Diagnostic Radiology Notes

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Introduction to Image Pattern Recognition CRT04211 · Image Pattern Recognition START READING NOTES Study Introduction to Image Pattern Recognition using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic LEARNING OBJECTIVES Introduction Introduction to Image Pattern Recognition INTRODUCTION TO IMAGE PATTERN RECOGNITION LEARNING OBJECTIVES At the end of sessions in image pattern recognition students should be able to ; Apply radiological pathology concepts in recognizing abnormalities of axial and appendicular system patterns Apply systematic chest analysis in identifying chest abnormalities Apply radiological pathology pattern recognition technique in identifying abnormalities in GIT contrast image Apply image pattern recognition approach in evaluating abnormalities of the Genital urinary system contrast investigations Apply image pattern recognition steps in identifying abnormalities in dental radiographs Apply image pattern recognition steps in documenting radiological image Introduction Pattern recognition may be defined as being able to recognise normal anatomical and physiological appearances on an image and those variations of appearances, which may indicate pathology. Some criteria should be met, to be competent in pattern recognition. A person who performs pattern recognition should have a fair amount of expertise in medical imaging and knowledge of radiographic anatomy and normal variants so as to identify variations that may indicate pathology. Introduction to Image Pattern Recognition Optimal image quality allows one to make accurate diagnosis Unacceptable images may cause one to miss a fracture or a destructive lesion. NOTE: It would be difficult to confidently perform pattern recognition if the image quality of a dynamic image or hard copy is not of an acceptable standard. There is consensus that optimal image quality entails meeting medico-legal requirements, such as each image to contain the patient's details, date of examination, anatomical marker, and adequate visualisation of radiographic anatomy /signs.This means that patient positioning should be correct for each projection, that the images are not blurred and that optimal image density is visualised. Introduction to Image Pattern Recognition Thus Image quality depends on correct radiographic techniques being used for each projection, correct selection of exposure factors and use of suitable imaging systems which are of an optimal standard. The patient/area of interest should be in accordance with recommended projections to ensure that all relevant anatomical parts are visualized. For example in skull radiography the patient's head should be straight to allow one to comment of symmetry of the skull bones, Chest radiographers should always be exposed on full inspiration to prevent incorrect diagnosis due to unacceptable radiography THANK YOU FOR LISTENING NEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Normal Chest Radiographic Patterns CRT04211 · Image Pattern Recognition START READING NOTES Study Normal Chest Radiographic Patterns using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Normal Chest Radiographic Patterns Simplified technique of reading (CXR) The A-H Technique Explained 5. E – Extrathoracic: Is there any rotation seen? Bones On Bones Check for the followings NOTE: NORMAL CHEST RADIOGRAPHIC PATTERNS Normal Chest Radiographic Patterns Opacity in radiology means an area on an image that appears whiter or denser than surrounding areas, indicating increased density or a blockage of X-rays. Simplified technique of reading (CXR) The A-H technique for reading a chest x-ray is a systematic approach that ensures all key areas are assessed, minimizing the chance of missing important findings. It involves checking patient details, orientation, and positioning, and then systematically reviewing the Airway, Bones, Cardiac structures, Diaphragm, Extrathoracic structures, Fields (lungs), and Hilum. The A-H Technique Explained A – Airway: Evaluate the trachea, carina, and bronchi for any abnormalities like narrowing or masses. B – Bones: Assess the thoracic cage for fractures, deformities, or other bony abnormalities. C – Cardiac: Evaluate the heart size and shape, and check for any calcifications, or other cardiac abnormalities. D – Diaphragm: Inspect the hemidiaphragms for position, shape, and any signs of elevation or abnormalities. 5. E – Extrathoracic: Assess the soft tissues outside the chest wall for foreign bodies, swelling, or other abnormalities. F – Fields (Lungs): Systematically evaluate the lung fields for opacities, densities, or other abnormalities. G – Gastric Bubble: Check for the presence of a gastric bubble, which is important for confirming proper positioning and may indicate abnormalities. H – Hilum: Inspect the hilar structures, which are important for assessing lung function and identifying any masses or abnormalities. Is there any rotation seen? Which side is the patient rotated to? To which side is the patient rotated? Overexposure and underexposure Bones Clavicles (check rotation) Ribs (posterior vs anterior) Spine (alignment and shape) Scapula position On Bones Check for the followings Symmetry Cortical continuity Bone density Fractures or lesions Joint alignment NOTE: Symmetry: Clavicles and ribs should be symmetrical on both sides. Bone Density: Should be consistent, without areas of excessive darkness (lysis) or brightness (sclerosis). Cortical Line: Should be smooth and unbroken — fractures will disrupt this. Vertebral Bodies: Should gradually become darker (less dense) lower down due to overlying soft tissue and air SCLEROSIS : ABNORMAL HARDENING LYSIS : DISINTERGRATION OF CELLS BY RUPTURE OF THE CELL WALLS BRONCHOVASCULAR MARKINGS: appearance of blood vessels and bronchial tube in the lungs, visible on the chest x-ray . Assess the following CXR images Thank you for listening ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Introduction