Emergency RadiologyEmergency RadiologyEmergency Radiology

Prof. Mahmoud DawoudProf. Mahmoud DawoudChairman of the Radiology & Imaging Dept.Chairman of the Radiology & Imaging Dept.

Tanta University Tanta University Faculty of MedicineFaculty of Medicine

What to order, When

Emergency RadiologyEmergency Radiology

What are the different Radiological investigation to order In different Emergency situations

Emergency RadiologyEmergency Radiology

Common Topics CNS Emergencies Face & Neck Emergencies. Spinal Emergencies. Chest Emergencies. Cardiovascular Emergencies. Abdominal Emergencies. Gynecological & Obstetrical emergencies. Male Genitourinary Emergencies. Pelvis Extremities Pediatric Emergencies

EmergencyEmergency RadiologyRadiology

CNS Emergencies: Skull Fractures Hemorrhage: (TraumaticNon Traumatic)

Extra-axial Parenchymal

Cerebral infarction. Spinal trauma.

Emergency Radiology

CNS Emergencies: Skull Fractures:Skull Fractures: What to order:

Plain X-ray of the skull (lateral view - AP) Computed tomography of the Brain (Axial

Coronal) (bone window)

When: History of trauma evident injury of the

scalp

Findings:

Skull Fractures (Plain X-ray)

Skull Fractures (Plain X-ray)

Skull Fractures (CT Scan)

Bone window

Skull Fractures (CT Scan)

Soft tissue window Bone window

Skull Fractures (CT Scan)

Skull Fractures (CT Scan) 3D Reconstruction

Emergency Radiology

CNS Emergencies: Hemorrhage: Traumatic Hemorrhage: Traumatic Non Non

TraumaticTraumatic What to order:

Computed tomography (CT) of the Brain (Axial)

When: Head trauma focal neurological defect.

Findings:

Emergency Radiology

CNS Emergencies: Hemorrhage: Traumatic Findings in:

Extra Dural Blood Subdural Blood. Cerebral contusion.

Traumatic Extraddural Hematoma (CT Scan)

Traumatic Subdural Hematoma (CT Scan)

Traumatic Cerebral Contusion (CT Scan)

Traumatic Cerebral Contusion (CT Scan)

Emergency Radiology

CNS Emergencies: Hemorrhage: Non Hemorrhage: Non -- TraumaticTraumatic Findings in:

Subarachnoid Blood Intraparenchymal Blood. Intraventricular Blood

Subarachnoid Hemorrhage (CT Scan)

Intraparenchymal Hemorrhage (CT Scan)

Intraparenchymal Hemorrhage (CT Scan, Angiography)

Intraventricular Hemorrhage (CT Scan)

Emergency Radiology

CNS Emergencies: Cerebral Infarction:Cerebral Infarction: What to order:

Computed tomography (CT) of the Brain (Axial)

Magnetic Resonance Imaging (MRI) : DWI

When: Focal neurological defect - Stroke

Findings:

Cerebral Infarction (CT Scan)

Cerebral Infarction (CT Scan, Angiography)

Cerebral Infarction (CT Scan, MRI)

Cerebral Infarction (MRI, DWI)

Emergency Radiology

Face Emergencies: Facial FracturesFacial Fractures

Orbit Zygoma Maxillary Frontal - Nasal

Soft tissue injuries of the orbitSoft tissue injuries of the orbit FB occular injuries

Emergency Radiology

Facial fractures:Facial fractures: What to order?

Plain X-ray of the Skull (Lateral view PA view)

Computed Tomography of the facial bones (Bone windowAxial & coronal3D recon.)

When? History of trauma to the face

disfigurement Severe facial contusions

Findings

Facial Fractures (Plain X-ray)

Fracture Maxilla (CT Scan)

Fracture Maxilla, Mandible, Zygoma (CT Scan)

Fracture Mandible (Plain X-ray, Panorama)

FACE (3D Reconstruction)

Emergency Radiology

Orbital Injuries:Orbital Injuries: What to order?

Plain X-ray of the Skull (Lateral view PA view)

Computed Tomography of the Orbit (Axial & Coronal - Bone & Soft tissue settings)

When? History of trauma to the orbit History of

FB to the eye

Findings

Blowout Fracture (Plain X-ray, CT Scan)

Blowout fracture (CT scan)

Foreign Body of the Orbit (CT scan)

Emergency Radiology

Spinal Emergencies:

TraumaTrauma Vertebral fracture (Varieties) Spinal cord injuries.

Emergency Radiology

Spinal trauma:Spinal trauma: What to order?

Plain X-ray of the spine (Lateral view AP view)

Computed Tomography of the Spine (Axial - Bone & Soft tissue settings3D recon.)

