Pathology

Atelectasis Incomplete expansion of lung at birth or collapse of adult lung Negative pressure within the chest is disturbed Causes: – Obstruction of a bronchus – Compression of lung by pleural effusion or pneumothorax. – Improper placement of endotracheal tube – Bronchogenic carcinoma. Radiographic Signs: – Local increased density – Elevation of the hemidiaphram – Displacement of the mediastinum – Compensatory over-inflation of the lung

Bronchiectasis Chronic dilation of one or more bronchi Causes: – Repeated pulmonary infection and bronchial obstruction – Lung abscess Radiographic Signs: – Courseness and loss of definition of interstitial markings – Oval or circular cystic spaces – Honeycomb pattern

Emphysema / Chronic Obstructive Pulmonary Disease (COPD) Associated with chronic bronchitis. Increased air spaces with associated tissue destruction. “leather lung disease” – alveoli lose their elasticity and remain filled with air during expiration. Incurable Radiographic Signs: – Hyperinflated lungs – Depressed diaphram – Increased Bronchovascular markings

Pleural Effusion (Hydrothorax) Fluid in pleural cavity Causes – Congestive Heart Failure – Infection – Neoplasm – Trauma Radiographic Signs – Blunt costophrenic angles – Air/Fluid levels – Mediastinal Shift

Pulmonary Embolism Potentially Fatal – Patients with cardiovascular dz or severe debilitating illness often result with infarction 95% arise from the deep venous thrombi Radiographic Sign – Hampton’s Hump Inverted wedge- shaped opacity of the lung

TB Caused by Myobacterium Tuberculosis Primary Lesion – Collection of inflammatory cells collects around a clump of TB to form a mass – Outcomes depend on the number of bacilli and the resistance of infected tissues Scars commonly found in posterior apical segments Radiographic Signs: – Demonstrates cavitation and calcification – Lobar or segmental air-space consolidation – Enlarged hilar or mediastinal lymph nodes – Pleural Effusion

Pneumonoconiosis Long-continued irritation of certain dusts encountered in industrial occupations that cause a chronic interstitial pneumonia. 3 Types: – Silicosis – Asbestosis – Berylliosis

Volvulus Medical Emergency! Abnormal twisting or torsion of intestine causing obstruction and impairment of normal blood flow. Small intestine, cecum, and sigmoid colon are subject to volvulus. Clinical Signs – Sudden onset – Abdominal pain – Nausea – Vomiting – Blood in stool Treatment – Surgical intervention If not treated, a patient may suffer from: – Gangrene – Death of that segment of GI tract – Intestinal Obstruction – Perforation of the Intestine – Peritonitis

Fistulae or Sinus Tract Fistula – An abnormal connection between 2 organs or leading from an internal organ to the surface of the body. Most are caused by surgery but may also result from infection or inflammation. Sinus Tract – Abnormal channel permitting the escape of pus. Ba study: gastric outlet obstruction with choledochoduodenal and abdominal fistulae. fistulagram

Ascites Accumulation of excessive fluid within the peritoneal cavity. CommonCauses – Cirrhosis – Heart Failure – Budd-Chiari Syndrome – Cancer – TB – Pancreatitis Treatment – Salt Restriction – Fluid Restriction – Diuretics – Paracentesis – Shunting – Liver Transplant Portal hypertension. In ascites the soggy bowel floats medially, there is some separation of the ill-defined loops and loss of retroperitoneal planes. Note enlarged spleen.

Prolapse "To fall out of place." – Rectal prolapse Partial prolapse – The lining of the rectum falls out of place when you strain to have a bowel movement. Complete prolapse – The entire wall of the rectum falls and usually sticks out of the body. Internal prolapse (intussusception) – Part of the wall of the colon telescopes into or over another part. (occurs inside of the body) – Causes Straining to have bowel movements Child Birth Weakening of anal sphincter muscle & ligaments that support rectum Neurologic problems – Symptoms Stool leakage Bleeding, anal pain, itching, irritation Tissue that protrudes from rectum Small stools Urgency for bowel movement – Treatment Fiber rich diet Increased fluids Physical Therapy Surgery Prolapsed Transverse Colon Rectal Prolapse

Colon and Rectal Cancer Leading cause of death from cancer in US Annular carcinoma has “apple-core” pattern imaged during BE

