Pathology

Atelectasis

• Incomplete expansion of lung at birth or collapse of adult lung

• Negative pressure within the chest is disturbed

• Causes:– Obstruction of a bronchus – Compression of lung by pleural

effusion or pneumothorax.– Improper placement of endotracheal

tube– Bronchogenic carcinoma.

• Radiographic Signs:– Local increased density – Elevation of the hemidiaphram– Displacement of the mediastinum– Compensatory over-inflation of the

lung

Bronchiectasis• Chronic dilation of one or more bronchi

• Causes:– Repeated pulmonary

infection and bronchial obstruction

– Lung abscess

• Radiographic Signs:– Courseness and loss of

definition of interstitial markings

– Oval or circular cystic spaces

– Honeycomb pattern

Emphysema / Chronic Obstructive Pulmonary Disease (COPD)

• Associated with chronic bronchitis. • Increased air spaces with associated tissue

destruction.• “leather lung disease”

– alveoli lose their elasticity and remain filled with air during expiration.

• Incurable• Radiographic Signs:

– Hyperinflated lungs– Depressed diaphram– Increased Bronchovascular markings

Pleural Effusion (Hydrothorax)• Fluid in pleural cavity• Causes

– Congestive Heart Failure– Infection– Neoplasm– Trauma

• Radiographic Signs– Blunt costophrenic angles– Air/Fluid levels– Mediastinal Shift

Pulmonary Embolism• Potentially Fatal

– Patients with cardiovascular dz or severe debilitating illness often result with infarction

• 95% arise from the deep venous thrombi

• Radiographic Sign– Hampton’s Hump

• Inverted wedge-shaped opacity of the lung

TB• Caused by Myobacterium

Tuberculosis• Primary Lesion

– Collection of inflammatory cells collects around a clump of TB to form a mass

– Outcomes depend on the number of bacilli and the resistance of infected tissues

• Scars commonly found in posterior apical segments

• Radiographic Signs:– Demonstrates cavitation and

calcification– Lobar or segmental air-space

consolidation– Enlarged hilar or mediastinal lymph

nodes– Pleural Effusion

Pneumonoconiosis

• Long-continued irritation of certain dusts encountered in industrial occupations that cause a chronic interstitial pneumonia.

• 3 Types:– Silicosis– Asbestosis– Berylliosis

Volvulus• Medical Emergency!• Abnormal twisting or torsion of

intestine causing obstruction and impairment of normal blood flow.

• Small intestine, cecum, and sigmoid colon are subject to volvulus.

• Clinical Signs– Sudden onset– Abdominal pain– Nausea– Vomiting – Blood in stool

• Treatment– Surgical intervention

• If not treated, a patient may suffer from:

– Gangrene– Death of that segment of GI tract– Intestinal Obstruction– Perforation of the Intestine– Peritonitis

Fistulae or Sinus Tract• Fistula

– An abnormal connection between 2 organs or leading from an internal organ to the surface of the body.

• Most are caused by surgery but may also result from infection or inflammation.

• Sinus Tract– Abnormal channel permitting the escape of pus.

Ba study: gastric outlet obstruction with choledochoduodenal and

abdominal fistulae. fistulagram

Ascites• Accumulation of excessive fluid

within the peritoneal cavity.• CommonCauses

– Cirrhosis– Heart Failure– Budd-Chiari Syndrome– Cancer– TB– Pancreatitis

• Treatment– Salt Restriction– Fluid Restriction– Diuretics– Paracentesis– Shunting– Liver Transplant Portal hypertension. In ascites the

soggy bowel floats medially, there is some separation of the ill-defined loops and loss of retroperitoneal planes. Note enlarged spleen.

Prolapse• "To fall out of place."

– Rectal prolapse• Partial prolapse

– The lining of the rectum falls out of place when you strain to have a bowel movement.

• Complete prolapse – The entire wall of the rectum falls and usually sticks out of

the body. • Internal prolapse (intussusception)

– Part of the wall of the colon telescopes into or over another part. (occurs inside of the body)

– Causes• Straining to have bowel movements• Child Birth• Weakening of anal sphincter muscle & ligaments that

support rectum• Neurologic problems

– Symptoms • Stool leakage• Bleeding, anal pain, itching, irritation• Tissue that protrudes from rectum• Small stools• Urgency for bowel movement