MRI of the spine. (for cord injury)

When? History of trauma Falling from hieght.

Findings

Lumbar Spine Fracture (Plain X-ray)

Cervical Spine Fracture (Plain X-ray, CT scan)

Cervical Spine Fracture (CT scan, MRI)

Emergency Radiology

Chest Emergencies: Chest TraumaChest Trauma

Rib fractures Traumatic Hemothorax pneumothorax pneumomediastinum pulmonary contusion, laceration & hematoma Esophageal injury diaphragmatic injury etc.

Airway Foreign Body.Airway Foreign Body.

Emergency Radiology

Chest trauma:Chest trauma: What to order?

Plain X-ray of the Chest (PA view - Lateral view)

Computed Tomography of the Chest Angiography (Aortography)

When? History of trauma Difficulty of breathing.

Findings

Multiple Ribs Fracture (Plain X-ray)

Multiple Ribs Fracture (Plain X-ray)

Pneumothorax (Plain X-ray)

Pneumothorax, Lung Contusion (CT Scan)

Hemopneumothorax (Plain X-ray)

Hemopneumothorax, Lung Contusion, Fracture ribs (Plain X-ray)

Diaphragmatic Rupture (Plain X-ray Contrast Meal)

Diaphragmatic Rupture (Plain X-ray CT)

Tracheal Injury (Plain X-ray, CT scan)

Emergency Radiology

FB of the Airway:FB of the Airway: What to order?

Plain X-ray of the Chest (PA view - Lateral view)

Computed Tomography of the Chest

When? Children Bad Habits Unconscious

patient.

Findings

FB of the Airways (Plain X-ray)

FB of the Airways (Plain X-ray)

FB of the Airways (Plain X-ray)

Emergency Radiology

Cardiovascular Emergencies: CHF Pericardial effusion Aortic dissection, trauma. Pulmonary Edema Pulmonary Embolism. Peripheral ischemia (acute) DVT

Emergency Radiology

CHF:CHF: What to order?

Plain X-ray of the Chest (PA view - Lateral view)

Echocardiography

When? Dyspnea signs of low cardiac output.

Findings

CHF (Plain X-ray)

Emergency Radiology

Pericardial effusion: What to order?

Plain X-ray of the Chest (PA view - Lateral view)

Echocardiography

When? Chest pain friction rub faint heart

sounds on auscultation.

Findings

Pericardial Effusion (Plain X-ray)

Emergency Radiology

Aortic dissection: What to order?

Plain X-ray of the Chest (PA viewLat. view) CT scan. MRI Aortography

When? Sudden severe tearing substernal chest

pain.

Findings

Aortic Dissection (Plain X-ray, CT scan)

Aortic Dissection (Angiography)

Emergency Radiology

Acute peripheral ischemia: What to order?

Arteriography Color doppler Ultrasound (chronic)

When? Sudden onset of severe pain, coldness,

numbness or pallor in a portion of an extremity.

Findings

Acute Peripheral Ischemia (Angiography)

Emergency Radiology

DVT (Deep Vein Thrombosis): What to order?

Color Doppler Ultrasound. Venography

When? Asymptomatic pain edema skin

discoloration.

Findings

DVT (Color Doppler)

Emergency Radiology

Abdominal Emergencies: Abdominal Trauma

Hemoperitonium Visceral injuries (Liver, Spleen, Kidney,

UB, etc.)

Non-Traumatic emergencies. Intestinal obstruction, Appendicitis, GUT

perforation Ascites, Jaundice, peritonitis, GI bleeding

Emergency Radiology

Abdominal trauma: What to order?

Chest & Abdominal radiographs. Ultrasound (FAST) CT scan Arteriorgraphy.

When? History of trauma to the abdomen Motor

vehicle accidents.

Findings

Abdominal Trauma (Plain X-ray, US)

Abdominal Trauma (US, CT scan)

Abdominal Trauma (CT scan)

Abdominal Trauma (CT scan, Ultrasound)

Emergency Radiology

Miscellaneous Abdominal Emergencies: Intestinal Obstruction

What to order? Abdominal radiograph. CT scan

When? Crampy abdominal pain nausea &

vomiting abdominal tenderness.

Findings

Intestinal Obstruction (Plain X-ray)

Intestinal Obstruction (Plain X-ray, CT scan)

Emergency Radiology

Miscellaneous Abdominal Emergencies: Gut Perforation (e.g. Perforated DU)

What to order? Abdominal radiograph (Erect). US

When? History of peptic ulceration signs of

peritonitis.

Findings

Perforated Gut (Plain X-ray)

Perforated Gut (Plain X-ray)

Emergency Radiology

Miscellaneous Abdominal Emergencies: Jaundice

What to order? Ultrasound CT scan Percutaneous transhepatic cholangiography (PTHC)

Endoscopic retrograde cholangiopancreatograpgy(ERCP)

When? Yellowish discoloration of the skin dark urine

pale stools

Findings

Obstructive Jaundice (ERCP, PTC)

Emergency Radiology

Miscellaneous Abdominal Emergencies:

Appendicitis:Appendicitis: What to order?

Abdominal radiograph. Ultrasound CT scan

When? Sudden onset of epigastric pain rebound

tenderness.

Findings

Appendicitis (Plain X-ray)

Appendicitis (Plain X-ray, US)

Appendicitis (CT Scan, US)

Emergency Radiology

Miscellaneous Abdominal Emergencies:

CholecystitisCholecystitis:: What to order?

Ultrasound

When? Sudden onset of epigastric pain rebound

tenderness.

Findings

Cholecystitis (Plain X-ray, US)

Emergency Radiology

Genitourinary Emergencies: UT stones Hematuria Urinary tract trauma. Urethral Injuries, stones (male) Scrotal injuries, swellings, testicular

torsion, epidiymitis (male)

Emergency Radiology

UretericUreteric Stones (Renal Colic):Stones (Renal Colic): What to order?

Plain X-ray of the urinary tract (PUT) Ultrasound Intravenous Urography (IVU) CT of the abdomen

When? Sudden onset of loin pain radiating to the

groin.

Findings

Ureteric Stones (Plain X-ray, IVU)

Ureteric Stones (IVU)

Emergency Radiology

HematuriaHematuria (Painful (Painful -- Painless):Painless): What to order?

Plain X-ray of the urinary tract (PUT) Ultrasound Intravenous Urography (IVU) CT of the abdomen Cystoscopy

When? Passage of blood or blood clots with urination

(either painful or painless).

Findings

Renal Stones (Plain X-ray, IVU)

Renal Stones (Plain X-ray, IVU)

Urinary Bladder Stones (Plain X-ray)

Renal Mass (US, CT)

UB Mass (IVU, CT ,US)

Emergency Radiology

Urinary tract trauma (Renal Urinary tract trauma (Renal Urinary Urinary Bladder Bladder male urethra):male urethra): What to order?

Plain X-ray of the urinary tract (PUT) Ultrasound Intravenous Urography (IVU) CT of the abdomen Ascending urethrocystography

When? History of blunt trauma to the abdomen Falling

astride.

Findings

Renal Trauma (CT)

Renal Trauma (CT)

UB Extraperitoneal rupture (Ascending Cystogram)

UB Rupture (Ascending cystogram , CT)

Urethral Trauma (Ascending Urethrogram)

Emergency Radiology

Scrotal emergencies:Scrotal emergencies: What to order?

Ultrasound with color Doppler.

When? Acute scrotal pain trauma to testis.

Findings

Testicular Torsion (US)

Testicular Torsion (Doppler US)

Acute Epididymo-orchitis (US)

Acute Epididymo-orchitis (Doppler US)

Testicular Trauma (US)

Emergency Radiology

Gyncological & Obstetric Emergencies: Ovarian Torsion PID Abortion Ectopic pregnancy Placenta Previa

Emergency Radiology

Gynecological emergencies:Gynecological emergencies: What to order?

Ultrasound (Color Doppler)

When? Lower abdominal pain fever vaginal

discharge

Findings

Ovarian Torsion (US)

Ovarian Torsion (US)

Emergency Radiology

Obstetric emergencies:Obstetric emergencies: What to order?

Ultrasound (Color Doppler)

When? Bleeding in early / late pregnancy.

Findings

Viable Fetus (US)

Non Viable Fetus (US)

Incomplete Abortion (US)

Blighted Ovum (US)

Ectopic Pregnancy (US)

Ectopic Pregnancy (US)

Retroplacental Hematoma, Placenta Previa (US)

Emergency Radiology

Muscloskeletal Emergencies: Upper & lower extremities Fractures &

dislocations Pelvic Fractures. Joint injuries Ligaments and tendons injuries.

Emergency Radiology

MuscloskeletalMuscloskeletal emergencies:emergencies: What to order?

Plain X-ray. CT scan. MRI

When? History of trauma.

Findings

Fracture Both bones forearm (Plain X-ray)

Fracture dislocation of the elbow (Plain X-ray)

Fracture Big toe, Fracture neck humerus (Plain X-ray)

Fracture Pelvic Bone (Plain X-ray, CT)

Emergency Radiology

Pediatric Emergencies: Neonatal emergencies (intestinal

obstruction ) Intussception. Foreign body aspiration. Bone injuries.

Neonatal Intestinal Obstruction (Plain X-ray, Contrast)

Duodenal Atresia Ileal Atresia

Intussusception (Plain X-ray, Contrast)