To Abnormal Chest X-ray Findings CRT04211 · Image Pattern Recognition START READING NOTES Study Introduction To Abnormal Chest X-ray Findings using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Learning objective Congenital Disorders Introduction To Abnormal Chest X-ray Findings Acquired Disorders Traumatic Disorders Degenerative Disorders Aortic aneurysm (thoracic): Widened mediastinal silhouette, abnormal aortic contour(enlargement of aortic knob). Introduction to Abnormal findings in chest radiographs Learning objective Students should be able to describe abnormal findings in chest radiographs under the following categories: Congenital disorders Acquired disorders Traumatic disorders Degenerative disorders Congenital Disorders These are abnormalities present at birth due to genetic or developmental causes and can cause structural or functional defects. Abnormal Findings ; Congenital diaphragmatic hernia: Herniation of abdominal contents into the thoracic cavity which can be presented with Air-filled bowel loops in the thoracic cavity and mediastinal shift. Congenital heart disease (e.g., Tetralogy of Fallot): presents with boot-shaped heart and can cause increased or decreased pulmonary vascular markings. Congenital diaphragmatic hernia Tetralogy of Fallot(heart disease) Introduction To Abnormal Chest X-ray Findings Bronchopulmonary Sequestration: Non-functioning lung tissue with abnormal blood supply in chest x-ray present with Mass-like opacity with systemic arterial supply (may not be obvious on plain X-ray). Bronchogenic cysts: Well-defined, round mediastinal or intrapulmonary mass. Eventration of diaphragm: Smooth, elevated hemidiaphragm without signs of trauma or infection. Pulmonary Agenesis: Complete absence of lung tissue, leading to mediastinal shift. Bronchogenic cysts Eventration of diaphragm Pulmonary Agenesis Acquired Disorders These develop later in life (after birth) due to various factors such as infections, tumors, or systemic diseases. Abnormal Findings: Pneumonia: Infection leading to Localized consolidation, opacities and air bronchograms. Tuberculosis: Upper lobe opacities, cavitations, calcified granulomas, fibrosis. Pleural effusion: Accumulation of fluid in the pleural spaces in chest x-ray will present with Blunting of costophrenic angles, meniscus sign, homogeneous opacity. Cavitation: Calcified granulomas: Fibrosis: Pneumonia Tuberculosis Pleural effusion Introduction To Abnormal Chest X-ray Findings Pulmonary edema (e.g., in CHF): Fluid accumulation in the lung causing Bilateral perihilar infiltrates ("bat-wing" appearance), Kerley B lines, cardiomegaly. Interstitial lung disease: Presents with Reticulonodular patterns, and honeycombing. Sarcoidosis: Bilateral hilar lymphadenopathy, interstitial infiltrates. Lung cancer: Mass lesion with irregular borders and possible hilar enlargement, and possible collapse or consolidation Pulmonary edema Interstitial lung disease Sarcoidosis Traumatic Disorders Result from direct physical injury to the chest wall or internal thoracic structures. Abnormal Findings: Rib fractures: Discontinuity in rib cortex, soft tissue swelling. Note rib fracture can potentially leading to pneumothorax. Pneumothorax: Abnormal air in the pleural space causing lung collapse presents with Visible pleural line with absent lung markings peripheral to it. Rib fractures Pneumothorax Introduction To Abnormal Chest X-ray Findings Hemothorax: Blood accumulation in the pleural cavity in chest x-ray will present with Fluid level or opaque hemithorax (depending on volume). Pulmonary contusion: Also known as lung contusion Patchy opacities, often localized to site of trauma. Flail chest: Paradoxical chest wall motion (clinical), multiple adjacent rib fractures on X-ray. Diaphragmatic rupture: Elevated hemidiaphragm, bowel loops in thorax. Hemothorax Diaphragmatic rupture Degenerative Disorders These are chronic conditions, usually progressing with age or chronic stress on the lungs. Abnormal Findings: Chronic Obstructive Pulmonary Disease (COPD): Emphysema and chronic bronchitis leading to Hyperinflated lungs, flattened diaphragms, increased retrosternal airspace. Pulmonary fibrosis: Scarring of lung tissue causing Reticular or reticulonodular pattern, volume loss, honeycombing. Aortic aneurysm (thoracic): Widened mediastinal silhouette, abnormal aortic contour(enlargement of aortic knob). Degenerative spinal changes (visible on chest X-ray): Osteophytes, vertebral body sclerosis, kyphosis affecting lung expansion. Silicosis: Interstitial lung disease due to inhalation of silica dust ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Pleural Effusion CRT04211 · Image Pattern Recognition START READING NOTES Study Pleural Effusion using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic PLEURAL EFFUSION –BASIC ANATOMY EVALUATION OF PLEURAL EFFUSION IN CHEST X-RAY There are other patterns; Pleural Effusion On the supine CXR A “WHITE OUT” CAUSED BY A MASSIVE PLEURAL EFFUSION Assess pleural effusion in the following PLEURAL EFFUSION PLEURAL EFFUSION –BASIC ANATOMY The pleura can be likened to a sac enveloping the lung. This sac has two membranous walls – the inner visceral and the outer parietal. The pleura is not visible on a normal CXR except where it forms part of a lung Fissure or where the two lungs abut each other in the midline. The pleural space is a closed cavity between the layers of the visceral and parietal pleura. A small amount of lubricating fluid lies within the cavity. The lung fissures extend between the lobes of each lung and are lined by two layers of visceral pleura. EVALUATION OF PLEURAL EFFUSION IN CHEST X-RAY Fluid in the pleural space can adopt several different appearances on both erect and supine CXRs. On the erect frontal CXR The commonest appearance is an opaque meniscus at a costophrenic angle. It requires approximately 200–300 ml of pleural fluid to efface the normal sharp recess between the diaphragm