Can affect both the small and large bowel. Small bowel obstructions (SBO) are more common. opening Occurs when the lumen of the bowel becomes partially or completely blocked causing abdominal pain, nausea, vomiting, distention Can have a range of causes such as adhesions, hernia, malignancy, diverticular disease, volvulus twisting of the valve AXR may be used as a screening tool AXR is often replaced by CT there are dilated loops of bowel , well define , the width exceeds the size pacemaker contrast increasing the density of the bowel metal device (internal ) seeing how the contrast is progressing through the bowel , in highlighting it Extremities Fractures Most common skeletal abnormality Defined as a disruption of bone caused by mechanical forces Although often obvious, some fractures are subtle and difficult to detect Will typically be depicted radiographically as a radiolucent line crossing the bone and disrupting the cortical outline outlines of bone are generally well defined , so when there is a fracture , you’ll see a break in the fracture Soft tissue signs may be present such as joint effusion, swelling and oedema Types of fractures Can be described by their extent, direction and position, the number of factures and the integrity of overlying skin  lots of segements paediatric word , more commonly seen as green stick fracture Greenstick and Torus is specific to paediatrics Distal Radius Colles fracture called Colles cause of the rotation  also Colles “Dinner fork deformity” Boxers Fracture associated with boxing eg: punching a wall Avulsion Fracture disruption to the tendon will cause disruption to the eg: ball hitting finger  Forearm Monteggia Fracture Galeazzi Fracture fracture of ulna fracture of radius Treatment May be conservative Closed reduction Open reduction/Internal fixation External fixation Followed by cast/splint + physical therapy  smith is the fracture of a distal radius smiths is opposite of a Colles ORIF= Open Reduction Internal Fixation kids usually have K wire for a fracture K wire with casting Osteoarthritis (OA) severe degenerative change , irregular bone formation Note- AP oblique rather than PA Summary Anatomy Pathology Chest Pneumothorax Abdomen Pleural effusion Clavicle Pneumonia Hand/Wrist Kidney stones (Urolithiasis) Gallstones (Cholelithiasis) Bowel Obstruction Fractures Osteoarthritis Kahoot! www.kahoot.it  The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather. The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather.