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)
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