and the ribs. If the effusion is very large, then the entire hemithorax may be opaque, and the heart may be pushed towards the normal side. There are other patterns; Lamellar – A linear (lamellar) shadow paralleling the lateral aspect of the lung. Encysted – Loculation within a fissure or elsewhere Sub-pulmonary – Pooling within the pleural space below the lung. This is a subpulmonary effusion and is a relatively common occurrence. Pleural Effusion A sub-pulmonary effusion is usually easier to detect on the left side, where the pool can cause the gastric air bubble to appear widely separate from the (apparent) superior margin of the diaphragm. Note: The normal distance between the dome of the diaphragm and the air in the stomach does not normally exceed 7 mm in 98% of people aged 50 years and over On the supine CXR When the patient is supine, pleural fluid layers out in the posterior part of the pleural space. This causes the hemithorax to appear whiter or paler grey than the normal side. In most instances the normal lung vessels will be seen through this shadowing. Approximately 200 ml of fluid needs to be present before an abnormal pale grey appearance is produced. A “WHITE OUT” CAUSED BY A MASSIVE PLEURAL EFFUSION A completely white hemithorax, often referred to as a “white out”, may be caused by a large volume (5–7 litres) of pleural fluid. Assess pleural effusion in the following chest radiographs ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Pneumonia And Pulmonary Tuberculosis CRT04211 · Image Pattern Recognition START READING NOTES Study Pneumonia And Pulmonary Tuberculosis using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Terminologies used Pneumonia And Pulmonary Tuberculosis Bronchiectasis: an irreversible dilatation of the bronchial tree, may appear as tram tracks, ring shadows, or tubular opacities. Note: Consider the followings INTRODUCTION CLINICAL FINDINGS Classifications of tuberculosis PRIMARY TB MOST COMMON RADIOLOGICAL FINDINGS IN PRIMARY TB. POST- PRIMARY TB MILIARY TB GENERAL RADIOGRAPHIC FEATURES OF PULMONARY TB PNEUMONIA Terminologies used Lung Consolidation: Is a radiological term describing an area of increased lung density, often caused by fluid, cells, or other material filling the alveoli (tiny air sacs in the lungs). It appears with homogenous opacity, Air bronchograms, which are visible air-filled airways surrounded by consolidated tissue, are a key characteristic of consolidation. Pneumonia is by far the commonest cause of an area of CXR consolidation. Pneumonia And Pulmonary Tuberculosis Air bronchogram sign: Is a radiographic sign of consolidation, characterized by black lines within a white, dense area of lung tissue, representing air-filled bronchi within consolidated lung. Patch opaque shadows: also known as pulmonary opacities, represent areas where the X-ray beam is attenuated more than the surrounding lung tissue, resulting in a denser or whiter appearance on the image. Bronchiectasis: an irreversible dilatation of the bronchial tree, may appear as tram tracks, ring shadows, or tubular opacities. Peribronchovascular infiltrates: increased density or opacity along the pathways of the bronchi and blood vessels, often described as peribronchovascular thickening or consolidation. SOB – Note: Empyema: a collection of pus within the pleural space, often appearing as a fluid density that may contain air-fluid levels Pleurisy: or pleuritis, is the inflammation of the pleura, the membrane lining the lungs and chest wall. Bacteremia: Refers to the presence of bacteria in the bloodstream. Pneumonia And Pulmonary Tuberculosis The most frequent chest radiographic findings of COVID-19 pneumonia: Are Multifocal consolidation or ground-glass opacity (GGO), usually with bilateral, peripheral, and lower zone predominance. Consider the followings The CXR is excellent for detecting the presence and extent of most pneumonias. All the same, on the CXR, some pneumonias are furtive and secretive and do their best to hide. Fortunately, there is help at hand – the silhouette sign. If you look for the silhouette sign, then you will be able to detect these hidden pneumonias. Identify the type of pneumonia PULMONARY TUBERCULOSIS INTRODUCTION Tuberculosis is an airborne infectious disease caused by bacteria called mycobacterium tuberculosis which primarily affect the lungs but can spread to other organs. It is transmitted through airborne droplets when an infected person coughs or sneezes ,once inhaled the bacteria settle in the lungs and trigger the immune response leading to the granuloma formation. CLINICAL FINDINGS A persistent cough (lasting longer than 3 weeks), often with blood or mucus Fatigue weight loss loss of appetite Fever night sweats Additionally, some individuals may experience chest pain or shortness of breath. Classifications of tuberculosis The classifications of the tuberculosis it depends on the range of infections ,the following are the two categories of tuberculosis,(Patterns that raise the suspicion of PTB) PRIMARY TB POST PRIMARY TB NOTE : MILIARY TB PRIMARY TB Primary TB refers to the initial infection with Mycobacterium tuberculosis, often occurring in previously uninfected individuals, typically in children. It's characterized by the development of a "primary complex," which includes a lung lesion (usually a Ghon focus), lymphadenopathy in the hilar lymph nodes, and sometimes pleural effusion. Radiologically, primary TB can manifest as parenchymal consolidation(may show air fluid level), hilar lymphadenopathy, miliary nodes and possible pleural effusion Ghon complex (a calcified granuloma) and a corresponding calcified lymph node can be seen in healed primary TB. MOST COMMON RADIOLOGICAL FINDINGS IN PRIMARY TB. 1.Lymphadenopathy: the enlargement of lymph nodes near the hilum ,often appears as bulky or rounded opacity on the X rays. This is the most Common radiological manifestation of primary TB. 2.Lung consolidation 3.Possible pleural effusion Primary