BOOK
Accident and Emergency Radiology: A Survival Guide E-Book
Nigel Raby | Laurence Berman | Simon Morley | Gerald de Lacey
(2014)
Additional Information
Book Details
Abstract
Since it was first published, Accident and Emergency Radiology: A Survival Guide has become the classic reference and an indispensable aid to all those who work in the Emergency Department. The core and substantial value lies in the step-by-step analytical approaches which help you to answer this question: "These images look normal to me, but . . . how can I be sure that I am not missing a subtle but important abnormality?"
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
- Ensure accuracy in reading and interpretation of any given image. Common sources of error and diagnostic difficulty are highlighted.
- Prevent mistakes. Pitfalls and associated abnormalities are emphasized throughout.
- Avoid misdiagnoses. Normal anatomy is outlined alongside schemes for detecting variants of the norm. Each chapter concludes with a summary of key points. Will provide a useful overview of the most important features in diagnosis and interpretation.
- Easily grasp difficult anatomical concepts. Radiographs accompanied by clear, explanatory line-drawings.
- Spend less time searching with an improved layout and design with succinct, easy-to-follow text. A templated chapter approach helps you access key information quickly. Each chapter includes key points summary, basic radiographs, normal anatomy, guidance on analyzing the radiographs, common injuries, rare but important injuries, pitfalls, regularly overlooked injuries, examples, and references.
- Grasp the nuances of key diagnostic details. Updated and expanded information, new radiographs, and new explanatory line drawings reinforce the book’s aim of providing clear, practical advice in diagnosis.
- Avoid pitfalls in the detection of abnormalities that are most commonly overlooked or misinterpreted.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Accident & Emergency Radiology | i | ||
| Copyright page | ii | ||
| Table of Contents | iii | ||
| Preface | iv | ||
| Acknowledgements | iv | ||
| 1 Key principles | 1 | ||
| Introduction | 1 | ||
| Basic radiology | 2 | ||
| The radiographic image | 2 | ||
| Fracture lines: usually black, but sometimes white | 3 | ||
| Fat pads and fluid levels | 3 | ||
| The principle of two views | 4 | ||
| Important information: patient position | 5 | ||
| Assessing the radiographs: discipline is essential | 5 | ||
| Describing injuries | 6 | ||
| Fractures of the long bones | 6 | ||
| Dislocations | 9 | ||
| References | 10 | ||
| 2 Particular paediatric points | 11 | ||
| Paediatric Points addressed in other chapters | 11 | ||
| Bones in children are different | 12 | ||
| Child versus adult | 12 | ||
| The end of a long bone in a child | 13 | ||
| Fracture sites | 14 | ||
| Epiphyseal–metaphyseal (Salter–Harris) fractures | 14 | ||
| Metaphyseal–diaphyseal fractures | 18 | ||
| Diaphyseal fractures | 20 | ||
| Toddler’s fracture | 22 | ||
| Sports injuries | 24 | ||
| Stress fractures | 24 | ||
| Avulsion injuries | 26 | ||
| Chondral & osteochondral injuries | 28 | ||
| Chest emergencies | 30 | ||
| Inhaled foreign body | 30 | ||
| Child abuse: skeletal injuries | 31 | ||
| Under- and over-diagnosis of NAI | 31 | ||
| Radiographic features suggestive of NAI | 32 | ||
| Radiographic features highly suggestive of NAI | 32 | ||