Crohn’s Disease Chronic bowel inflammation Separated by normal segments of bowel

Diverticulosis Pouch-like herniations through wall of colon

Intussusception Prolapse of one segment of bowel into another segment Telescoping

Small / Large Bowel Obstruction Massive accumulation of gas proximal to the obstruction Absence of gas distal to obstruction High risk perforation EXAMPLE: Ileus – Adynamic: Caused by bowel immobility – Mechanical Caused by mechanical obstruction

Urinary System Bladder Cancer Cystitis Glomerulonephritis Polycystic Kidney Disease Pyelonephritis Renal Calculus Renal Carcinoma / Wilm’s Tumor Renal Cysts Reflux

Myelogram Herniated intervertebral disks Degenerative dz Space occupying lesions – L3-L4 interspace – Subarachnoid Space

Arthrography Joint Trauma Meniscal Tears Capsular Damage Deformities caused by arthritis Rupture of articular ligaments

Spina Bifida Occulta “Open Spine” Congenital deformity of the vertebral column in which the laminae fail to unite posteriorly at the midline.

Vertebral Subluxation Misalignment or partial dislocation – one or more vertebrae move out of position and create pressure on or irritate spinal nerves.

Spondylolisthesis A developmental crack in one of the vertebrae (usually at the L5-S1 junction.) The cracked vertebra slips forward over the vertebra below it. This is known as adult isthmic spondylolisthesis.

Ankylosing Spondylitis Chronic inflammatory disease that causes arthritis of the spine and SI joints. It is a systemic rheumatic disease and can affect other joints & cause inflammation of the eyes, lungs, & kidneys.

Herniated Nucleus Pulposus “Slipped Disc”

Compression Fracture A bone break that disrupts osseous tissue and collapses the affected bone. This injury tends to happen in 2 groups of people. – Patients involved in traumatic accidents when the load placed on the vertebrae exceeds its stability. (This is commonly seen after a fall) – Patients with osteoporosis (most common)

Osteitis Deformans/Pagets chronic bone disorder that results in enlarged, deformed bones due to excessive breakdown & formation of bone tissue that can cause bones to weaken and may result in bone pain, arthritis, bony deformities and fractures.

Osteochondroma A benign tumor that contains both bone and cartilage and usually occurs near the end of a long bone.

Ewing’s Sarcoma ( Peripheral Primitive Neuroectodermal Tumors ) Bone cancer found in children and young adults.

Multiple myeloma Multiple myeloma is a cancer of your plasma cells. Plasma cells are a type of white blood cell present in your bone marrow.

Osteomyelitis Infection of the bone or bone marrow caused by pyogenic bacteria or myobacteria.

Neuroma Any tumor of cells of the nervous system. Neuromas may be benign or malignant.

Bakers Cyst

Osgood-Schlatter’s Disease The large powerful quadriceps contracts & the patellar tendons can pull away from the shin bone. Athletes present with pain and swelling at the tibial tubercle. Repetitive activity and tight quadriceps cause – cartilage swelling – cortical bone fragmentation – patellar tendon thickening – infrapatellar bursitis.

Rheumatoid Arthritis Chronic Systemic Disease of unknown origin. Manifests as an inflamed peripheral joint. Polymorphonulear leukocytes are attracted to the joint space causing destruction of the joint structures.

36 “Open Book” Injury Widening of the anterior pubic arch diastasis of > 2.5 cm = ligament damage at the SI joint

37 Duverney’s Fracture Stable fracture at the lateral margin of the iliac wing (just below the anterior inferior spine) caused by vertically directed forces Complications: Possible hemorrhage from the internal iliac arterial system.

38 Osteosarcoma Most common type of malignant bone cancer. Often localized at long bones. Commonly affects the lower end of the femur or the upper end of the tibia or humerus.

POSITIONING REVIEW

What are the proximal and distal rows in the wrist?

Carpals 8 Carpal Bones – Proximal Row Scaphoid (Navicular) Lunate (Semilunar) Triquetrum(Cuneiform) Pisiform – Distal Row Trapezium(Greater Multangular) Trapezoid (Lesser Multangular) Capitate (Os Magnum) Hamate(Unciform)

In what position was this image taken?

What bone is demonstrated in this position?

In what position was the patient for this image?

In what position was the patient placed for this shoulder image?

What image is demonstrated? How do you determine anterior/posterior dislocation?