TB(Lymphadenopathy) POST- PRIMARY TB Usually post primary tuberculosis is thought to results from the reactivation of infection with dormat tuberculosis(latent TB), The radiological findings of post primary TB . Cavitary lesion (these are hollow spaces in lungs tissues due to bacteria destruction). Are frequently found in a consolidation area and can be multifocal. Cavitation is typically findings in post primary tuberculosis ,seen on chest radiographs PA chest radiograph showing patchy air spaces opacity(arrows) in right upper lobe with a cavity lesion(arrowheads), Extensive shadowing, and some volume loss, in the right upper lobe. Post primary PTB WHAT TYPE OF TB IS THIS MILIARY TB Refers to disseminated form where bacteria spread through the bloodstream causing tiny nodules through lungs. This represents haematogenous spread of the bacilli. It is most commonly associated with primary PTB but it can occur with post-primary PTB. The term “miliary” refers to the millet-seed appearance of the tiny nodules scattered throughout the lungs Pneumonia And Pulmonary Tuberculosis characterized by fibronodular changes in the apical and upper lung zones (numerous small pulmonary opacities that are generally uniform in size and widely distributed) MILLIARY TB GENERAL RADIOGRAPHIC FEATURES OF PULMONARY TB Summarize the above findings Thank you for listening ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? 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DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Bronchial Carcinoma,Pneumothorax & Pulmonary Edema CRT04211 · Image Pattern Recognition START READING NOTES Study Bronchial Carcinoma,Pneumothorax & Pulmonary Edema using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic OVERVIEW Introduction to Bronchial carcinoma Bronchial Carcinoma,Pneumothorax & Pulmonary Edema Causes and risk factors CXR FINDINGS OF BRONCHIAL CARCINOMA. Pleural effusion: Fluids accumulation in the pleural spaces , often seen in the advanced cases/stages. TUMOR WILL HIDE. Below the horizon of each dome of the diaphragm. Golden’s S sign Pulmonary metastases Atypical features include consolidation, cavitation, cystic change, calcification, ossification, haemorrhage, and Introduction to pneumothorax 1. Spontaneous Pneumothorax Caused by the chest injuries such as PATHOLOGIC Open / sucking pneumothorax Tension pneumothorax. CLINICALS FEATURES. SYMPTOMS RADIOLOGICAL FINDINGS OF PNEUMOTHORAX 3: Increase in radiolucency 4: Flattened Diaphragm 6. Deep sulcus sign Note these radiographic features: PULMONARY EDEMA Causes/Etiology non-cardiogenic pulmonary edema Phases/types of pulmonary edema Radiographic features Features of pulmonary interstitial oedema: Features of pulmonary alveolar edema: General radiographic features of pulmonary edema BRONCHIAL CARCINOMA. OVERVIEW Introduction to bronchial carcinoma Types of bronchial carcinoma Radiographic features/findings Introduction to Bronchial carcinoma Also known as bronchogenic carcinoma,refers to the lung cancer originating from the bronchi (the large airways of the lungs). The most common types of lung cancer can be classified into two main categories histologically as follows: Bronchial Carcinoma,Pneumothorax & Pulmonary Edema 1: Non–small cell lung cancer(NSCLC): The most common type of lung cancer, accounting for approximately 85% of all lung cancers. It's characterized by abnormal cells in the lungs reproducing rapidly and uncontrollably. Include 3 types Adenocarcinoma Squamous cell carcinoma Large cell 2: Small cell lung carcinoma(SCLC) Oat cell carcinoma is a faster-growing cancer that often spreads early. Histological types Causes and risk factors Smoking( primary causes) Exposure to random gas Air pollution and harzadous chemicals. Genetic predisposition Symptoms Persistent cough Chest pain Coughing up blood Unexplained weight loss CXR FINDINGS OF BRONCHIAL CARCINOMA. Irregular mass (tumour): A solitary or multiple lung masses, often with edges. (lung consolidation) Hilar enlargement: Due to the tumour growth near the bronchi. Lung collapse ( Atelectasis): If the tumour obstructs a bronchus, leading to segmental or lobar collapse. Golden S sign Cavitations: 15% of peripheral primary carcinomas cavitate. Most of these are squamous cell carcinomas that may show central necrosis with cavitation. Pleural effusion: Fluids accumulation in the pleural spaces , often seen in the advanced cases/stages. Note: Most cancers ( more than 70%) occurs in the upper lobes. Many bronchial carcinomas are easy to detect usually as conspicous mass. BRONCHOGENIC CARCINOMA. Lung cancer. Left hilum bronchogenic carcinoma TUMOR WILL HIDE. Some of carcinomas are difficult to detect because of their position or because they are overlapped by normal structures. To locate a hidden mass you need to inspect four areas very carefully. Superimposed on the heart. Make sure that the density on the heart on both side of the supine is equal. Bronchial Carcinoma,Pneumothorax & Pulmonary Edema The lung apices. Some tumor begin as flat lesion and the CXR appearance may be dismissed as simple pleural thickness ,A flat apices carcinoma can mimic a apical pleural cap Below the horizon of each dome of the diaphragm. A large part of each lower lobe lies below the horizon of each dome of the diaphragm ,even so if a lung mass is surrounded by air it is usually detectable on frontal CXR. Bronchial Carcinoma,Pneumothorax & Pulmonary Edema Around the hila: This does not refer to hilar enlargement. It refers to the lung parenchyma around, behind and in front of a hilum. Overlap by vessels entering or leaving the hilum can cause a nearby lung lesion to be overlooked. Golden’s S sign A collapsed right upper lobe with a mass at the hilum results in a reverse S configuration. The reversed S is made up of an elevated horizontal fissure and a bulky tumour at the hilum. Golden S sign Pulmonary metastases Refer to distant tumour spread from a variety of primary tumours to the lungs via the