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Radiographic DISEASE

Pathology Pathology is the study of diseases that can cause

abnormalities in the structure or function of various
Pathology organ systems.
By: Assoc. Prof. Myna Marie DC. Nerona RRT, Is a study of diseases that can cause abnormalities in the structure or In essence, a disease is the pattern of the body’s
MSRT function of various organ systems. response to some form of injury that causes a
Dean, Institute of Imaging Health Sciences deviation from or variation of normal conditions.
University of Makati Diseases may be hereditary or may result from a broad
Disease spectrum of traumatic, infectious, vascular, or
Is the pattern of the body’s response to some form of injury that
metabolic processes manifesting as a set of
causes a deviation from or variation of normal condition. characteristics known as signs and symptoms.

1 2 3

Inflammation
Terms for Disease Signs vs Symptoms
Term Definition

SIGNS Measureable/ objective manifestation

Signs Acute inflammation is the initial response of body
SYMPTOMS Feelings that the patient describes/subjective manifestation measurable tissues to local injury.
ASYMPTOMATIC Without subjective/ objective manifestation objectives manifestations
DIAGNOSIS Identification of the disease
The various types of injury include those caused by
ETIOLOGY Study of the cause of the disease process
Symptoms blunt or penetrating trauma, infectious organisms, and
Subjective manifestations
irritating chemical substances.
IDIOPATHIC Underlying cause is unknown

PROGNOSIS Probable patient outcome Patient’s feels and describes

The earliest bodily response to local injury is dilation of
SYNDROME Linked combination of signs and symptoms
Not measurable and observable arterioles, capillaries, and venules, leading to a dramatic
IATROGENIC Disease caused by a physician or treatment
E.g. (Alterations of cell growth, caused by physicians and their treatment (iatrogenic) increase in blood flow in and around the injury site.
NOSOCOMIAL INFECTION Infections contracted in the acute care facility

Infections contracted in a public setting outside of the acute care

COMMUNITY-ACQUIRED INFECTION facility

4 5 6

There are two types of

INFLAMMATION inflammation:
is the response of living tissue to injury. It involves a well-organized
cascade of fluid and cellular changes within living tissue.

is a non specific, localized immune reaction of the organism, Acute

which tries to localized the pathogen agent. Many consider the
syndrome a self-defense mechanism.
Chronic
A normal response of living tissues to injury. It prepares the tissue
for healing and repair.

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Acute Inflammation Five Principal effects of Inflammation

RUBOR
represents an initial concentrated effort to eliminate an
injurious agent. It was described nearly 2,000 years ago TUMOR
is characterized histologically by the presence of by the Roman Aulus Cornelius Celsus, CALOR
neutrophils more commonly known as Celsus.
occurs on the time scale of hours to days
DOLOR
FUNCTIO LAESA

10 11 12

“The more cardinal signs of inflammation present,

the more acute the problem.”

Redness (rubor) Swelling (tumor)

Swelling results from edema, the accumulation

An acutely inflamed tissue appears red, of fluid in the extravascular space as part of the
due to dilatation of small blood vessels inflammatory fluid exudate, and to a much lesser
within the damaged area (hyperemia). extent, from the physical mass of the
inflammatory cells migrating into the area.

Increased of blood flow Accumulation of fluid

13 14 15

Pain (dolor)
Loss of function (functio laesa)

Heat (calor) Loss of function, a well-known consequence

Increase in temperature is readily detected in the skin. It is
due to increased blood flow (hyperemia) through the region,
resulting in vascular dilation and the delivery of warm blood to
the area.
Increased of blood flow
Pain results partly from the stretching and
distortion of tissues due to inflammatory edema
and, in part from some of the chemical
mediators of acute inflammation.
of inflammation, was added by Virchow (1821-
1902) to the list of features described in
Celsus’ written work. Movement of an
inflamed area is inhibited by pain, either
consciously or by reflexes, while severe
swelling may physically immobilize the
affected area.