| References | 34 | ||
| 3 Paediatric skull—suspected NAI | 35 | ||
| The standard radiographs | 35 | ||
| Abbreviations: the sutures | 35 | ||
| Normal anatomy | 36 | ||
| Infants and toddlers—normal accessory sutures | 36 | ||
| The lateral SXR | 37 | ||
| The AP frontal SXR | 38 | ||
| The Towne’s SXR | 39 | ||
| Analysis: suture recognition | 40 | ||
| The principal question: is it a suture or a fracture? | 40 | ||
| Be aware… | 40 | ||
| Assessing the radiographs | 40 | ||
| Suture recognition on the Towne’s view | 41 | ||
| Suture recognition on the lateral view | 42 | ||
| Suture recognition on the AP view | 44 | ||
| References | 46 | ||
| 4 Adult skull | 47 | ||
| The standard radiographs | 47 | ||
| Abbreviations | 47 | ||
| Anatomy | 48 | ||
| Normal features on a lateral SXR | 48 | ||
| Towne’s view | 48 | ||
| Analysis: false positive diagnoses | 49 | ||
| difficulties with interpretation | 49 | ||
| Analysis: recognising a fracture | 50 | ||
| Linear fracture | 50 | ||
| Depressed fracture | 50 | ||
| Fluid level in the sphenoid sinus | 51 | ||
| A frequent pitfall | 52 | ||
| Vascular marking versus fracture | 52 | ||
| References | 52 | ||
| 5 Face | 53 | ||
| The standard radiographs | 53 | ||
| Regularly overlooked injuries | 53 | ||
| Abbreviations | 53 | ||
| Normal anatomy: midface & orbit | 54 | ||
| Facial bone anatomy | 54 | ||
| Occipitomental (OM) views | 55 | ||
| Normal anatomy: mandible | 56 | ||
| The orthopantomogram (OPG) | 56 | ||
| The temporomandibular joint (TMJ) | 56 | ||
| Straight PA radiograph | 57 | ||
| Analysis: the checklists | 58 | ||
| Midface injury | 58 | ||
| Suspected blow-out fracture | 61 | ||
| Injury to mandible | 61 | ||
| The common injuries | 62 | ||
| Injuries to the midface | 62 | ||
| Orbital blow-out fracture | 64 | ||
| Orbital blow-out fracture—the OM findings | 66 | ||
| Injuries to the mandible | 68 | ||
| Injuries to the nasal bone | 70 | ||
| Pitfalls | 71 | ||
| References | 72 | ||
| 6 Shoulder | 73 | ||
| Regularly overlooked injuries | 73 | ||
| The standard radiographs | 73 | ||
| Abbreviations | 73 | ||
| Standard radiographs | 74 | ||
| Normal anatomy | 75 | ||
| AP view | 75 | ||
| Apical oblique view | 76 | ||
| Lateral scapula view—ie the Y view | 77 | ||
| Analysis: the checklists | 78 | ||
| The AP radiograph | 78 | ||
| Apical oblique view | 79 | ||
| The common fractures | 80 | ||
| Greater tuberosity of the humerus | 80 | ||
| Humeral head and/or rim of the glenoid | 80 | ||
| Clavicle | 81 | ||
| The common dislocations | 82 | ||
| Anterior dislocation of the glenohumeral (GH) joint | 82 | ||
| Anterior dislocation of the glenohumeral (GH) joint with accompanying fractures | 84 | ||
| Subluxations and dislocations at the acromioclavicular joint (ACJ) | 86 | ||
| Uncommon but important injuries | 88 | ||
| Posterior dislocation at the glenohumeral (GH) joint | 88 | ||
| Fractures of the proximal humerus | 90 | ||
| Fractures of the body or neck of the scapula | 91 | ||
| Sternoclavicular rupture | 91 | ||
| Inferior dislocation of the humeral head (luxatio erecta) | 91 | ||
| Pitfalls | 92 | ||
| Positioning | 92 | ||
| ACJ assessment | 92 | ||
| Developmental variants that can mislead | 92 | ||
| References | 94 | ||
| 7 Paediatric elbow | 95 | ||
| Regularly overlooked injuries | 95 | ||
| The standard radiographs | 95 | ||
| Abbreviations | 95 | ||
| Anatomy | 96 | ||