blood or lymphatics. Radiographic features Pulmonary metastases typically appear as multiple, peripheral, rounded nodules scattered throughout both lungs. Larger nodules and masses may be termed cannonball metastases. Atypical features include consolidation, cavitation, cystic change, calcification, ossification, haemorrhage, and secondary pneumothorax(post–primary). Cannonball PNEUMOTHORAX OVERVIEW Introduction to Pneumothorax. Clinical types. Radiological findings. Introduction to pneumothorax Pneumothorax refers to the presence of air in the pleural spaces/ refers to the presence of gas in the pleural space which allows the parietal and visceral pleura to separate and the lung to collapse. Occurs when the air enter in the pleural spaces( the area between the lung and the chest wall), causing the lungs to collapse partially or completely. There are several types of the pneumothorax,classified based on their causes and severity: 1. Spontaneous Pneumothorax Occurs without trauma and is further divided into: Primary spontaneous pneumothorax : happens in young healthy individuals without underlying lung disease. often due to ruptured lung blebs(sub pleural blebs). Secondary spontaneous pneumothorax: occurs in people with underlying lung diseases like COPD, asthma or cyst fibrosis. Caused by the chest injuries such as Blunt trauma: Ribs fractures puncturing the lung the lung. Penetrating trauma: stab wound, gunshot injuries or medical procedures like lung biopsies. Traumatic pneumothorax Bronchial Carcinoma,Pneumothorax & Pulmonary Edema Occurs when the air enter in the pleural spaces but can not escape and increasing pressure in the chest and progressive lungs collapse, this can compress the heart and the major blood vessels cause cardiovascular instability. Iatrogenic pneumothorax Occurs due to the medical procedures such as; Mechanical ventilation ,Excessive pressure causing lung rupture. Tension pneumothorax: PATHOLOGIC Simple/ closed pneumothorax: The opening in lung is very small and hence ,it heals rapidly. There is no continuous communication between the lung and pleural cavity. This means that pleural pressure is less than atmospheric pressure. Open / sucking pneumothorax The rupture site remains open and there is a communication between the pleural cavity and the

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Degenerative Disorders Cxr CRT04211 · Image Pattern Recognition START READING NOTES Study Degenerative Disorders Cxr using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic OVERVIEW Introduction to COPDs Causes and risk factors of COPDs There are however a number of other less common risk factors/etiologies, each with their own demographics. They include: Clinical presentation : Symptoms of COPD include: 1. Chronic bronchitis Radiological findings of chronic bronchitis. 2. Emphysema Radiological findings of emphysema Hyperlucency (Increased translucency): The lungs appear more black than usual due to the presence of air. Pulmonary fibrosis Radiological features/findings CHRONIC OBSTRUCTIVE PULMONARY DISEASES(COPDs) OVERVIEW Introduction to COPDs Types/components of COPDs Radiographic features Introduction to COPDs Refers to a group of disorders that cause chronic airways obstruction and breathing difficulties. Represents a spectrum of obstructive airway diseases. Includes two key components Chronic bronchitis(small air way disease) Emphysema Causes and risk factors of COPDs The most common cause has historically been (and unfortunately continues to be) cigarette smoking It takes many years of smoking to develop COPD and as such typically patients are older adults. There are however a number of other less common risk factors/etiologies, each with their own demographics. They include: Industrial exposure (e.G. Mining) Cystic fibrosis Alpha-1 antitrypsin deficiency Intravenous drug use (IVDU) Immune deficiency syndromes Vasculitides and connective tissue disorders Clinical presentation : Symptoms of COPD include: Dyspnea on exertion Wheezing Productive cough Pursed-lip breathing and use of accessory respiratory muscle (shortness of breath) 1. Chronic bronchitis This is the long-term inflammation of the bronchial tubes often due to the smoking or air pollution. The pollutants irritate the mucous lining of the bronchial tree and increase the susceptibility to both bronchial and virus infections. NOTE: Chronic exposure to these respiratory irritants leads to hyperplasia of mucous glands hypertrophy of the smooth muscles, thickening of the bronchial wall. Radiological findings of chronic bronchitis. Findings of chronic bronchitis are non specific on chest radiography and includes: Increased bronchovascular markings. pulmonary vessels and bronchial wall(thicker) may appear larger than normal(prominent). Cardiomegaly a)Cardiomegaly b)Lung marking 2. Emphysema This is the condition in which the lungs alveoli(air sacs) become distended, usually from loss of the elasticity ,it characterized by an increase in the air spaces distal to the terminals of the bronchioles with the destruction of alveolar walls. Radiological findings of emphysema Lung Hyperinflation(lung enlargement): The lungs appears over- inflated with increased (lucency). Flattened diaphragms :The diaphragms may appear lower than normal due to the hyperinflation of the lungs. Blunting of the costophrenic angles , the sharp between the diaphragm and the rib cage is lost which is the hallmark of the emphysema. Hyperlucency (Increased translucency): The lungs appear more black than usual due to the presence of air. Small heart: The heart shadow may appear smaller than normal due to the large amount of air in the lungs. Bullous changes: Air- filled pockets(bullae) may be visible in the lungs. Barrel shape(increased in AP diameter): The chest appears wider from front to back, resembling a barrel on the lateral radiograph. Emphysema Bullous changes Pulmonary fibrosis Pulmonary fibrosis is the preferred general term for the permanent