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Chronic

Edema is the accumulation of abnormal

leads to a progressive shift in the type of cells
present at the site of inflammation, such
as mononuclear cells, and is characterized by
simultaneous destruction and healing of the tissue
from the inflammatory process.
amounts of fluid in the intercellular tissue
spaces or body cavities. Congenital and Hereditary Disease
Localized edema results from an inflammatory Diseases present at birth and resulting from genetic or
reaction, whereas generalized edema occurs environmental factors are termed congenital.
with pronounced swelling of subcutaneous
tissues throughout the body (anasarca).

19 20 21

Metabolic Disease

Metabolism is the sum of all physical and chemical processes in the

body. Diseases caused by a disturbance of the normal physiologic
function of the body are classified as metabolic diseases. These
include endocrine disorders such as diabetes mellitus and
Degenerative Disease
Hereditary diseases are caused by developmental hyperparathyroidism and disturbances of fluid and electrolyte
Degenerative diseases are caused by deterioration of the body. balance.
disorders genetically transmitted from either parent to a
Although they are usually associated with the aging process, some
child through abnormalities of individual genes in
degenerative conditions may exist in younger patients.
chromosomes and are derived from ancestors.

22 23 24

Neoplastic Disease
Trauma may injure a bone,
resulting in fractures.

It may also injure soft tissues. A

Traumatic Disease
Another general classification of diseases is traumatic diseases.
These diseases may result from mechanical forces such as crushing
or twisting of a body part or from the effects of ionizing radiation on
wound is an injury of soft parts
associated with rupture of the skin. Neoplastic disease results in new, abnormal tissue growth.
Normally, growing and maturing cells are subject to mechanisms that direct
Traumatic injuries may damage soft
cell proliferation and cell differentiation, controlling their growth rate.
tissues even if the skin is not broken.

the human body. Bleeding into the tissue spaces as a Proliferation refers to cell division, and differentiation refers to the process

result of capillary rupture is known of cellular specialization.

as a bruise or a contusion.

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A benign neoplasm is composed of well-differentiated cells with

uncontrolled growth. Lesion -types of cellular change in response to disease
Thus, a benign neoplasm remains localized and is generally noninvasive. Cancer -types of malignant neoplasms

A malignant neoplasm exhibits the loss of control of both cell The spread of malignant cancer cells resulting in a secondary tumor distant CARCINOMA is one type of cancer from epithelial tissue.
from the primary lesion is termed metastasis. SARCOMA from connective tissue
proliferation and cell differentiation, which changes its functional
Metastatic spread ways:
capabilities. LEUKEMIA from blood cells
HEMATOGENOUS SPREAD(Invade The Circulatory System)
Malignant neoplasms grow at a faster rate compared with benign neoplasms LYMPHOMA from lymphatic cells.
LYMPHATIC SPREAD. (Lymphatic System)
and tend to spread and invade other tissues. SEEDING- cells travel to a distant site or distant organ system

28 29 30

Staging and Grading Cancer Skeletal System

Comprised of 206 separate bones
The TNM system is a premise that cancers of similar histology or origin are
Axial (80)
similar in their patterns of growth or extension.

The “T” refers to the size of the untreated primary cancer or tumor. Skeletal System Appendicular (126)

Body support
As the size increases, lymph node involvement (N) occurs, eventually leading
to distant metastases (M). Body Protection

The addition of numbers to these three letters indicates the extent of Movement
malignancy and the progressive increase in size or involvement of the tumor. Blood cell production

31 32 33

Osteopetrosis (marble bones)

Osteopetrosis results in a symmetric,

Congenital/Hereditary Disease of Bone Osteopetrosis is a rare hereditary bone dysplasia in which generalized increase in bone density.
failure of the resorptive mechanism of calcified cartilage
Spina Bifida (myelomeningocele) interferes with the normal replacement by mature one. To produce a diagnostic image, the
Spina bifida refers to a posterior defect of the spinal canal resulting from failure of the radiographer must increase the exposure
posterior elements to fuse properly. This prevents the bone marrow from forming, so that the
bones become very brittle and stress fractures occur often. factors to compensate for the increase in bone
A mild, insignificant form is spina bifida occulta, in which there is a splitting of the
bony neural canal at the at the L5 or S1 level. formation (increased attenuation factor). The
The patient may also become anemic as a result of the lack image may appear blurred because of the
Large defects are associated with spinal cord abnormalities and may lead to a variety of
muscular abnormalities and lack of bladder or bowel control. of blood-producing bone marrow. structural changes; in some cases, a good
In many cases a slight dimpling of the skin or a tuft of hair over the vertebral defect image may be difficult to produce.
indicates the site of lesion.

