Emergency Radiology

What to order, When

Prof. Mahmoud Dawoud
Chairman of the Radiology & Imaging Dept.
Tanta University Faculty of Medicine

Emergency Radiology

What

are the different

Radiological
investigation
to
order
In
different
Emergency situations

Emergency Radiology
Common Topics

CNS Emergencies
Face & Neck Emergencies.
Spinal Emergencies.
Chest Emergencies.
Cardiovascular Emergencies.
Abdominal Emergencies.
Gynecological & Obstetrical emergencies.
Male Genitourinary Emergencies.
Pelvis
Extremities
Pediatric Emergencies

Emergency Radiology
CNS Emergencies:
Skull Fractures
Hemorrhage: (TraumaticNon Traumatic)
Extra-axial
Parenchymal

Cerebral infarction.
Spinal trauma.

Emergency Radiology
CNS Emergencies:
Skull Fractures:
What to order:
Plain X-ray of the skull (lateral view - AP)
Computed tomography of the Brain (Axial
Coronal) (bone window)

When:
History of trauma evident injury of the
scalp

Findings:

Skull Fractures (Plain X-ray)

Skull Fractures (Plain X-ray)

Skull Fractures (CT Scan)

Bone window

Skull Fractures (CT Scan)

Soft tissue window

Bone window

Skull Fractures (CT Scan)

Skull Fractures (CT Scan) 3D Reconstruction

Emergency Radiology
CNS Emergencies:
Hemorrhage:

Traumatic

Traumatic

Non

What to order:
Computed tomography (CT) of the Brain
(Axial)

When:
Head trauma focal neurological defect.

Findings:

Emergency Radiology
CNS Emergencies:
Hemorrhage: Traumatic
Findings in:
Extra Dural Blood
Subdural Blood.
Cerebral contusion.

Traumatic Extraddural Hematoma (CT Scan)

Traumatic Subdural Hematoma (CT Scan)

Traumatic Cerebral Contusion (CT Scan)

Traumatic Cerebral Contusion (CT Scan)

Emergency Radiology
CNS Emergencies:
Hemorrhage: Non - Traumatic
Findings in:
Subarachnoid Blood
Intraparenchymal Blood.
Intraventricular Blood

Subarachnoid Hemorrhage (CT Scan)

Intraparenchymal Hemorrhage (CT Scan)

Intraparenchymal
Angiography)

Hemorrhage

(CT

Scan,

Intraventricular Hemorrhage (CT Scan)

Emergency Radiology
CNS Emergencies:
Cerebral Infarction:
What to order:
Computed tomography (CT) of the Brain
(Axial)
Magnetic Resonance Imaging (MRI) : DWI

When:
Focal neurological defect - Stroke

Findings:

Cerebral Infarction (CT Scan)

Cerebral Infarction (CT Scan, Angiography)

Cerebral Infarction (CT Scan, MRI)

Cerebral Infarction (MRI, DWI)

Emergency Radiology
Face Emergencies:
Facial Fractures
Orbit Zygoma Maxillary Frontal - Nasal

Soft tissue injuries of the orbit

FB occular injuries

Emergency Radiology
Facial fractures:
What to order?
Plain X-ray of the Skull (Lateral view PA
view)
Computed Tomography of the facial bones
(Bone windowAxial & coronal3D recon.)

When?
History of trauma to the face
disfigurement Severe facial contusions

Findings

Facial Fractures (Plain X-ray)

Fracture Maxilla (CT Scan)

Fracture Maxilla, Mandible, Zygoma (CT Scan)

Fracture Mandible (Plain X-ray, Panorama)

FACE (3D Reconstruction)

Emergency Radiology
Orbital Injuries:
What to order?
Plain X-ray of the Skull (Lateral view PA
view)
Computed Tomography of the Orbit (Axial
& Coronal - Bone & Soft tissue settings)

When?
History of trauma to the orbit History of
FB to the eye

Findings

Blowout Fracture (Plain X-ray, CT Scan)

Blowout fracture (CT scan)

Foreign Body of the Orbit (CT scan)

Emergency Radiology
Spinal Emergencies:
Trauma
Vertebral fracture (Varieties)
Spinal cord injuries.

Emergency Radiology
Spinal trauma:
What to order?
Plain X-ray of the spine (Lateral view AP
view)
Computed Tomography of the Spine (Axial
- Bone & Soft tissue settings3D recon.)
MRI of the spine. (for cord injury)

When?
History of trauma Falling from hieght.