replacement of lung parenchyma by connective tissue and is typically associated with functional impairment. A variety of insults cause focal or diffuse lung injury (mechanical, infectious, inflammatory, and iatrogenic). Lung repair culminates in fibrosis with volume loss and architectural distortion. Radiological features/findings In a chest X-ray, pulmonary fibrosis often presents with: Reticular opacities: Small, irregular, and often seen as a network of lines. These reticular patterns tend to be more pronounced at the lung bases, particularly in the subpleural regions. Volume loss Traction bronchiectasis Honeycombing may also be observed These are the most common finding, appearing as a network of lines within the lung tissue Pulmonary fibrosis ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Skeletal System CRT04211 · Image Pattern Recognition START READING NOTES Study Skeletal System using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Introduction Skeletal System Bone is a specialized connective tissue made primarily of collagen and calcium phosphate, which provides strength and flexibility. Osteoblasts are specialized bone-forming cells that play a crucial role in the formation of new bone tissue. Osteoclasts a bone cell that breaks down bone tissue to help with bone repair and mineral balance. Axial and Appendicular skeleton radiographic landmarks SKULL Facial Bones: Sutures: VERTEBRAL COLUMN Thoracic Vertebrae(T1-T12) Lumber vertebrae Sacrum Thoracic Cage: Ribs Appendicular Skeleton Radiographic Landmarks Upper Limb: Clavicle Scapula Arm Forearm Hand Lower Limb: Thigh Leg Foot NORMAL RADIOGRAPHIC PATTERNS OF THE AXIAL AND APPENDICULAR SYSTEM 4.Sella turcica is intact with normal size. Cervical Spine (C1–C7) 3.Intervertebral disc spaces are equal and maintained. Thoracic Spine (T1–T12) 3.Spinous processes well-aligned. Lumbar Spine (L1–L5) & Lumbosacral Junction (L5-S1) 3.Intervertebral disc spaces are well-preserved. Sacrum & Coccyx 3.Sacroiliac (SI) joints are symmetrical Shoulder Joint 3. Smooth Humeral Head and Glenoid Cavity Elbow Joint 3. Clear Anterior and Posterior Fat Pads Wrist Joint Hip Joint 3.Equal Joint Spaces Knee Joint 3.No Tibial Plateau Fractures Ankle Joint 3.No Soft Tissue Swelling Importance of Normal Radiographic Appearance ABNORMAL RADIOGRAPHIC FINDINGS IN THE AXIAL AND APPENDICULAR SYSTEM CONGENITAL DISORDERS 1. Osteogenesis imperfecta (OI) Clinical presentation Radiological Features of OI Bone Deformities 2. Osteopetrosis Radiological Findings of osteopetrosis Bone-within-bone 3. Diaphyseal Aclasis (Hereditary Multiple Exostoses/Osteochondromatosis) Radiological findings 4. Scoliosis ACQUIRED DISORDERS 1.Osteoporosis Radiological features 2. Osteomyelitis Sequestrum 4. Tuberculosis of the Spine/ spondylitis (Pott's Disease) 5. Paget’s disease The most frequent sites of involvement are: Plain radiographic features Spine Pelvis Long bones 6. Spondylolisthesis Pathology Radiographic Findings Consider the following on Plain Radiographic features 7. Rickets 8. Ankylosing Spondylitis Radiographic features On the Spine 9. Rheumatoid Arthritis (RA) The radiographic hallmarks of rheumatoid arthritis are: 10.Gout In plain radiograph Bone Surrounding soft tissues DEGENERATIVE DISORDERS 1. Osteoarthritis(OA) The Kellgren and Lawrence system is a common method of classifying the severity of osteoarthritis (OA) using five grades Risk factors Subchondral Cysts 2. Degenerative Disc Disease(DDD) Irregular Vertebral Alignment: Traumatic disorders Acute traumatic fractures are classified as: Descriptive terms used to indicate the shape or pattern of an acute fracture in the adult are: Dislocations Fractures in children Radiographic diagnosis of fractures 1. Vertebral Fractures Findings Bone Fragmentation 2. Pelvic Fractures 3.Clavicle Fracture 3. Colles' Fracture Fractures of the forearm Distal radio-ulnar fracture-dislocation (Galeazzi fracture) 4. Femoral Neck Fracture 5. Tibial Plateau Fracture Type II Type V 6.Ankle fractures Ankle fractures are classified using the Weber classification Type C Dislocation of the shoulder Anterior dislocation Posterior dislocation COMMUNICATING AXIAL AND APPENDICULAR RADIOGRAPHIC FINDINGS Ankylosing Spondylitis (SI Joints) Appendicular Skeleton (Limbs, Joints) Colles’ Fracture (Wrist) Type B Salter-Harris classification Types of Salter-Harris Fractures: Application of Radiological Pathology in Identifying Abnormalities of the Axial and Appendicular Skeleton Introduction The skeletal system is composed of 206 separate bones and is responsible for body support, protection, movement, and blood cell production. It contains more than 98% of the body’s total calcium and up to 75% of its total phosphorus. Skeletal System The system is commonly divided into the axial skeleton, which contains 80 bones, and the appendicular skeleton, which contains 126 bones. Bone is a specialized connective tissue made primarily of collagen and calcium phosphate, which provides strength and flexibility. The construction of bone classifies tissue as either compact or spongy. The outer portion of bone is composed of compact bone, and the inner portion, termed the medullary canal, is made up of cancellous bone. Osteoblasts are specialized bone-forming cells that play a crucial role in the formation of new bone tissue. They are responsible for bone growth , repair, and remodelling throughout a person's life. Osteoclasts a bone cell that breaks down bone tissue to help with bone repair and mineral balance. They break down bone tissue, releasing minerals such as calcium and phosphate into the bloodstream. Osteoclasts work in balance with osteoblasts (bone-forming cells) to maintain bone health and homeostasis. Axial and Appendicular skeleton radiographic landmarks The axial skeleton consists of 80 bones that form the central axis of the body, including the skull, vertebral column, and thoracic cage. Key radiographic landmarks include SKULL Cranial Bones: Frontal, parietal, occipital, temporal, sphenoid, and