•

•

•

•

•

•

•

•

•

•

•

SET T0006 -
Emergency Department

CASE 1

HISTORY	HISTORY It is 2008. This City of London banker has developed chest discomfort after visiting the Gym.
QUESTION	QUESTION This CXR is abnormal. (a) Define the abnormality; (b) list five posssible causes for the abnormality; (c) most likely cause in this patient ?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW Pneumomedistinum. The air is mainly situated around the left side of the heart. Also, some air is seen in the soft tissues of both sides of the neck - quite subtle. Five possible causes? *See : The Chest X-Ray : A Survival Guide : Pages 123-127* The most likely cause in this young man? Alveolar rupture during vigorous inspiration whilst exercising in the Gym. (On the other hand, this known Master of the Universe may have been smoking Cocaine). Another alternative: a spontaneous pneumomediastinum.

CASE 2

HISTORY	HISTORY 73 year old female patient. Smoker. Short of breath for some years. The dyspnoea is more marked today. The GP has referred the patient for a CXR and has asked if there is any explanation for the increase in the dyspnoea?
QUESTION	QUESTION What findings would you communicate to the GP?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW Heart size is normal. Lungs clear. No evidence of pleural fluid. The mediastinal appearances are satisfactorily explained by age related unfolding of the aorta. No significant abnormality on this CXR. Age related unfolding of the aorta? *See : The Chest X-Ray : A Survival Guide : Page 26*

CASE 3

HISTORY	HISTORY Young man with pain in the right hip - on and off for some years. His General Practitioner has suggested that a check X-ray would be a good idea.
QUESTION	QUESTION Explain the two findings shown on this radiograph.
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW Two findings : 1) The large well corticated bone fragment is a long standing abnormality. It represents an old avulsion fracture of the apophysis that forms the anterior superior iliac spine. Undoubtedly this injury has been the cause for the earlier pain in the hip - an avulsion fracture consequent on muscle contraction. 2) The somewhat faint, and very small, bone fragment at the lateral and superior margin of the acetabulum is a normal variant : an unfused secondary ossification centre. Often referred to as an os acetabuli. Apophyseal injuries . . . *See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 222-225* Os acetabuli . . . *See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 226 and 242* The 3rd edition will be published in July 2014.

CASE 4

HISTORY	HISTORY Young male patient. Hip pain - bilateral - after a powerful tackle in a rugby match.
QUESTION	QUESTION Normal or abnormal?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW No recent fracture shown. In effect - a normal pelvis. Note the separate, obliquely aligned, bone fragment/ossicle at the lateral and superior margin of the roof of each acetabulum. A relatively frequent finding . . . and it is often unilateral. There is some doubt/dispute as to the nature of this appearance. Some consider the bone fragment to be a variation of an unfused os acetabuli; others have raised the possibility that it may (in some patients) represent a type of stress fracture. It is not an acute injury. *See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Page 226* The 3rd edition will be published in July 2014.

© Copyright: Radiology Courses

Website: Wotnot Web Works

Privacy & Cookies

By accepting or continuing to browse this site, you are agreeing to our use of cookies and our cookie policy