Findings

Lumbar Spine Fracture (Plain X-ray)

Cervical Spine Fracture (Plain X-ray, CT scan)

Cervical Spine Fracture (CT scan, MRI)

Emergency Radiology
Chest Emergencies:
Chest Trauma
Rib fractures Traumatic Hemothorax
pneumothorax pneumomediastinum
pulmonary
contusion,
laceration
hematoma

Esophageal
injury
diaphragmatic injury etc.

Airway Foreign Body.

&

Emergency Radiology
Chest trauma:
What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Computed Tomography of the Chest
Angiography (Aortography)

When?
History of trauma Difficulty of breathing.

Findings

Multiple Ribs Fracture (Plain X-ray)

Multiple Ribs Fracture (Plain X-ray)

Pneumothorax (Plain X-ray)

Pneumothorax, Lung Contusion (CT Scan)

Hemopneumothorax (Plain X-ray)

Hemopneumothorax, Lung Contusion, Fracture ribs (Plain

X-ray)

Diaphragmatic Rupture (Plain X-ray Contrast

Meal)

Diaphragmatic Rupture (Plain X-ray CT)

Tracheal Injury (Plain X-ray, CT scan)

Emergency Radiology
FB of the Airway:
What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Computed Tomography of the Chest

When?
Children Bad Habits Unconscious
patient.

Findings

FB of the Airways (Plain X-ray)

FB of the Airways (Plain X-ray)

FB of the Airways (Plain X-ray)

Emergency Radiology
Cardiovascular Emergencies:

CHF
Pericardial effusion
Aortic dissection, trauma.
Pulmonary Edema
Pulmonary Embolism.
Peripheral ischemia (acute)
DVT

Emergency Radiology
CHF:
What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Echocardiography

When?
Dyspnea signs of low cardiac output.

Findings

CHF (Plain X-ray)

Emergency Radiology
Pericardial effusion:
What to order?
Plain X-ray of the Chest (PA view - Lateral
view)
Echocardiography

When?
Chest pain friction rub faint heart
sounds on auscultation.

Findings

Pericardial Effusion (Plain X-ray)

Emergency Radiology
Aortic dissection:
What to order?

Plain X-ray of the Chest (PA viewLat. view)

CT scan.
MRI
Aortography

When?
Sudden severe tearing substernal chest
pain.

Findings

Aortic Dissection (Plain X-ray, CT scan)

Aortic Dissection (Angiography)

Emergency Radiology
Acute peripheral ischemia:
What to order?
Arteriography
Color doppler Ultrasound (chronic)

When?
Sudden onset of severe pain, coldness,
numbness or pallor in a portion of an
extremity.

Findings

Acute Peripheral Ischemia (Angiography)

Emergency Radiology
DVT (Deep Vein Thrombosis):
What to order?
Color Doppler Ultrasound.
Venography

When?
Asymptomatic pain edema skin
discoloration.

Findings

DVT (Color Doppler)

Emergency Radiology
Abdominal Emergencies:
Abdominal Trauma
Hemoperitonium
Visceral injuries (Liver, Spleen, Kidney,
UB, etc.)

Non-Traumatic emergencies.
Intestinal obstruction, Appendicitis, GUT
perforation
Ascites, Jaundice, peritonitis, GI bleeding

Emergency Radiology
Abdominal trauma:
What to order?

Chest & Abdominal radiographs.

Ultrasound (FAST)
CT scan
Arteriorgraphy.

When?
History of trauma to the abdomen Motor
vehicle accidents.

Findings

Abdominal Trauma (Plain X-ray, US)

Abdominal Trauma (US, CT scan)

Abdominal Trauma (CT scan)

Abdominal Trauma (CT scan, Ultrasound)

Emergency Radiology
Miscellaneous Abdominal Emergencies:

Intestinal Obstruction
What to order?
Abdominal radiograph.
CT scan

When?
Crampy abdominal pain nausea
vomiting abdominal tenderness.

Findings

&

Intestinal Obstruction (Plain X-ray)

Intestinal Obstruction (Plain X-ray, CT scan)

Emergency Radiology
Miscellaneous Abdominal Emergencies:

Gut Perforation (e.g. Perforated DU)

What to order?
Abdominal radiograph (Erect).
US

When?
History of peptic ulceration signs of
peritonitis.

