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Radiology

Radiology. Sameer Bahal 28 th January 2013. Content . Chest X –Rays Abdo X-rays, CT Head,. Case 1. A 34-year-old woman, immigrant from Eastern Europe, C omplaints of vague chest discomfort 5 days after an upper respiratory tract infection. N ot a smoker BCG vaccination as child.

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Radiology

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  1. Radiology Sameer Bahal 28th January 2013

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

  3. 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.

  4. Where is the mass?

  5. Case 2 • 25 year old with sudden onset chest pain

  6. 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

  7. Types of consolidation

  8. 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

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

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

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

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

  13. Case 6 • 30 year old admitted with headache and confusion

  14. 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.

  15. Step 1, Check pH, • Results: 6 • Step 2, CXR

  16. Case 8 • 50 year old patient in hospital following MI. Develops SoB at night

  17. 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

  18. 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). Kerley B Lines

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

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

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

  22. 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

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

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