| AP view—child age 9 or 10 years | 96 | ||
| Lateral view—child age 9 or 10 years | 96 | ||
| Elbow fat pads | 97 | ||
| AP and lateral: the CRITOL sequence | 98 | ||
| Exceptions to the CRITOL sequence? | 98 | ||
| Medial epicondyle—normal anatomy | 100 | ||
| AP and lateral—two anatomical lines | 101 | ||
| Analysis: four questions to answer | 102 | ||
| Question 1—Are the fat pads normal? | 102 | ||
| Question 2—Is the anterior humeral line normal? | 103 | ||
| Question 3—Is the radiocapitellar (RC) line normal? | 104 | ||
| Question 4—Are the ossification centres normal? | 105 | ||
| The common injuries | 106 | ||
| Supracondylar fracture | 106 | ||
| Fracture of the lateral humeral condyle | 109 | ||
| Avulsion of the medial epicondyle | 110 | ||
| Pulled (“nursemaids”) elbow | 111 | ||
| Plastic bowing injury | 111 | ||
| Rare but important injuries | 112 | ||
| Avulsion of the lateral epicondyle | 112 | ||
| Isolated dislocation of the head of the radius | 112 | ||
| Monteggia injury | 112 | ||
| Pitfalls | 113 | ||
| Normal variants that can mislead | 113 | ||
| Puzzled by the appearance of the epicondyles? | 114 | ||
| Misleading lines | 114 | ||
| References | 114 | ||
| 8 Adult elbow | 115 | ||
| Regularly overlooked injuries | 115 | ||
| The standard radiographs | 115 | ||
| Abbreviations | 115 | ||
| Normal Anatomy | 116 | ||
| AP view | 116 | ||
| Lateral view | 116 | ||
| Radiocapitellar line | 117 | ||
| Elbow fat pads | 117 | ||
| Analysis: three questions to answer | 118 | ||
| Question 1—Are the fat pads normal on the lateral view? | 118 | ||
| Question 2—Is the cortex of the radial head and neck smooth on both views? | 119 | ||
| Question 3—Is the radiocapitellar (RC) line normal? | 120 | ||
| The common injuries | 121 | ||
| Fracture of the head or neck of the radius | 121 | ||
| Fracture of the olecranon | 122 | ||
| A rare but important injury | 123 | ||
| The Monteggia injury | 123 | ||
| Pitfalls | 124 | ||
| References | 124 | ||
| 9 Wrist & distal forearm | 125 | ||
| Regularly overlooked injuries | 125 | ||
| The standard radiographs | 125 | ||
| Abbreviations | 125 | ||
| Normal anatomy | 126 | ||
| PA projection: bones and joints | 126 | ||
| Lateral projection: bones and joints | 127 | ||
| Analysis: the checklists | 128 | ||
| The PA view | 128 | ||
| The lateral view | 130 | ||
| The scaphoid series | 132 | ||
| Wrist myths | 135 | ||
| The common fractures | 136 | ||
| Fractures of the distal radius | 136 | ||
| Fractures of the distal radius in children | 140 | ||
| Fractures of the distal ulna | 142 | ||
| Scaphoid fracture | 144 | ||
| Triquetral fracture | 145 | ||
| Subluxations and dislocations | 146 | ||
| Distal radio-ulnar joint subluxation | 146 | ||
| Scapho-lunate separation | 147 | ||
| Rare but important injuries | 148 | ||
| Fractures of the other carpal bones | 148 | ||
| Subluxations/dislocations of the carpus | 148 | ||
| Normal variants that can mislead | 151 | ||
| Normal radial beak | 151 | ||
| Normal longitudinal ridges | 151 | ||
| Accessory ossicles | 152 | ||
| References | 152 | ||
| 10 Hand & fingers | 153 | ||
| The standard radiographs | 153 | ||
| Regularly overlooked injuries | 153 | ||
| Abbreviations | 153 | ||
| Normal anatomy | 154 | ||
| PA and oblique views | 154 | ||
| The thumb | 155 | ||
| The carpometacarpal (CMC) joints | 156 | ||
| The normal CMC joints | 157 | ||
| Analysis: the checklist | 158 | ||