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Osteogenesis Imperfecta
(brittle bones)
Osteogenesis imperfecta is an inherited generalized
disorder of connective tissue characterized by multiple
fractures and an unusual blue color of the normally white
sclera of the eye.
Due to imperfectly formed or inadequate bone collagen,
adult patients are generally wheel chair bound because the
skeletal structure does not support their body weight.
37
Achondroplasia
Achondroplasia is the most common form of dwarfism
it results from diminished proliferation of cartilage in growth plate.
This autosomal dominant condition does not affect membranous
bone formation. Therefore the individual has short limbs, which
contrast with the nearly normal length of the trunk.
Other characteristic physical features include a large head with
frontal bulging, saddle nose, a prognathous jaw, and prominent
buttocks that give the false impression of lumbar lordosis.
40
Ultrasound imaging now provides an alternative
imaging method. The sonolucent femoral head can
be viewed in relationship to the acetabulum to
demonstrate the femoral angles. If sonography is
available, its use allows the ionizing radiation dose
to the child to be reduced because previously,
clinicians relied on two different x-ray projections
for each assessment.
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Imaging appearance. Patients with this condition suffer
repeated fractures caused by the severe osteoporosis and the
thin, defective.
Because of the severe cortical bone loss in advanced stages of disease,
producing a good radiographic
image may require lowering the kilovoltage to compensate for the loss
of bone quality.
“Child abuse”
may be confused with osteogenesis imperfecta because of the
presentation of multiple fractures in different stages of the healing
process
38 39
Congenital Hip Dysplasia/
Developmental dysplasia of the hip (DDH)
also known as developmental hip dysplasia,
results from incomplete acetabulum formation
cause by physiologic and mechanical factors.
Anteroposterior (AP) pelvis and bilateral frog-leg
Hip dysplasia is more common in females. Upon (Cleaves) views are required to make a
pediatric assessment of the hip, when the leg is
flexed and abducted, the hip may “Pop” out of diagnosis. In many cases, the AP image appears
joint and a “Click” is felt or heard. The tendons almost normal with only a slightly larger joint
and ligaments responsible for proper femoral head
alignment are affected. space. On the bilateral frog-leg view, the hip is
usually dislocated superiorly and posteriorly.
is a condition where the 'ball and socket' joint of
the hips doesn't properly form in babies and
Because children with this disorder will undergo
young children. a multitude of follow-up images to recheck
development it is very important to shield the
gonadal anatomy
41 42
Inflammatory and Infectious
Disorders
Rheumatoid Arthritis
Treatment depends on the type of femoral head
is a chronic systemic disease of unknown cause that appears primarily as a non
movement: subluxation or dislocation. suppurative inflammatory arthritis of the small joints of the hands and feet.
Children not diagnosed and treated before walking may Women are affected about three times more frequently than men, the average
appear to “waddle like a duck.”
age of onset in adults in 40 years.
Signs and symptoms of rheumatoid arthritis may include:
Immobilization of the femoral head is the most common
treatment. To accomplish this, a harness or pelvic cast is Tender, warm, swollen joints
used. Such immobilization allows the acetabulum to
continue to form correctly before the infant begins to walk. Joint stiffness that is usually worse in the mornings and after inactivity
