Unofficial Guide to Radiology: 100 Practice Abdominal X-Rays

Daniel Weinberg MBCHB (Hons) MPHIL, Rebecca Best BSc (Hons) MBBCh, Lydia Shackshaft, Mark Rodrigues BSc (Hons) MBCHB (Hons) FRCR, Zeshan Qureshi BM BSc (Hons) MSc BM MRCPCH FAcadMEd MRCPS (Glasg)

• Publisher: Zeshan Qureshi
• Year: 2020
• ISBN:
  9781910399248
• Edition: 1
• Topic: Medicina
• Subtopic: Teoría, práctica y referencia médicas

The Unofficial Guide to Radiology: 100 Practice Abdominal X Rays is the sequel to The Unofficial Guide to Radiology, which has been recommended by the Royal College of Radiologist, and won awards from the British Institute of Radiology and the British Medical Association. This book teaches systematic analysis of Abdominal X Rays. The layout is designed to make the book as relevant to clinical practice as possible; the X-rays are presented in the context of a real life scenario. The reader is asked to interpret the X-ray before turning over the page to reveal a model report accompanied by a fully colour annotated version of the X-ray. Uniquely, all cases provide realistic high quality X Ray images, are annotated in full colour, and are fully reported, following international radiology reporting guidelines. This means the X Rays are explained comprehensively, but with clear annotation so that a complete beginner can follow the thinking of the expert. This book has relevance beyond examinations, for post graduate further education and as a day-to-day reference for professionals.

INTERMEDIATE

SCENARIO 34

A 75 year old female presents to ED with generalised abdominal pain and right-sided hip and groin pain radiating to the upper thigh. She is unable to move her right leg due to the pain. She has not opened her bowels in 1 week. Her past medical history is significant for multiple falls and she is a non-smoker. On examination, she has saturations of 97% in room air and a temperature of 36.9°C. Her HR is 90 bpm, RR is 20 and blood pressure is 115/65 mmHg. There is pain and bony instability on palpation of the right groin region. There is significant bruising of the groin region and upper thigh.

An abdominal X-ray is requested to assess for possible bowel obstruction.

REPORT – MULTIPLE FRACTURES WITH VASCULAR CALCIFICATION

REPORT

Patient ID: Anonymous.

Projection: AP supine.

Rotation: Adequate.

Penetration: Underpenetrated – the spinous processes are not visible.

Coverage: Adequate – the anterior ribs are visible superiorly and the inferior pubic rami are visible.

BOWEL GAS PATTERN

There is a prominence of bowel loops throughout the abdomen, however no dilatation, which may represent a degree of ileus.

BOWEL WALL

There is no evidence of mural thickening or intramural gas within the large or small bowel.

PNEUMOPERITONEUM

There is no evidence of free intra-abdominal gas.

SOLID ORGANS

The solid organ contours are within normal limits with no solid organ calcification.

VASCULAR

The abdominal aorta is calcified.

There is calcification of the iliac arteries.

BONES

There are complete moderately displaced fractures of both the right-sided superior and inferior right pubic rami. The superior pubic ramus fracture appears acute. The inferior pubic ramus fracture is well-corticated and likely related to an old injury.

There is an area of sclerosis in the right ilium with adjacent disruption of the pelvic ring, which is suspicious for a further old fracture.

The thoracic and lumbar spine are not visible due to poor penetration.

There are no fractures of the femoral heads.

Bone density appears normal.

SOFT TISSUES

The psoas muscle outline is not visible bilaterally, which is non-specific.

The extra-abdominal soft tissues are unremarkable.

OTHER

There are no radiopaque foreign bodies.

There are no vascular lines, drains or surgical clips.

REVIEW AREAS

Gallstones / Renal calculi: No radiopaque calculi.

Lung bases: Normal.

Spine: Not visible due to underpenetration.

Femoral heads: Normal.

SUMMARY

This X-ray demonstrates prominent bowel loops throughout the abdomen, which may represent a degree of ileus, however no evidence of bowel obstruction. There is a probable acute fracture of the right superior pubic ramus and old fractures of the right ilium and the right inferior pubic ramus. The abdominal aorta is calcified. The iliac vessel calcification is an incidental finding.

INVESTIGATIONS AND MANAGEMENT

The patient should be resuscitated using an ABCDE approach.

Adequate analgesia and hydration should be provided.

Bloods should be taken, including FBC, U&Es, LFTs, bone profile, CRP, TFTs, blood gas, and group and save.

The patient should be referred urgently to the orthopaedic surgical team.

Depending on previous imaging, a CT of the pelvis should be considered to better assess the extent of injury, chronicity of injuries, for any potential operative planning and to assess for potential associated injuries (for example to the bladder).

SCENARIO 35

A 32 year old male presents to ED with acute abdominal pain and a GCS of 13. He has no significant past medical history and is a non-smoker. On examination, he has saturations of 98% in room air and a temperature of 37.6°C. His HR is 75 bpm, RR is 25 and blood pressure is 115/65 mmHg. The abdomen is soft and there is generalised mild tenderness with normal bowel sounds. Urine dipstick is unremarkable.

An abdominal X-ray is requested to look for possible bowel obstruction.

REPORT – DRUG MULE

REPORT

Patient ID: Anonymous.

Projection: AP supine.

Rotat...