| Adopt a three-step approach | 158 | ||
| The common injuries | 160 | ||
| Fractures of the phalanges or metacarpals | 160 | ||
| Uncommon but important injuries | 164 | ||
| Fractures and dislocations involving the thumb | 164 | ||
| Carpometacarpal (CMC) joint dislocations | 167 | ||
| The 4th and 5th CMC joints on the PA radiograph | 168 | ||
| Pitfalls | 169 | ||
| Mobile basal joint of the thumb | 169 | ||
| Additional bones | 169 | ||
| Accessory epiphyses | 170 | ||
| References | 170 | ||
| 11 Cervical spine | 171 | ||
| Regularly overlooked injuries | 171 | ||
| The standard radiographs | 171 | ||
| Abbreviations | 171 | ||
| Normal anatomy | 172 | ||
| Lateral view | 172 | ||
| AP Peg view | 173 | ||
| Long AP view | 173 | ||
| Analysis: the checklists | 174 | ||
| Priority 1: Lateral view checklist | 174 | ||
| Priority 2: AP Peg view checklist | 180 | ||
| Priority 3: Long AP view checklist | 184 | ||
| The common injuries | 186 | ||
| Injuries at C1 | 186 | ||
| Injuries at C2 involving the Peg | 188 | ||
| Injuries involving the body or the posterior elements of C2 | 190 | ||
| C2 subluxation due to rupture of the transverse ligament | 191 | ||
| Fractures C3–C7 | 192 | ||
| Subluxations/dislocations C3–C7 | 193 | ||
| Explaining unilateral facet joint dislocation | 194 | ||
| Pitfalls | 195 | ||
| On the AP Peg view | 195 | ||
| On the long AP view | 195 | ||
| Developmental variants | 195 | ||
| Anterior opacity | 196 | ||
| Spasm related—delayed instability | 196 | ||
| Age related changes | 197 | ||
| References | 198 | ||
| 12 Thoracic & lumbar spine | 199 | ||
| Regularly overlooked injuries | 199 | ||
| The standard radiographs | 199 | ||
| Abbreviations | 199 | ||
| Normal anatomy | 200 | ||
| Lateral view—thoracic and lumbar vertebrae | 200 | ||
| The three column spine | 200 | ||
| AP view—thoracic vertebrae | 201 | ||
| AP view—lumbar vertebrae | 201 | ||
| Analysis: the checklists | 202 | ||
| On the lateral view | 202 | ||
| On the AP view | 204 | ||
| The common injury | 206 | ||
| Less frequent but important injuries | 207 | ||
| Fractures following trauma | 207 | ||
| Pitfalls | 211 | ||
| The right paraspinal line | 211 | ||
| Dismissing transverse process fractures as trivial | 211 | ||
| Schmorl’s nodes | 211 | ||
| References | 212 | ||
| 13 Pelvis | 213 | ||
| Regularly overlooked injuries | 213 | ||
| The standard radiograph | 213 | ||
| Abbreviations | 213 | ||
| Normal anatomy | 214 | ||
| Normal AP view | 214 | ||
| Developing skeleton: Synchondroses | 214 | ||
| Developing skeleton: Pelvic bone apophyses | 215 | ||
| Analysis: the checklist | 216 | ||
| The AP radiograph | 216 | ||
| Common fractures, high energy | 218 | ||
| Fractures involving the main bone ring | 218 | ||
| Acetabular fractures | 219 | ||
| Sacral fractures | 220 | ||
| Common fractures, low energy | 222 | ||
| Simple fall in the elderly | 222 | ||
| Injury to the coccyx | 222 | ||
| Apophyseal avulsion in the young | 222 | ||
| Sports injuries: specific avulsions | 224 | ||
| Pitfalls | 225 | ||
| References | 226 | ||
| 14 Hip & proximal femur | 227 | ||
| Regularly overlooked injuries | 227 | ||
| The standard radiographs | 227 | ||
| Abbreviations | 227 | ||
| Normal anatomy | 228 | ||
| AP view | 228 | ||
| Lateral view | 228 | ||
| AP and lateral views | 229 | ||
| Secondary centres (apophyses) | 229 | ||
| Analysis: the checklists | 230 | ||
| The common injuries | 232 | ||