Fatigue, fever and weight loss
44 45
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Rheumatoid Variants:
Psoriatic Arthritis
Ankylosing Spondylitis
Reiter’s Syndrome
46
Reiter’s syndrome (reactive arthritis) is characterized by
arthritis, urethritis, and conjunctivitis. It primarily affects
young adult men and appears to occur after certain types
of venereal or gastrointestinal infections. Reiter’s
syndrome most frequently involves the sacroiliac joints,
heel, and toes. Unlike in ankylosing spondylitis, the
sacroiliac involvement here is usually bilateral but
asymmetric, and Reiter’s syndrome tends to cause only
minimal changes in the spine
Reiter’s syndrome tends to be asymmetric and primarily
involves the feet rather than thehands.
49
The main difference between osteoarthritis and
rheumatoid arthritis is the cause behind the joint
symptoms.
Osteoarthritis is caused by mechanical wear
and tear on joints.
Rheumatoid arthritis is an autoimmune disease in
which the body's own immune system attacks the
body's joints
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Ankylosing spondylitis almost always begins in
the sacroiliac joints, causing bilateral and
usually symmetric involvement.
Psoriatic arthritis refers to a rheumatoid arthritis–like destructive
process involving peripheral joints that develops in patients Blurring of the articular margins and patchy sclerosis
with typical skin changes of psoriasis. generally progress to narrowing of the joint space
and may lead to complete fibrous and bony
ankylosis. The disease typically progresses from the
lumbar spine upward.
47 48
Osteoarthritis (Degenerative Joint Disease)
is an extrem ely com m on generalized disorder characterized pathologically by loss of joint cartilage
and reactive new bone form ation.
The earliest radiographic findings in degenerative joint disease
P art of the w ater and tear of the aging process, degenerative joint disease tends to predom inantly are narrowing of the joint space, caused by thinning of the
affect the w eigh t-b earin g join ts an d th e in terp h alan geal join ts of th e fin gers. A secondary
form of degenerative joint disease m ay develop in a joint that has been re p e a te d ly tra um a tize d articular cartilage, and development of small bony spurs
o r sub je c te d to a b no rm a l stre sse s because of orthopedic deform ities, or it m ay be a result of a (osteophytes) along the margins of the articular edges of the
septic or inflam m atory arthritis that destroys cartilage.
bones.
is a com m on joint disease that m ost often affects m iddle-age to elderly people.
It is com m only referred to as "w ear and tear" of the joints
50 51
Bursitis/ tenosynovitis
Bursitis refers to an inflammation of the bursae
Repeated physical activity commonly causes bursitis, but trauma, rheumatoid
arthritis, gout, or infections also can cause this inflammation.
is usually not visualized on plain radiographers, but disorders of the bursa a synovium
can be seen on ultrasound images. Plain films may exclude other disorders that cause
similar symptoms.
The most common locations for bursitis are:
SHOULDER
ELBOW
HIP
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OSTEOMYELITIS
Rotator Cuff Tears
The rotator cuff of the shoulder is a musculotendinous structure composed
of the:
Supraspinatus
BACTERIAL OSTEOMYELITIS
Infraspinatus
Opacification of the subacromial and subdeltoid bursae
Teres minor indicates abnormal communication between them and the TUBERCULOUS MYELITIS
Subscapularis glenohumeral joint cavity, thus confirming the diagnosis.
Rupture of the rotator cuff produces a communication between the
shoulder joint and the subacromial bursa that can be demonstrated by
arthrography.