– Treatment • Fiber rich diet• Increased fluids• Physical Therapy• Surgery

Prolapsed Transverse Colon

Rectal Prolapse

Colon and Rectal Cancer• Leading cause of

death from cancer in US

• Annular carcinoma has “apple-core” pattern imaged during BE

Crohn’s Disease• Chronic bowel

inflammation• Separated by

normal segments of bowel

Diverticulosis

• Pouch-like herniations through wall of colon

Intussusception• Prolapse of one

segment of bowel into another segment

• Telescoping

Small / Large Bowel Obstruction• Massive accumulation

of gas proximal to the obstruction

• Absence of gas distal to obstruction

• High risk perforation• EXAMPLE: Ileus

– Adynamic: • Caused by bowel

immobility

– Mechanical• Caused by mechanical

obstruction

Urinary System• Bladder Cancer• Cystitis• Glomerulonephritis• Polycystic Kidney

Disease• Pyelonephritis• Renal Calculus• Renal Carcinoma /

Wilm’s Tumor• Renal Cysts• Reflux

Myelogram• Herniated

intervertebral disks

• Degenerative dz• Space occupying

lesions– L3-L4 interspace– Subarachnoid

Space

Arthrography• Joint Trauma• Meniscal Tears• Capsular Damage• Deformities caused

by arthritis• Rupture of articular

ligaments

Spina Bifida Occulta“Open Spine”

• Congenital deformity of the vertebral column in which the laminae fail to unite posteriorly at the midline.

www.pbs.org

Vertebral Subluxation• Misalignment or

partial dislocation– one or more

vertebrae move out of position and create pressure on or irritate spinal nerves.

Spondylolisthesis

A developmental crack in one of the vertebrae (usually at the L5-S1 junction.) The cracked vertebra slips forward over the vertebra below it. This is known as adult isthmic spondylolisthesis.

Ankylosing Spondylitis

Chronic inflammatory disease that causes arthritis of the spine and SI joints. It is a systemic rheumatic disease and can affect other joints & cause inflammation of the eyes, lungs, & kidneys.

Herniated Nucleus Pulposus“Slipped Disc”

Compression Fracture

• A bone break that disrupts osseous tissue and collapses the affected bone.

• This injury tends to happen in 2 groups of people. – Patients involved in

traumatic accidents when the load placed on the vertebrae exceeds its stability. (This is commonly seen after a fall)

– Patients with osteoporosis (most common)

Osteitis Deformans/Pagets• chronic bone disorder that results in enlarged, deformed bones due

to excessive breakdown &

formation of bone tissue that can cause bones to

weaken and may result in bone pain, arthritis, bony deformities and fractures.

Osteochondroma• A benign tumor that contains both bone and cartilage

and usually occurs near the end of a long bone.

Ewing’s Sarcoma(Peripheral Primitive Neuroectodermal Tumors )

• Bone cancer found in children and young adults.

Multiple myeloma

• Multiple myeloma is a cancer of your plasma cells. Plasma cells are a type of white blood cell present in your bone marrow.

Osteomyelitis

• Infection of the bone or bone marrow caused by pyogenic bacteria or myobacteria.

Neuroma

• Any tumor of cells of the nervous system. Neuromas may be benign or malignant.

Bakers Cyst

Osgood-Schlatter’s Disease

• The large powerful quadriceps contracts & the patellar tendons can pull away from the shin bone.

• Athletes present with pain and swelling at the tibial tubercle.

• Repetitive activity and tight quadriceps cause – cartilage swelling– cortical bone fragmentation– patellar tendon thickening– infrapatellar bursitis.

Rheumatoid Arthritis

• Chronic Systemic Disease of unknown origin.

• Manifests as an inflamed peripheral joint.

• Polymorphonulear leukocytes are attracted to the joint space causing destruction of the joint structures.

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“Open Book” Injury• Widening of the anterior pubic arch

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diastasis of > 2.5 cm = ligament damage at the SI joint

www.scielo.br.com

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Duverney’s Fracture• Stable fracture at the lateral margin of the iliac wing

(just below the anterior inferior spine) caused by vertically directed forces

Complications: Possible hemorrhage from the internal iliac arterial system.

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Osteosarcoma• Most common type of malignant bone cancer. Often

localized at long bones. Commonly affects the lower end of the femur or the upper end of the tibia or humerus.

www.findhealer.com

POSITIONING REVIEW

What are the proximal and distal rows in the wrist?

Carpals• 8 Carpal Bones

– Proximal Row• Scaphoid (Navicular)• Lunate (Semilunar)• Triquetrum (Cuneiform)• Pisiform

– Distal Row• Trapezium (Greater

Multangular)• Trapezoid (Lesser

Multangular)• Capitate (Os Magnum)• Hamate (Unciform)

In what position was this image taken?

What bone is demonstrated in this position?

In what position was the patient for this image?

In what position was the patient placed for this shoulder image?

What image is demonstrated? How do you determine anterior/posterior dislocation?

Scapular Y

• Useful in demonstrating dislocations– Anterior Subcoracoid

dislocation• Head beneath the

coracoid process– Posterior Subacromial

dislocation• Head projected

beneath acromion process

What is the attempted image? How was it accomplished?