| Elderly patient after a simple fall | 232 | ||
| Adolescent patient with acute hip pain | 236 | ||
| Uncommon but important injuries | 238 | ||
| Acetabular fracture | 238 | ||
| Dislocations | 239 | ||
| Pitfall | 242 | ||
| References | 242 | ||
| 15 Knee | 243 | ||
| The standard radiographs | 243 | ||
| Regularly overlooked injuries | 243 | ||
| Abbreviations | 243 | ||
| Normal anatomy | 244 | ||
| AP view | 244 | ||
| Lateral view | 245 | ||
| Analysis: the checklists | 246 | ||
| The AP radiograph | 246 | ||
| The lateral radiograph | 248 | ||
| The common fractures | 250 | ||
| Tibial plateau fracture | 250 | ||
| Tibial plateau fracture—the four features to look for | 252 | ||
| Fracture through the body of the patella | 254 | ||
| Osteochondral fracture: articular surface of the patella | 255 | ||
| Neck of fibula fracture | 256 | ||
| Osteochondritis dissecans of the knee | 257 | ||
| Supracondylar and intracondylar fractures of the femur | 257 | ||
| Fracture/avulsion of the tibial spine | 257 | ||
| Small fragments around the knee | 258 | ||
| Cruciate ligament injury | 258 | ||
| Cruciate ligament or meniscus injury—Segond fracture | 259 | ||
| A common dislocation | 260 | ||
| Patella dislocation | 260 | ||
| Infrequent but important injuries | 260 | ||
| Pitfalls | 262 | ||
| References | 264 | ||
| 16 Ankle & hindfoot | 265 | ||
| Regularly overlooked injuries | 265 | ||
| The standard radiographs | 265 | ||
| Abbreviations | 265 | ||
| Normal anatomy | 266 | ||
| Lateral view—bones and joints | 266 | ||
| Lateral view—ligaments | 267 | ||
| AP mortice | 268 | ||
| Axial projection—calcaneum | 269 | ||
| Analysis: the checklists | 270 | ||
| AP mortice | 270 | ||
| Lateral view | 272 | ||
| Axial view | 273 | ||
| Common fractures/torn ligaments | 274 | ||
| The malleoli | 274 | ||
| Base of the 5th metatarsal | 276 | ||
| The calcaneum | 277 | ||
| Several types of calcaneal fracture | 278 | ||
| Growth plate (Salter–Harris) fractures | 280 | ||
| Ligamentous injuries | 281 | ||
| Torn medial or lateral ligaments | 281 | ||
| Tear of the interosseous membrane | 281 | ||
| Infrequent but important injuries | 282 | ||
| Fractures of the talus | 282 | ||
| Maisonneuve fracture | 284 | ||
| Distal tibial fractures involving the articular surface | 285 | ||
| Complex Salter–Harris fractures | 286 | ||
| Infrequent calcaneal fractures | 288 | ||
| Os trigonum fracture | 288 | ||
| Talar dislocations—Infrequent but important | 289 | ||
| Pitfalls | 290 | ||
| Calcaneum: the apophysis | 290 | ||
| Calcaneum: the anterior process | 291 | ||
| Normal accessory ossicles | 291 | ||
| References | 292 | ||
| 17 Midfoot & forefoot | 293 | ||
| Regularly overlooked injuries | 293 | ||
| The standard radiographs | 293 | ||
| Abbreviations | 293 | ||
| Normal anatomy | 294 | ||
| AP view | 294 | ||
| Oblique view | 294 | ||
| The cuneiform mortice and the Lisfranc joints | 295 | ||
| Analysis: the checklists | 296 | ||
| The AP radiograph | 296 | ||
| The oblique radiograph | 296 | ||
| The lateral radiograph | 297 | ||
| The common fractures | 298 | ||
| Metatarsals and phalanges | 298 | ||
| Base of the 5th metatarsal | 298 | ||
| Fatigue (march/stress) fractures | 299 | ||
| Infrequent but important fractures | 300 | ||
| Tarsal bone fractures | 300 | ||
| Base of the second, 3rd, or 4th metatarsal | 300 | ||
| Jones fracture | 301 | ||
| Dislocations/subluxations | 302 | ||
