IMAGING IN FAMILY MEDICINE

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Claribel McDaniel
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1 IMAGING IN FAMILY MEDICINE

2 Imaging Methods Ultrasonography (USG) X-ray Computed tomography (CT) Magnetic resonance imaging (MRI) Scintigraphy Angiography

3 SNC MEDIASTINUM LUNGS ABDOMEN PELVIS

4 USG SNC - first-line investigation in neonates; - large fontanel is used as acoustic window. Cerebral edema Intraventricular hemorrhage (a) with dilation of lateral ventricles anterior hornes (b)

5 X-ray - first-line investigation in craniocerebral trauma; - evaluation of cranial base bones fractures is impossible.

6 X-ray Is used for evaluation of paranasal sinuses disorders. Hydro-aeric level is showed on the left images

$trauma: bone fractures Intracranial$ hemorrhage (ex.

7 CT Method of choise in craniocerebral trauma: bone fractures Intracranial hemorrhage (ex.: epidural/subdural/subarachnoidal hematoma, short scanning time (2 min)

8 CT AND MRI STADIALIZATION OF INTRACRANIAL HAEMORRHAGE CT scan is almost always the first imaging modality used to assess patients with suspected intracranial haemorrhage. Fortunately acute blood is markedly hyperdense compared to brain parenchyma (60-80 Hu) The imaging characteristics of blood on MRI are variable and change with the age of the blood: - acute (1 to 2 days) - T2 signal intensity drops (T2 shortening), T1 remains intermediate-to-low - late subacute (7 to days) - extracellular methaemoglobin leads to an increase in T2 signal - chronic (>14-28 days) periphery low on both T1 and T2 center - isointense on T1, hyperintense on T2

11 (A)CT hyperdense lesion in the right frontal lobe, peripheral edema (B) MRI T1w heterogeneous lesion in the right frontal lobe, with hypointense centrum and hyperintense periphery

13 Chest imaging X-ray, CT, MRI - Chest X-ray is made in PA and lateral projections for localising lesions. - Main indications for chest CT scanning: Staging malignancy Detecting pulmonary metastases Far superior in assessing chest wall and pleural lesions, lung mass, the hilum and mediastinum High value in the diagnosis of diffuse lung desease Evaluation of bronchiectasis (surgery is undertaken without preoperative bronchography) - MRI helpful in the diagnosis of hilar masses, lymphadenopathy and mediastinal lesions

14 Hilul pulmonar se vizualizeaza prin formațiunea de volum Thymoma Anterior mediastinal lymphoma Anterior mediastinal masses: 1. Thymoma 2. Teratoma 3. Lymphoma 4. Ectopic thyroid Thymoma

15 B Well-defined cystic mass in the posterior mediastinum- (A) X-ray; (B) CT A PA and lateral X-rays reveal pulmonary opacity in the posterior mediastinum (neuroblastoma)

X-ray, AP projection welldefined homogeneous retrocardiac pulmonary

16 A. MRI T2w axial scan welldefined cystic mass in the posterior mediastinum B. X-ray, AP projection welldefined homogeneous retrocardiac pulmonary opacity (bronchogenic cyst) A B C. MRI scans - demonstrate a thoracic neuroblastoma with intraspinal extension (hourglass neuroblastoma)

17 Abdominal imaging USG, X-ray, CT, MRI Ultrasound imaging of the abdomen uses sound waves to produce pictures of the structures within the upper abdomen. It is used to help diagnose pain or distention and evaluate the kidneys, liver, gallbladder, pancreas, spleen and abdominal aorta.. Abdominal X-ray is helpful in detection of intestine obstruction, hollow organs perforation, abnormal calcifications, foreign radiopaque bodies.

18 A. USG- normal pancreas B.USG- mass in the pancreatic head with Wirsung duct stenosis C. Hyperechoic pancreas sign of chronic pancreatitis

19 A B USG (A) C D

Gases in the sigmoid colon 6. Sacrum 7. Sacroiliac joints 8.

20 Simple abdominal x-ray 1. ribs 2. Spinal column 3. Air bubble of the stomach 4. Gases in the splenic flexure of the colon 5. Gases in the sigmoid colon 6. Sacrum 7. Sacroiliac joints 8. Gases in the ascending colon 9. Iliac crest 10. Gases in the hepatic flexure of the colon 11. Psoas. ABDOMINAL X-RAY

21 A B C Hydro-aeric levels in bowel obstruction (A) Radiopaque foreign bodies (B) Extraluminal free air under right hemidiaphragm(c)

22 INTRAVENOUS UROGRAPHY

23 Abdominal CT scanning (with/without contrast media) is used in the evaluation of trauma victims for visceral injury and in the evaluation of acute abdominal pain, with a major role in the evaluation of renal calculi, acute appendicitis, and complex abdominal pathology.