Which ribs are demonstrated in RAO position?

52

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AP Axial “Outlet” projection(Taylor Method)

• 10X12 crosswise (14X17 for entire pelvis) Pt supine without rotation

• Males: 20-35 degree cephalad

• Females: 30-45 degree cephalad

CR 2 inches distal to the superior border of the pubic symphysis

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Superoinferior Axial “Inlet” Projection(Bridgeman Method)

• 10X12 crosswise (14X17 if entire pelvis is routine)

• Demonstrates axial projection of pelvic ring, or inlet, in its entirety

CR 40 degrees caudad centered @ level ASIS

Which way do you rotate?

How was this image accomplished?

AP Knee

• Central ray depends on the measurement between the ASIS and the tabletopThin pelvis 18 cm and below 3-5 degrees caudad

Average 19-24 cm perpendicular

Large pelvis 25 cm and above 3-5 degrees cephalic

What does this image demonstrate? How was it done?

Name the parts of the scottie dog.

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L5-S1 SPOT PROJECTIONWhere to you center?

Center on coronal plane 2 in posterior to ASIS and 1.5 in inferior to the iliac crest.

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L5-S1 SPOT PROJECTIONWhere to you center?

Center on coronal plane 2 in posterior to ASIS and 1.5 in inferior to the iliac crest.

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How was this image taken?

What is the evaluation requirement for this image?

How was this image taken?

45

C Spine

T Spine

L Spine

AP side downPA side up

87

Caldwell Sinus Projection Film

• This view will provide a clear view of the frontal and ethmoid sinuses.

• The super orbital rims can be evaluated for fracture when facial bone are of interest.

• To project the petrous ridges farther down, increase angle to 30 degrees

Sinus Lateral

• Lateral – External auditory meatus externally and mandible inferiorly with supracillary arch superiorly in view.

• CR centered to zygoma, midway between outer canthus and EAM

• Midsagittal plane is parallel to IR• IPL is perpendicular to IR

Lateral Sinus Anatomy

Positioning: Waters

• Prone or seated upright

• Chin on bucky -OML 37 angle with plane of cassette

• Mentomeatal line should be perpendicular to film with mouth closed.

• Nose 3/4 inch from IR

• Suspend respiration

• CR perpendicular to exit acanthion

Waters Radiograph

• Distance from lateral border of skull and orbit equal on each side

• Petrous ridges projected immediately below maxillary sinuses

Modified Parietoacanthial (Modified Waters)

• OML 55 degrees to the IR• Chin and nose on table• Petrous pyramids are seen mid-maxillary sinus• CR exits acanthion• Blowout Fractures

• See pg. 355 (Merrill’s 12th Edition)

Modified Waters Radiograph

• Petrous ridges projected immediately below the inferior border of the orbits

• Equal distance from lateral orbit to lateral skull on both sides

Reverse Waters

• Supine

• Extend neck so OML is 37 degree with plane of IR

• MML perp

• Suspend respiration

• CR perpendicular and enters acanthion

Lateral Nasal Bones

• Semiprone

• IPL perpendicular

• CR perpendicular to the bridge of nose at a point ½ inch distal to the nasion

Bilateral Arches - SMV

• IOML parallel to IR and perpendicular to CR

• CR midsaggital and collimate to outer edges of zygoma

Oblique Tangential

• Same position as SMV except head tilt 15 degrees toward side of interest

(Merrill’s p. 362 12 ed)

Esophagus

• RAO• Left side elevated

35-40 degrees• Center at T-5 or T-6

Stomach• PA

– Center at pylorus L2 (midway between xiphoid and umbilicus)

– Expiration• RAO

– L side elevated 40-70 degrees– Between vertebrae and elevated

surface– Center at duodenal bulb– Expiration

• Lateral– Recumbant (R lateral), Erect (L

lateral)– Between axilla and anterior

surface – Center at pylorus

Small Bowel

• Central ray at iliac crest (or slightly above for early exposures)

Colon

• PA or AP– Center at iliac crest

• PA Axial (may be done AP)– Prone– Center @ iliac crest– CR 30-40 degrees caudad– Sigmoid Colon– Smaller IR; CR enters @ ASIS

• Bilat Obliques• Lateral Decubitus• Lateral Rectum

– Enter at ASIS

Intravenous Urography

• KUB• Obliques

– Rotated 30 degrees – kidney farthest from IR is parallel; kiney closest is perpendicular to film

• AP Bladder– CR at ASIS

Cystography

• AP Axial– 10-15 degrees caudal– CR 2-3 in above pubic

syphysis• Oblique

– 40-60 degrees• PA Bladder

– CR 1 in distal to tip of coccyx– 10-15 degree cephalad

angle• Lateral