| Injury to the tarsometatarsal joints | 302 | ||
| Pitfalls | 304 | ||
| Sesamoids and accessory ossicles | 304 | ||
| Apophysis | 305 | ||
| Epiphyseal clefts | 305 | ||
| An unrelated abnormality can cause distraction | 306 | ||
| An error/pitfall that needs repeated emphasis… | 306 | ||
| References | 306 | ||
| 18 Chest | 307 | ||
| The chest X-ray (CXR) | 307 | ||
| The standard radiographs | 307 | ||
| Abbreviations | 307 | ||
| Normal anatomy | 308 | ||
| Frontal CXR—the lungs | 308 | ||
| Frontal CXR—lung markings | 308 | ||
| Frontal CXR—hila | 309 | ||
| Frontal CXR—cardiothoracic ratio | 309 | ||
| Lateral CXR—the lobes of the lung | 310 | ||
| Lateral CXR—skeletal shadows | 311 | ||
| Lateral CXR—three normal appearances | 311 | ||
| Analysis: the checklists | 312 | ||
| The frontal CXR | 312 | ||
| The lateral CXR | 314 | ||
| Ten clinical problems | 316 | ||
| Question 1: Is there pneumonia (consolidation)? | 316 | ||
| Question 2: Is there a pneumothorax? | 319 | ||
| Question 3: Are there signs of left ventricular failure (LVF)? | 321 | ||
| Question 4: Severe asthmatic attack—is there a complication? | 323 | ||
| Question 5: Is there a pleural effusion? | 324 | ||
| Question 6: (a) Is there an aortic dissection? (b) Is there a traumatic rupture of the aorta? | 326 | ||
| Question 7: Is there a rib fracture? | 327 | ||
| Question 8: Is there a cause for non-specific chest pain? | 327 | ||
| Question 9: Is there evidence of a pulmonary embolus? | 327 | ||
| Question 10: Is there evidence of an inhaled foreign body? | 328 | ||
| References | 328 | ||
| 19 Abdominal pain & abdominal trauma | 329 | ||
| Appropriate imaging | 329 | ||
| Abbreviations | 329 | ||
| The AXR—its usefulness | 330 | ||
| Analysis: plain film checklists | 332 | ||
| Erect CXR | 332 | ||
| Supine AXR | 333 | ||
| The common problems | 334 | ||
| Non-specific abdominal pain | 334 | ||
| Suspected perforation | 335 | ||
| Suspected intestinal obstruction | 336 | ||
| Suspected constipation | 337 | ||
| Suspected renal colic | 338 | ||
| Suspected acute biliary disease | 340 | ||
| Suspected abdominal aortic aneurysm/rupture | 340 | ||
| Suspected foreign body ingestion | 340 | ||
| Infrequent but important problems | 341 | ||
| Blunt trauma to the abdomen | 341 | ||
| Penetrating injury to the abdomen | 341 | ||
| References | 342 | ||
| 20 Penetrating foreign bodies | 343 | ||
| The standard radiographs | 343 | ||
| Alternative imaging to consider | 343 | ||
| Regularly overlooked foreign bodies | 343 | ||
| Abbreviations | 343 | ||
| Appearances on plain radiographs | 344 | ||
| Glass | 344 | ||
| Metal | 344 | ||
| Wood or plastic | 344 | ||
| Suspected foreign bodies | 346 | ||
| Soft tissue laceration | 346 | ||
| Orbital injury | 347 | ||
| References | 348 | ||
| 21 Swallowed foreign bodies | 349 | ||
| Dangerous injuries | 349 | ||
| Useful tools | 349 | ||
| Abbreviations | 349 | ||
| The most common foreign bodies | 350 | ||
| Children: coins | 350 | ||
| Adults: fish bones | 352 | ||
| Infrequent but important FBs | 356 | ||
| Sharp objects other than fish bones | 356 | ||
| Button batteries | 358 | ||
| Magnets | 359 | ||
| Large objects—dentures | 360 | ||
| Hard plastic clips | 361 | ||
| Bezoars | 361 | ||
| References | 362 | ||
| 22 Test yourself | 363 | ||
| 23 Glossary | 373 | ||
| Further reading | 376 | ||
| Index | 377 | ||
| Test Yourself—answers | 380 |