ethmoid bones. Facial Bones: Radiographic landmarks Maxillae. zygomas. nasal bones, lacrimal bones and palatine bones. Sutures: Radiographic landmarks Coronal suture. Sagittal suture. Lambdoid suture. squamosal suture. VERTEBRAL COLUMN Cervical Vertebrae (C1-C7): Radiographic Landmarks Atlas (C1). axis (C2). typical cervical vertebrae (C3-C7). Thoracic Vertebrae(T1-T12) Radiographic landmarks Vertebral Bodies. Costovertebral Joints. Spinous Processes. Pedicles. Intervertebral Foramina. Lumber vertebrae Radiographic landmarks Vertebral Bodies. Spinous Processes. Pedicles. Intervertebral Foramina. Sacrum Radiographic landmarks Sacral Promontory. Sacral Foramina. Sacroiliac Joints (SI Joints). Sacral Curvature. Thoracic Cage: Sternum Radiographic landmarks Manubrium. Body. xiphoid process. Ribs Radiographic landmarks True ribs (1-7). false ribs (8-10). floating ribs (11-12). Appendicular Skeleton Radiographic Landmarks The appendicular skeleton includes 126 bones that form the limbs and their girdles. Key radiographic landmarks include: Upper Limb: Pectoral Girdle Radiographic landmarks Clavicle. scapula. Clavicle Radiographic landmarks Sternal end. acromial end. Scapula Radiographic landmarks Acromion. coracoid process. glenoid cavity. Arm Radiographic landmarks Head of humerus. greater and lesser tubercles. olecranon fossa. Forearm Radiographic landmarks Radius and ulna. olecranon process. radial head. Hand Radiographic landmarks Carpals. Metacarpals. phalanges. Lower Limb: Pelvic Girdle Radiographic landmarks Ilium. Ischium. Symphysis pubis. acetabulum. Thigh Radiographic landmarks Femur with head. Greater and lesser trochanters. Condyles. Leg Radiographic landmark Tibia. Fibula. Tibial tuberosity. Fibular head. Foot Radiographic landmark Tarsals. Metatarsals. Phalanges. NORMAL RADIOGRAPHIC PATTERNS OF THE AXIAL AND APPENDICULAR SYSTEM A normal radiographic pattern refers to the standard appearance of bones and joints in a healthy individual. Below is an overview of the axial and appendicular skeleton normal radiographic pattern. Skull Radiographic pattern 1.Smooth, well-defined outer and inner cortices. The bone structure should be without fractures, tumors, or

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Hand Fractures And Dislocation CRT04211 · Image Pattern Recognition START READING NOTES Study Hand Fractures And Dislocation using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Hand Anatomy Imaging First Metacarpal Fractures Bennett fracture Plain radiographic features • Dorsal and radial dislocation (force from abductor pollicis longus) Rolando fracture BOXER'S FRACTURE Fracture of phalanges Hand Fractures And Dislocation Proximal Phalanx Primer of Diagnostic Imaging fifth edition – Weissleder, hand fractures and dislocations Hand Anatomy Metacarpals Phalanges: distal, medial, proximal Joints: distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) Hand Anatomy Imaging Plain radiographs: multiple views are necessary: AP / PA Lateral Oblique CT Scan First Metacarpal Fractures Bennett and Rolando fractures are intra-articular MCP fracture-dislocations of the thumb. These fractures must be distinguished from extraarticular fractures located distal to the carpometacarpal (CMC) joint because the former may require open reduction. Bennett fracture A Bennett fracture is a fracture of the base of the thumb resulting from forced abduction of the first metacarpal. It is defined as an intra-articular two-part fracture of the base of the first metacarpal bone. Plain radiographic features Two-piece fracture of the base of the thumb metacarpal Fracture line (radiolucent line) Intra-articular extension Dorsolateral displacement A small fragment of the 1st metacarpal, attached to the anterior oblique ligament, continues to articulate with the trapezium. Lateral retraction of the first metacarpal shaft by the abductor pollicis longus When an intra-articular fracture of the 1st metacarpal is comminuted, producing at least three parts, it is referred to as a Rolando fracture which has a worse prognosis • Dorsal and radial dislocation (force from abductor pollicis longus) Small fragment maintains articulation with trapezium. Rolando fracture Is a three-part or comminuted intra-articular fracture-dislocation of the base of the thumb (proximal first metacarpal). It can be thought of as a comminuted Bennett fracture. Rolando Fracture Comminuted Bennett fracture; the fracture line may have a Y, V, or T configuration. BOXER'S FRACTURE Fracture of the MCP neck (most commonly fifth MCP) with volar angulation and often external rotation of the distal fragment Fracture of the 3rd, 4th, and 5th MCP, with angulation and external rotation of distal fragment 4th and 5th metacarpal fracture Fracture of phalanges Mechanism of Injury: Stepped on (direct force) Hit on the tip of finger Twisting/torsion Hand Fractures And Dislocation Mallet Finger. A small avulsion injury is noted at the base of the distal phalanx, which is where the extensor digitorum tendon inserts. This is termed a mallet finger or baseball finger because it is often caused by a baseball striking the distal phalanx and causing the avulsion MALLET FINGER Proximal Phalanx More common than middle phalanx fractures. May result in a great deal of disability. Dorsal or palmar angulation may occur with these fractures. Primer of Diagnostic Imaging fifth edition – Weissleder, Radiopedia professional website Imaging of Othopaedic- Springer 2007 ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Plain Abdominal X-ray Pattern Recognition CRT04211 · Image Pattern Recognition START READING NOTES Study Plain Abdominal X-ray Pattern Recognition using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Normal Plain and contrasted radiographic GIT INTRODUCTION NINE ANATOMICAL REGIONS ABDOMINAL QUADRANTS ABDOMINAL ORGANS GASTROINTESTINAL SYSTEM ORGANS IMAGING CONSIDERATIONS Anteroposterior (AP) projections of the abdomen are generally taken