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Bacterial Osteomyelitis

Bacterial osteomyelitis is an inflammation of the bone and bone

marrow caused by a broad spectrum of infectious organisms that
reach bone by hematogenous spread, by extension from an adjacent site
of infection, or by direct introduction of organisms.
Acute hematogenous osteomyelitis tends to involve bones with rich
red marrow.
It begins as an abscess of the bone, pus produced by an acute
inflammation spreads down and once it reached the outer margin of the
bone, it may spread along the surface for distance
Osteomyelitis begins as an abscess of the bone.
Abscess is a painful collection of pus, usually
Pus produced by the acute inflammation spreads down the caused by a bacterial infection. Abscesses can
medullary cavity and outward to the surface. Once the develop anywhere in the body.
infectious process has reached the outer margin of the
bone, it raises the periosteum from the bone and may
spread along the surface for a considerable distance.

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Metabolic Bone Disease

In Infants and Children affects the: Tuberculous Osteomyelitis
Osteoporosis
M ETAPHYSES OF LON G BON ES
Tuberculous osteomyelitis most commonly involves the thoracic
Osteoporosis is a generalized or localized deficiency of bone matrix in which
and lumbar spine. the mass of bone per unit volume is decreased in amount but normal in
composition.
In adults: Pott’s disease (tuberculosis of spine) occurs in the
midthoracic spine and thoracolumbar region. Pelvis and Spine
VERTEBRAE
Major causes of Osteoporosis:
Irregular, poorly marginated bone destruction within the
vertebral body is often associated with a characteristic AGING
paravertebral abscess, an accumulation of purulent material that
POSTMENOPAUSAL hormone changes
Staphylococci and Streptococci are most common organisms produces a fusiform soft tissue mass about the vertebra.

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Osteoporosis Osteomalacia refers to

insufficient mineralization of the
adult skeleton.
Osteomalacia
Osteoporosis is usually caused by accelerated resorption of bone
softening of the bones, typically Since the bones are softened, it may bend or give way as
through decreased bone formation. through a deficiency of vitamin a result of weight bearing.
D or calcium.
The lack of balance between Bowing deformities primarily involve the:
Loss of mineral salts causes the bone to become lucent than normal.

This is difficult to detect since about 30% of the bone density must be
osteoid formation and PELVIS
lost before it can demonstrate as a lucent area. mineralization influencing bone
VERTEBRAL COLUMN
Lowest kVp
quality results in either
excessive osteoid formation or, THORAX
Provides the extremely short scale of contrast to visualized
demineralized osteoporotic bones.
more frequently, insufficient PROXIMAL EXTREMITIES
mineralization.

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Rickets
Regardless of the cause, osteomalacia appears
radiographically as a loss of bone density because of
the presence of nonmineralized osteoid.
Although the cortex is thinned, it may stand out
more prominently than normal because of the
uniform deossification of medullary bone.
Rickets
Rickets is a systematic disease of infancy and childhood that is Early radiographic changes are best seen in:
the equivalent of osteomalacia in the mature skeleton.
STERNAL ENDS OF RIBS
In this condition, calcification of growing skeletal elements is
defective because of deficiency of vitamin D in the diet or lack Characteristic beading (RACHITIC Rosary/ Knobby Rosary)
of exposure to ultraviolent radiation, which converts sterols in
PROXIMAL ENDS OF TIBIA AND HUMERUS
the skin into vitamin D.
DISTAL ENDS OF RADIUS AND ULNA
It is most common in premature infants and develops ages 6
months to 1 year.

67 68 69

Massive deposition of calcium in a

long-standing tophaceous lesion about the
elbow.
Gout/ Gouty Arthritis
Gout is a disorder in the metabolism of purine in which an
increase in the blood level of uric acids leads to the deposition
of uric acid crystals in the joints, cartilage, and kidney.

is a common type of arthritis caused by too much uric acid in

the bloodstream.

The uric acid forms clumps of small, sharp crystals inside and
around the joints, leading to sudden attacks of severe pain,
swelling and redness.