Scapular Y Useful in demonstrating dislocations – Anterior Subcoracoid dislocation Head beneath the coracoid process – Posterior Subacromial dislocation Head projected beneath acromion process

What is the attempted image? How was it accomplished?

Which ribs are demonstrated in RAO position?

52

53 AP Axial “Outlet” projection (Taylor Method) 10X12 crosswise (14X17 for entire pelvis) Pt supine without rotation Males: degree cephalad Females: degree cephalad CR 2 inches distal to the superior border of the pubic symphysis

54 Superoinferior Axial “Inlet” Projection (Bridgeman Method) 10X12 crosswise (14X17 if entire pelvis is routine) Demonstrates axial projection of pelvic ring, or inlet, in its entirety CR 40 degrees caudad level ASIS

Which way do you rotate?

How was this image accomplished?

AP Knee Central ray depends on the measurement between the ASIS and the tabletop Thin pelvis18 cm and below3-5 degrees caudad Average19-24 cmperpendicular Large pelvis25 cm and above3-5 degrees cephalic

What does this image demonstrate? How was it done?

Name the parts of the scottie dog.

61 L5-S1 SPOT PROJECTION Where to you center? Center on coronal plane 2 in posterior to ASIS and 1.5 in inferior to the iliac crest.

62 L5-S1 SPOT PROJECTION Where to you center? Center on coronal plane 2 in posterior to ASIS and 1.5 in inferior to the iliac crest.

63 How was this image taken?

What is the evaluation requirement for this image?

How was this image taken?

45 C Spine T Spine L Spine

AP side down PA side up

87 Caldwell Sinus Projection Film This view will provide a clear view of the frontal and ethmoid sinuses. The super orbital rims can be evaluated for fracture when facial bone are of interest. To project the petrous ridges farther down, increase angle to 30 degrees

Sinus Lateral Lateral – External auditory meatus externally and mandible inferiorly with supracillary arch superiorly in view. CR centered to zygoma, midway between outer canthus and EAM Midsagittal plane is parallel to IR IPL is perpendicular to IR

Lateral Sinus Anatomy

Positioning: Waters Prone or seated upright Chin on bucky -OML 37 angle with plane of cassette Mentomeatal line should be perpendicular to film with mouth closed. Nose 3/4 inch from IR Suspend respiration CR perpendicular to exit acanthion

Waters Radiograph Distance from lateral border of skull and orbit equal on each side Petrous ridges projected immediately below maxillary sinuses

Modified Parietoacanthial (Modified Waters) OML 55 degrees to the IR Chin and nose on table Petrous pyramids are seen mid-maxillary sinus CR exits acanthion Blowout Fractures See pg. 355 (Merrill’s 12 th Edition)

Modified Waters Radiograph Petrous ridges projected immediately below the inferior border of the orbits Equal distance from lateral orbit to lateral skull on both sides

Reverse Waters Supine Extend neck so OML is 37 degree with plane of IR MML perp Suspend respiration CR perpendicular and enters acanthion

Lateral Nasal Bones Semiprone IPL perpendicular CR perpendicular to the bridge of nose at a point ½ inch distal to the nasion

Bilateral Arches - SMV IOML parallel to IR and perpendicular to CR CR midsaggital and collimate to outer edges of zygoma

Oblique Tangential Same position as SMV except head tilt 15 degrees toward side of interest (Merrill’s p ed)

Esophagus RAO Left side elevated degrees Center at T-5 or T-6

Stomach PA – Center at pylorus L2 (midway between xiphoid and umbilicus) – Expiration RAO – L side elevated degrees – Between vertebrae and elevated surface – Center at duodenal bulb – Expiration Lateral – Recumbant (R lateral), Erect (L lateral) – Between axilla and anterior surface – Center at pylorus

Small Bowel Central ray at iliac crest (or slightly above for early exposures)

Colon PA or AP – Center at iliac crest PA Axial (may be done AP) – Prone – iliac crest – CR degrees caudad – Sigmoid Colon – Smaller IR; CR ASIS Bilat Obliques Lateral Decubitus Lateral Rectum – Enter at ASIS

Intravenous Urography KUB Obliques – Rotated 30 degrees – kidney farthest from IR is parallel; kiney closest is perpendicular to film AP Bladder – CR at ASIS

Cystography AP Axial – degrees caudal – CR 2-3 in above pubic syphysis Oblique – degrees PA Bladder – CR 1 in distal to tip of coccyx – degree cephalad angle Lateral