1. Radiology Sameer Bahal 28 th January 2013

2. Content  Chest X –Rays  Abdo X-rays,  CT Head,

10. Case 1 A 34-year-old woman, immigrant from Eastern Europe, Complaints of vague chest discomfort 5 days after an upper respiratory tract infection. Not a smoker BCG vaccination as child. Physical examination is normal. PPD is 10-mm induration Induced sputum for acid-fast bacilli is negative.

12. Where is the mass?

13. Case 2  25 year old with sudden onset chest pain

17. Case 3  80-year-old male smoker with history of COPD.  Presents with lower chest pain and worsening of shortness of breath.  PH 7.30, CO2 3.6

19. Types of consolidation

22. Case 4  73 year presents with 1 week history of increased drowsiness. Recently started feeling Nauseous and loss of appetite.  History of stroke and AF  DH: Warfarin

25. CT vs MRI  MRI is better for:  Soft tissue (ligaments)  Spine  Younger Patients  Cerebellar Imaging

26. Case 5  70 yea old patient, longstanding history of HTN, AF, Diabetes, CRF and Dementia.  Admitted after fall with increasing confusion.

27. On Examination  Chest Clear,  Heart Sounds: I + II + ESM,  Abdo: SNT, BS present  AMTS: 3/10, (Normally 7/10)  Bloods Normal

29. Normal Pressure Hydrocephalus Triad of: –Gait Disturbance –Dementia –Urinary Incontinence Diagnosis –CT scan (enlarged ventricles)

30. Case 6  30 year old admitted with headache and confusion

32. Hematoma typeEpiduralSubdural Location Between the skull and the dura Between the dura and the arachnoid Involved vessel Temperoparietal locus (most likely) - Middle meningeal artery Frontal locus - anterior ethmoidal artery Occipital locus - transverse or sigmoid sinuses Vertex locus - superior sagittal sinus Bridging veins Symptoms Lucid interval followed by unconsciousness Gradually increasing headache and confusion CT appearanceBiconvex lensCrescent-shaped

33. Case 7  You are a busy on call F1 Doctor. A nurse bleeps you, she has inserted an NG tube and wants to check the position.

34.  Step 1, Check pH,  Results: 6  Step 2, CXR

36. Case 8  50 year old patient in hospital following MI. Develops SoB at night

38. Acute Pulmonary oedema Chest X-ray will show fluid in the alveolar walls, Kerley B lines, increased vascular shadowing in a classical batwing peri- hilum pattern, upper lobe diversion (increased blood flow to the superior parts of the lung), pleural effusions. In contrast, patchy alveolar infiltrates are more typically associated with noncardiogenic edema

39. Kerley B Lines These are short parallel lines at the lung periphery. These lines represent interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs. Kerley B lines are seen in Congestive Heart Failure (CHF) and Interstitial Lung Diseases (ILD).pleuracostophrenic angles

40. Case 9  4 year old lady Ms Amin presents to A+E with SoB. Pt unable to speak English  Chest Exam: Inspiratory Crackles throughout

42. Case 10  50 year old patient admitted with Nausea and vomiting.  Recently developed severe abdo pain  PHM, perforated duodenal ulcer, appendicitis.

44. Case 11  60 year old Patient admitted with Abdo Pain. Not opened bowel for 4 days.

46. Case 12  60 year old Patient admitted with Abdo Pain. Not opened bowel for 4 days.  Recent history of weight loss,  Smoker  OE: Abdominal Distension

49. Case 13  30 year old patient presents with sudden onset abdo pain.  Multiple abdominal surgeries in the past.

51.  WCC 30,  CRP 100,  BP 85/60  HR 130,  Sats 96% Room Air  Management?

52. Case 14  30 year old patient with Fibromuscular dysplasia.  Has History of Uncontrolled Hypertension.  Presents with history of lethargy and fatigue, with recent vomiting

53. Bloods  Na 145  K 6.3  Ur 21  Cr 430  GFR 15  What investigation of choice

55. Case 15  46 year old Nigerian lady arrives in UK from Nigeria and visits A+E with Sob. 6 months ago she spent time with a ill relative who turned out to have active TB.  Never had BCG  While you see her she coughs up blood stained phlegm.

57. Case 16

58. Case 17  44 year old man on ward  History of Dementia, AF, Stoke, MI  You are asked to see him at 0200 due to chest pain.  Unable to give clear history.

59.  ABG: pH 7.36  O2 8.4  CO2: 5.8  WCC 11, CRP 30, (70),  Hb 10.8 (11.6)