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Important !!
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
1. CNS Emergencies:
- Skull Fractures
- Hemorrhage: (Traumatic-Non 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)
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Emergency Radiology
CNS Emergencies:
- Hemorrhage: Traumatic - Non Traumatic
- 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 Extradural 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
Intraparenchymal Hemorrhage (CT Scan)
ICH, SAH (CT scan) Angiografi
IVH (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 (CTScan, Angiography)
Cerebral Infarction (CT Scan)
Cerebral Infarction (MRI, DWI)
Emergency Radiology
2. 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 window-Axial & coronal-3D recon.)
- When?
• History of trauma to the face -disfigurement
-Severe facial contusions
- Findings
FACIAL FRACTURE (SKULL AP/LATERAL)
Fracture Maxilla (CT Scan)
Fracture Maxilla, Mandible, Zygoma (CT Scan)
Fracture Mandible (Plain X-ray, Panorama)
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 (CTscan)
Foreign Body of the Orbit (CT scan)
Emergency Radiology
3. 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 settings-3D recon.)
• MRI of the spine. (for cord injury)
- When?
• History of trauma - Falling from height.
- Findings
Lumbar Spine Fracture (Plain X-ray)
Cervical Spine Fracture (Plain X-ray, CT scan)
Cervical Spine Fracture (CT scan)
Cervical Spine Fracture (MRI)
Emergency Radiology
4. 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)
Pneumothorax (Plain X-ray)
PASIEN DENGAN SESAK SPONTAN POST TRAUMA
Pneumothorax, Lung Contusion (CT Scan)
Hemopneumothorax (Plain X-ray)
Hemopneumothorax, Lung Contusion, Fracture ribs (Plain X-ray)
Diaphragmatic Rupture (Plain X-ray - Contrast Meal)
Tracheal injury (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
5. 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)
CARDIOMEGALI
EDEMA PARU / BUTTERFLY APPEARANCE
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)
Pericardial Effusion (CT scan)
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Emergency Radiology
Aortic dissection:
- What to order?
• Plain X-ray of the Chest (PA view-Lat. view)
• CT scan.
• MRI
• Aortography
- When?
• Sudden severe tearing substernal chest
pain.
- Findings
Aortic Dissection (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)
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Emergency Radiology
6. 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
• Arteriography.
- When?
• History of trauma to the abdomen - Motor
vehicle accidents.
- Findings
Abdominal Trauma (Plain X-ray, US)
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/duodenal ulcer)
- 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 cholangiopancreatography
(ERCP)
- When?
• Yellowish discoloration of the skin - dark urine -pale
stools
- Findings
Obstructive Jaundice
(ERCP, PTC)
Endoscopic Retrograde
Cholangiopancreatography
Percutaneus Transhepatic
Cholangiography
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)
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
7. Genitourinary Emergencies:
- UT stones
- Hematuria
- Urinary tract trauma.
- Urethral Injuries, stones (male)
- Scrotal injuries, swellings, testicular
torsion, epididymitis (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)
Urinary Bladder Stones (Plain X-ray)
Renal Mass (US, CT)
VU 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)
Extraperitoneal bladder rupture
(ASCENDING CYSTOGRAPHY)
VU 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 (Doppler US)
Acute Epididymo-orchitis (US)
Norma! testis