theRadiologist

Male 40s. What is the differential?

2 years ago | [YT] | 28

theRadiologist

Female in her 50s presents with a cough. What does it show?

2 years ago | [YT] | 21

theRadiologist

ULTRASOUND ABDOMEN
👨🏽‍💻With the increasing use of CT and MRI I know some radiologists who turn their nose up at ultrasound but for me it remains an incredibly useful tool

👨🏽‍💻Ultrasound uses sound waves which are out of the audible range with a frequency of over 20kHz. An ultrasound probe converts electrical energy to mechanical energy and sends ultrasound waves into the body where the beam is:
▫️Reflected (beam comes back at the probe)
▫️Refracted (beam continues but at a different angle)
▫️Attenuated (beam continues but with reduced energy)
▫️Scattered

👨🏽‍💻Each kind of structure in the body (eg bone, muscle, gas) has a different ACOUSTIC IMPEDANCE depending on its density. When a beam passes between two different structures it is reflected back to a different degree determined by the difference in acoustic impedance. This is why we get the pictures that we do - we see calcified and gas structures as bright (‘hyperechoic’) as much of the wave is reflected back and the reverse is true with fluid which we see as black (‘anechoic’).

👨🏽‍💻The advantages of ultrasound are that it is relatively low cost compared with CT/MRI and does not use ionising radiation. Abdominal ultrasound however is difficult in larger patients and in patients who have a lot of bowel gas obscuring the organs

👨🏽‍💻When it comes to abdominal imaging the big advantage of US over CT is the ability to be able to characterise gallstones

👨🏽‍💻Check out the anatomy of the upper abdomen in the picture above and compare what you see to an image from an abdominal CT at a similar level

🔻LEARNING POINT - notice how you can see a halo of fat around the SMA in both modalities - this is an important review area, when this is lost consider malignant infiltration

🔻@theradiologistpage
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#theradiologist #radiology #radiologist #physician #physicianassistant #medicine #medstudent #medicalstudent #medschool #medicalschool #radtech #medical #radiography #radiologystudent #doctor #medicalstudents #ultrasoundabdomen #surgeon #medic #frcr #usmle #ultrasound #exams #nursepractitioner

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2 years ago | [YT] | 64

theRadiologist

CHEST CT ANATOMY

👨🏽‍💻Here we have an axial image of a post-IV contrast CT of the chest at the level of the aortic arch. We can see we are at the level of the T5 vertebra

👨🏽‍💻To the right of the aortic arch is the superior vena cava - deoxygenated blood has drained into this via the right and left brachiocephalic veins. The SVC then carries this blood into the right atrium

👨🏽‍💻Deoxygenated blood enters the right atrium by one of three ways:
1️⃣Superior vena cava
2️⃣Inferior vena cava
3️⃣Coronary sinus (drains the myocardium)

👨🏽‍💻We can see muscles of the chest wall and the rotator cuff on either side. The rotator cuff is a group of muscles that allows movement of the shoulder whilst maintaining stability of the glenohumeral joint

👨🏽‍💻The rotator cuff includes the
Supraspinatus
Infraspinatus
Teres major
Subscapularis (not seen on this slice)

🔻@theradiologistpage

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2 years ago | [YT] | 68

theRadiologist

A female in her 60s presents with breathlessness. What does the X-Ray show?