Findings

Perforated Gut (Plain X-ray)

Perforated Gut (Plain X-ray)

Emergency Radiology
Miscellaneous Abdominal Emergencies:
Jaundice
What to order?
Ultrasound
CT scan
Percutaneous transhepatic cholangiography (PTHC)
Endoscopic
retrograde
cholangiopancreatograpgy
(ERCP)

When?
Yellowish discoloration of the skin dark urine
pale stools

Findings

Obstructive Jaundice (ERCP, PTC)

Emergency Radiology
Miscellaneous Abdominal Emergencies:

Appendicitis:
What to order?
Abdominal radiograph.
Ultrasound
CT scan

When?
Sudden onset of epigastric pain rebound
tenderness.

Findings

Appendicitis (Plain X-ray)

Appendicitis (Plain X-ray, US)

Appendicitis (CT Scan, US)

Emergency Radiology
Miscellaneous Abdominal Emergencies:

Cholecystitis:
What to order?
Ultrasound

When?
Sudden onset of epigastric pain rebound
tenderness.

Findings

Cholecystitis (Plain X-ray, US)

Emergency Radiology
Genitourinary Emergencies:

UT stones
Hematuria
Urinary tract trauma.
Urethral Injuries, stones (male)
Scrotal injuries, swellings, testicular
torsion, epidiymitis (male)

Emergency Radiology
Ureteric Stones (Renal Colic):
What to order?

Plain X-ray of the urinary tract (PUT)

Ultrasound
Intravenous Urography (IVU)
CT of the abdomen

When?
Sudden onset of loin pain radiating to the
groin.

Findings

Ureteric Stones (Plain X-ray, IVU)

Ureteric Stones (IVU)

Emergency Radiology
Hematuria (Painful - Painless):
What to order?

Plain X-ray of the urinary tract (PUT)

Ultrasound
Intravenous Urography (IVU)
CT of the abdomen
Cystoscopy

When?
Passage of blood or blood clots with urination
(either painful or painless).

Findings

Renal Stones (Plain X-ray, IVU)

Renal Stones (Plain X-ray, IVU)

Urinary Bladder Stones (Plain X-ray)

Renal Mass (US, CT)

UB Mass (IVU, CT ,US)

Emergency Radiology
Urinary tract trauma (Renal Urinary

Bladder male urethra):

What to order?

Plain X-ray of the urinary tract (PUT)

Ultrasound
Intravenous Urography (IVU)
CT of the abdomen
Ascending urethrocystography

When?
History of blunt trauma to the abdomen Falling
astride.

Findings

Renal Trauma (CT)

Renal Trauma (CT)

UB Extraperitoneal rupture (Ascending Cystogram)

UB Rupture (Ascending cystogram , CT)

Urethral Trauma (Ascending Urethrogram)

Emergency Radiology
Scrotal emergencies:
What to order?
Ultrasound with color Doppler.

When?
Acute scrotal pain trauma to testis.

Findings

Testicular Torsion (US)

Testicular Torsion (Doppler US)

Acute Epididymo-orchitis (US)

Acute Epididymo-orchitis (Doppler US)

Testicular Trauma (US)

Emergency Radiology
Gyncological & Obstetric Emergencies:
Ovarian Torsion
PID
Abortion
Ectopic pregnancy
Placenta Previa

Emergency Radiology
Gynecological emergencies:
What to order?
Ultrasound (Color Doppler)

When?
Lower abdominal pain fever vaginal
discharge

Findings

Ovarian Torsion (US)

Ovarian Torsion (US)

Emergency Radiology
Obstetric emergencies:
What to order?
Ultrasound (Color Doppler)

When?
Bleeding in early / late pregnancy.

Findings

Viable Fetus (US)

Non Viable Fetus (US)

Incomplete Abortion (US)

Blighted Ovum (US)

Ectopic Pregnancy (US)

Ectopic Pregnancy (US)

Retroplacental Hematoma, Placenta Previa (US)

Emergency Radiology
Muscloskeletal Emergencies:
Upper & lower extremities Fractures &
dislocations
Pelvic Fractures.
Joint injuries
Ligaments and tendons injuries.

Emergency Radiology
Muscloskeletal emergencies:
What to order?
Plain X-ray.
CT scan.
MRI

When?
History of trauma.

Findings

Fracture Both bones forearm (Plain X-ray)

Fracture dislocation of the elbow (Plain X-ray)

Fracture Big toe, Fracture neck humerus (Plain

X-ray)

Fracture Pelvic Bone (Plain X-ray, CT)

Emergency Radiology
Pediatric Emergencies:
Neonatal
emergencies
obstruction )
Intussception.
Foreign body aspiration.
Bone injuries.

(intestinal

Neonatal Intestinal Obstruction (Plain X-ray, Contrast)

Duodenal Atresia

Ileal Atresia

Intussusception (Plain X-ray, Contrast)