26 Magnetic resonance imaging (MRI) MRI ABDOMEN WITHOUT CM - Done to evaluate: Biliary tract, common bile duct Pancreatic duct Gall bladder stones MRI ABDOMEN WITH CM - Done to evaluate: Liver pathology (hemangiomas, masses, etc) Kidney pathology (cysts, tumors) Adrenal pathology (cysts, tumors) Pancreas pathology(cysts, tumors) Splenic pathology (cysts, tumors) Abd pain MRI PELVIS WITHOUT CM Done for: SI joint pain Pelvis fracture Sacral and/or coccyx disorders MRI PELVIS WITH/WITHOUT CM Done for: Ovarian or uterine pathology, fibroid tumors Bladder pathology Mass, Mets to bone CA of Prostate Plexus lesions

27 A B C D

29 A B C Hepatic cystic lesion (hemangioma) CT(A) IRM(B) USG(C)

31 B,C.MRI pelvis-axial T2,T1 : intrauterine gestational sac and uterine fibroid

32 MRI, axial T2w - normal prostate gland MRI, axial T2w prostate gland carcinoma

33 CE MRI, saggital view tumoral invasion of the upper 1/3 rectum, with subtotal luminal narrowing, no signs of extending into the mesorectum.

34 SCINTIGRAPHY

36 Recognizing Pneumonia 1) Pneumonia can be defined as consolidation of the lung produced by inflammatory exudate, usually as a result of an infectious agent. 2) Most pneumonias produce airspace disease, either lobar or segmental. Other pneumonias demonstrate interstitial disease and others produce findings in both the airspaces and the interstitium 3)Most microorganisms that produce pneumonia are spread to the lungs via the tracheobronchial tree, either through inhalation or aspiration of the organisms. 4)In some instances, microorganisms are spread via the bloodstream and, in even fewer cases, by direct extension. 5)Because many different microorganisms can produce similar imaging findings in the lungs, it is difficult to identify with certainty the causative organism from the radiographic presentation alone. However, certain patterns of disease are very suggestive of a particular causative organism 6)Some use the term infiltrate synonymously with pneumonia, although many diseases, from amyloid to pulmonary fibrosis, can infiltrate the lung.

37 PATTERNS OF PNEUMONIA Learning Radiology. Recognizing the basics. 3 rd edition

38 PATTERNS OF PNEUMONIA Lobar pneumonia The prototypical lobar pneumonia is pneumococcal pneumonia caused by Streptococcus pneumoniae. Although we are calling it lobar pneumonia, the patient may have symptoms before the disease involves the entire lobe. In its most classical form, the disease fills most or all of a lobe of the lung.

39 CT FINDINGS- HOMOGENEOUS CONSOLIDATION OF AFFECTED SUPERIOR LOBE WITH AIR BRONCHOGRAM.

Many gram-negative bacteria, such as Pseudomonas aeruginosa, can produce the same picture.

40 II. SEGMENTAL PNEUMONIA (BRONCHOPNEUMONIA) The prototypical bronchopneumonia is caused by Staphylococcus aureus. Many gram-negative bacteria, such as Pseudomonas aeruginosa, can produce the same picture. Bronchopneumonia is spread centrifugally via the tracheobronchial tree to many foci in the lung at the same time. Therefore it frequently involves several segments of the lung simultaneously.

41 Micro- and macronodular pattern Pseudolobar pneumonia

42 CT findings multiple hyperdense foci, round/ovoidal, ill-defined, with multisegmental and peribronchial distribution.

III. INTERSTITIAL PNEUMONIA The prototypes for interstitial pneumonia are viral pneumonia, Mycoplasma pneumoniae, and Pneumocystis pneumonia in patients with acquired

43 III. INTERSTITIAL PNEUMONIA The prototypes for interstitial pneumonia are viral pneumonia, Mycoplasma pneumoniae, and Pneumocystis pneumonia in patients with acquired immunodeficiency syndrome (AIDS). Interstitial pneumonia tends to involve the airway walls and alveolar septa and may produce, especially early in its course, a fine, reticular pattern in the lungs.

disease that may mimic the central distribution pattern of pulmonary edema.

44 Radiological findings. It classically presents as a perihilar, reticular interstitial pneumonia or as airspace disease that may mimic the central distribution pattern of pulmonary edema. Other presentations, such as unilateral airspace disease or widespread, patchy airspace disease are less common. There are usually no pleural effusions and no hilar adenopathy.

45 STREPTOCOCCUS PNEUMONIAE. CT FINDINGS: multiple confluent opacities with bilateral distribution, heterogeneous with air bronchogram, bilateral pleural effusion.

46 Staphylococcus pneumoniae. CT findings: left superior lobe consolidation, with central necrolysis (yellow arrows).

47 VIRAL PNEUMONIA. CT findings multifocal nodular opacities, with diffuse bilateral distribution

Lab Monitor Images Dissection of the Abdominal Vasculature + Lower Digestive System

Lab Monitor Images Dissection of the Abdominal Vasculature + Lower Digestive System Stomach & Duodenum Frontal (AP) View Nasogastric tube 2 1 3 4 Stomach Pylorus Duodenum 1 Duodenum 2 Duodenum 3 Duodenum