2 years ago | [YT] | 28

theRadiologist

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Let’s take a look at the veins of the upper limb....⁣
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🔻@theradiologistpage ⁣
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👨🏽‍💻We’ll start distally at the hand and work our way up. The dorsal venous network drains the dorsal side of the hand, draining into the CEPHALIC VEIN laterally and the BASILIC VEIN medially ⁣
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👨🏽‍💻 The palm is drained by the palmar venous network which drains into the MEDIAN ANTEBRACHIAL VEIN running up the forearm - there is then a lot of variation as to what happens at the antecubital fossa. The median antebrachial vein can bifurcate into median cephalic and basilic veins or as above can drain directly into the BASILIC VEIN leaving the CEPHALIC and BASILIC veins to be connected via the MEDIAN CUBITAL VEIN⁣
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👨🏽‍💻These large veins in the antecubital fossa make for good targets for venepuncture and IV injection⁣
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👨🏽‍💻The basilic vein then pierces the brachial fascia and enters the deep compartment draining into paired BRACHIAL VEINS which becomes the AXILLARY VEIN at the inferior margin or teres major⁣
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👨🏽‍💻The cephalic vein pierces the clavipectoral fascia and drains into the axillary vein directly⁣
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👨🏽‍💻In the deep compartment the RADIAL and ULNA VEINS run alongside the radial and ulna arteries before uniting as paired BRACHIAL veins just before the antecubital fossa before then draining into the axillary vein⁣
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👨🏽‍💻The axillary vein then becomes the subclavian vein which joins the internal jugular vein to become the brachiocephalic (innominate vein) - the right and left brachiocephalic veins then join to drain into the superior vena cava which drains into the right atrium ⁣
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#theradiologist #radiology #radiologist #physician #physicianassistant #medicine #medstudent #medicalstudent #medschool #medicalschool #radtech #xray #medical #radiography #radiologystudent #doctor #medicalstudents #surgeon #frcr #anatomy #usmle #premed⁣ #nursepractitioner #ultrasound #sonographer

2 years ago | [YT] | 53

theRadiologist

Here we have a view of an IV contrast enhanced CT of the abdomen and pelvis. We know we are towards the back of the patient as we can see the spine and kidneys

👨🏽‍💻There are different ways we can scan the kidneys - let’s run through some of the main protocols (the time in seconds refers to the time after injection of IV contrast):

1️⃣UNENHANCED CT KUB
Here we scan the urinary tract without contrast trying to highlight high density stones either within the kidneys themselves or within the renal pelvis/ureters where they can cause obstruction and hydronephrosis. Although sensitive for stones this is less sensitive for pathology such as renal tumours

2️⃣RENAL ANGIOGRAM 15-25s
An early arterial phase is best to visualise the renal arteries - used when looking for renal artery stenosis or planning before potential renal transplantation

3️⃣CORTICOMEDULLARY PHASE 30-40s
Here there is strong enhancement of the renal cortex and less so of the medulla which enhances the contrast between the two. Renal cell carcinomas (RCC) can start to enhance in this phase, particularly the clear cell subtype. This phase is good for reviewing the renal veins - important in cases of RCC

4️⃣NEPHROGENIC PHASE 80-120s
Now the whole renal cortex enhances - this is good for subtle lesions. Look out for a ‘striated nephrogram’ where you’ll see stripes of low and high density characteristic of pyelonephritis. The striated appearance can sometimes be hard to differentiate from renal infarction so knowing the patient’s clinical history is key

5️⃣UROGRAPHIC PHASE >180s
Now we are looking at the pelvicalyceal system, ureters and bladders looking for filling defects which can be due to calculus (high density on non contrast), tumour (TCC), blood clot or sloughed papilla (renal papillary necrosis). This is a routine phase in the workup of haematuria

👨🏽‍💻You can see with all of the different phases it is really important to know the clinical question when trying to adopt the correct protocol. In practice many institutions employ a ‘dual bolus’ technique where you can get both corticomedullary and urographic phase images at the same time

🔻@theradiologistpage

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#radiology #radiologist #physician #physicianassistant #medicine #medstudent #medicalstudent #medschool #medicalschool #radtech #medical #radiography #radiologystudent #doctor #ct #medic #frcr #anatomy #kidneys #exams ⁣#nursepractitioner #renal #radiologia

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2 years ago | [YT] | 78

theRadiologist

A male in his 70s presents with acute breathlessness. What does the Chest X-Ray show? There may be a subtle finding…

2 years ago | [YT] | 16

theRadiologist

Pelvic X-Ray anatomy

2 years ago | [YT] | 62

theRadiologist

50 year old male presents with lower leg pain. What is the differential?

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2 years ago | [YT] | 27