in the supine position. As with other body areas, evaluation of the abdomen should be done systematically. Radiographic findings Plain Abdominal X-ray Pattern Recognition AIR-FLUID LEVEL BOWEL GAS(FREE AIR) Note: In Gastrointestinal System, Some contents of the abdomen can be seen without contrast media. Small bowel on plain x-ray Large bowel Other soft tissues seen on a plain films CONTRASTED INVESTIGATION OF THE GIT ORGAN TO BE INVESTIGATED STOMACH SMALL BOWEL CONGENITAL AND HEREDITARY BOWEL ATRESIA HYPERTROPHIC PYLORIC STENOSIS Abdominal radiography may show gastric distention with HPS. Sonography has become the standard and highly accurate method for diagnosing HPS without the need for radiation exposure. HIRSCHSPRUNG DISEASE (CONGENITAL MECKEL DIVERTICULUM Normal Plain and contrasted radiographic GIT Pattern Recognition INTRODUCTION The abdomen is composed of the abdominal and pelvic cavities and is often divided into nine anatomic regions. NINE ANATOMICAL REGIONS Right hypochondriac Epigastric Left hypochondriac Right lumbar Umbilical Left lumbar Right iliac Hypogastric Left iliac ABDOMINAL QUADRANTS It may also be described in terms of quadrants: Right-upper quadrant (RUQ) Right-lower quadrant (RLQ) Left-upper quadrant (LUQ) Left-lower quadrant (LLQ) ABDOMINAL ORGANS The abdominal cavity contains organs of the digestive system (stomach and intestines), the hepatobiliary system (liver, gallbladder, and pancreas), the urinary system (kidneys and ureters), and the circulatory system (spleen). The pelvic cavity contains the bladder, portions of the intestines,and the reproductive organs. GASTROINTESTINAL SYSTEM ORGANS A major portion of the gastrointestinal (GI) system is the alimentary tract, which serves to digest and absorb food. Extend from the mouth to Anus the alimentary tract consists of the mouth, pharynx, esophagus, stomach, small bowel, large bowel, and rectum. IMAGING CONSIDERATIONS Radiography Abdominal radiography is often performed for survey purposes, without contrast agents. The usual starting point is a supine radiograph taken to include the kidneys, ureters, and bladder (“KUB”). The frequency of abnormal findings on a conventional abdominal radiograph is fairly low and nonspecific, but it is of most value for patients complaining of severe abdominal tenderness and to rule out bowel obstructions and perforations Anteroposterior (AP) projections of the abdomen are generally taken in the supine position. An AP radiograph allows examination of air distribution within the bowels and of the size of the viscera, serves to evaluate vascular and other types of calcifications and body or soft tissue trauma, and, finally, serves as a preliminary radiograph for other procedures. As with other body areas, evaluation of the abdomen should be done systematically. This should include inspection of the renal outlines, ureters, psoas muscles, spleen, liver, gallbladder, and peritoneal fat stripes. Radiographic findings In a normal abdomen, varying amounts of gas and fecal material are always present in an unprepared patient. The liver,kidney, spleen, and psoas muscle shadows are variably outlined because of the lucent layer of fat surrounding them. Properitoneal fat stripes are visible as radiolucencies extending laterally from the costal margins down to the iliac crests. Plain Abdominal X-ray Pattern Recognition The aorta and pancreas are not normally seen unless they are calcified, as might be expected in an older patient in the case of the aorta or in a patient with chronic calcific pancreatitis. AIR-FLUID LEVEL Few, if any, air–fluid levels are present in the normal patient who is radiographed in the erect position. Limited fluid levels in the small bowel and large bowel, however, may be considered normal. Fluid levels are abnormal when they are seen in dilated bowel loops or when they are numerous. In infants and children,gas may be scattered throughout the bowel,but in adults gas is normally seen only in the stomach and colon. BOWEL GAS(FREE AIR) Small bowel gas in an adult, therefore, may indicate a pathologic process. In some patients, gas may be recognizable only on erect radiographs because of the presence of intraluminal fluid. Free air should not be visible in the peritoneal cavity and is indicative of a bowel perforation or other pathologic entities that introduce air into the peritoneum. Plain Abdominal X-ray Pattern Recognition Erect abdominal radiographs must include the diaphragm to assess for free air, and in instances in which the patient is unable to stand, a left lateral decubitus abdomen should be obtained. Note: In Gastrointestinal System, Some contents of the abdomen can be seen without contrast media. However, most of the GI tract cannot be examined directly. Small bowel on plain x-ray The small bowel lies centrally. There should be no more than 3 short air-fluid levels on an erect film. There should only be small amounts of gas in the small bowel. After being swallowed, air reaches the colon within 30 minutes. The jejunum is recognised by valvulae conniventes, folds which traverse the full width of the bowel. The distal ileum is smoother in appearance. Large bowel The large bowel lies peripherally. There may be longer fluid levels and the maximum diameter is variable. The large bowel often contains faeces & has a speckled appearance due to gas trapped in the faeces. The haustra may be outlined by gas. It is quite common to see gas outlining much of the large bowel normally. The haustra can be recognised by the fact that they do not cross the full width of the bowel and they are not regular. Other soft tissues seen on a plain films The bladder may be seen as a soft tissue density arising from the pelvic floor. The stomach is normally outlined with air below the left hemidiaphragm. CONTRASTED INVESTIGATION OF THE GIT Radiographic investigation of the GI system is commonly a combination of fluoroscopy and radiography. Fluoroscopic examination of the GI system requires positive and