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Paget’s disease / osteitis deformans
Paget’s disease is one of the most common chronic metabolic
disease of the skeleton.
Destruction of bone, followed by a reparative process results
in weakend, deformed, and thickened bony structures that
tend to fracture easily.
Occurs in middle life
Affects men twice than women
73
Fibrous Dysplasia
a disorder that usually begins during childhood, is characterized
by the proliferation of fibrous tissue within the medullary
cavity.
This proliferation causes loss of trabecular markings and
widening of the bone. The disease may be confined to a single
bone or the bones of one extremity, which is the most common
form of when it occurs in adult.
76
Fractures are the most common skeletal abnormality
seen in a general radiology practice. A fracture is
defined as a disruption of bone caused by mechanical
forces applied either directly to the bone or
transmitted along the shaft of a bone. Although
often obvious, some fractures are subtle and difficult
to detect.
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Paget’s Disease
It particularly affects:
PELVIS
FEMURS
SKULL
TIBIA
VERTEBRAE
CLAVICLES
RIBS
74 75
Fibrous replacement of the medullary cavity typically produces a well-
Fractures
defined radiolucent area, which may vary from completely radiolucent to
a homogeneous ground-glass density, depending on the amount of
fibrous or osseous tissue deposited in the medullary cavity.
The bone is often locally expanded (suggesting a balloon), and the cortex
may be eroded from within, predisposing to pathologic fractures.
In severe and long-standing disease, affected bones may become
bowed or deformed.
77 78
Imaging appearance. Fracture Treatment.
After the orthopedic reduction of a fracture, a second set of radiographs
determines whether the fracture fragments are in anatomic position. During the The overall goal of fracture treatment is to restore
next several weeks or months, additional radiographs are obtained to assess
fracture healing and to exclude possible complications. function and stability with an acceptable cosmetic
result and a minimum of residual deformity.
In all cases of trauma, it is essential to have at least two projections of the injured
part, preferably taken at 90 degrees to each other, to determine fracture
continuity or displacement in the anterior or posterior, medial or lateral, and
superior or inferior direction.
It is also important to demonstrate the joint above and below the fracture to In closed reduction, the fracture is treated by
search for a dislocation or a second fracture that may have resulted from
transmission of the mechanical force. An example of this mechanism is the fracture manipulation of the affected body part without
or dislocation of the head of the fibula that frequently occurs with a fracture of the
distal part of the tibia at the ankle.
surgical incision.
80 81
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Open reduction is a surgical procedure using
direct or indirect manipulation of the fracture
fragments and usually involving the
application or insertion of some type of
appliance or device to achieve and maintain
the reduction.
82
85
A spiral fracture encircles the shaft, is generally
longer than oblique fracture, and is caused by
torsional forces.
Avulsion fractures are generally small
fragments torn from bony prominences; they
are usually the result of indirectly applied
tension forces within attached ligaments and
tendons rather than direct blows.
88
External fixation is accomplished with the
use of splints, external reduction devices, or
casts;
Internal fixation uses metal plates and
screws, wires, rods, and nails, either alone or
in combination, to maintain the reduction.
83
A fracture that results in discontinuity between two or
more fragments is a complete fracture
an incomplete fracture causes only partial
discontinuity, with a portion of the cortex remaining
intact.
In closed fractures, the overlying skin is intact
if the overlying skin is disrupted, the fracture is open or
compound.
86
A comminuted fracture is composed
of more than two fragments.
A butterfly fragment is an elongated
triangular fragment of cortical bone
generally detached from two other larger
fragments of bone.
A segmental fracture consists of a
segment of the shaft isolated by
proximal and distal lines of fracture.
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Types of Fractures
Fractures are described and classified by:
EXTENT
DIRECTION
POSITION
84
A transverse fracture runs at a right angle to the long axis
of a bone and most commonly results from a direct blow or is
a fracture within pathologic bone.
An oblique fracture runs a course of approximately 45
degrees to the long axis of the bone and is caused by
angulation or by both angulation and compression forces.
87
A compression fracture results from a compression
force that causes compaction of bone trabeculae and
results in decreased length or width of a portion of a bone.
A depressed fracture occurs in the skull or tibial
plateau
90
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A bowing fracture is a plastic deformation caused by a stress

A stress/ fatigue/march fracture is the response of bone
repeated stresses, none of which is sufficient to cause a fracture.
Stress fractures can be described as very small slivers or cracks in the
bone.
A greenstick fracture is an incomplete fracture
with opposite cortex intact. Greenstick fractures are
found almost exclusively in infants and children
because of the softness of their cancellous bone.
that is too great to permit a complete recovery of normal
shape, but is less than the stress required to produce a fracture.
In children and young adolescents, the radius and ulna are the
most commonly affected bones, followed by the fibula

A pathologic fracture occurs in bone at an area of weakness
caused by such processes as tumor, infection, or metabolic bone
disease.
A torus (buckle) fracture is one in which one
cortex is intact with buckling or compaction of the
opposite cortex. An undisplaced fracture occurs when a plane of cleavage
exists in the bone without angulation or separation.

91 92 93

Anatomic Description of
Types Comminution
Fractures

94 95 96

Location Displacement

Dislocation refers to the displacement

of a bone that is no longer in contact
with its normal articulation. If there is
only partial loss of continuity of the joint
surfaces, the displacement is called
subluxation.

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Displacement refers to separation of
bone fragments; the direction of
displacement describes the relationship
of the distal fragment with respect to
the proximal fragment and is usually
measured in terms of the thickness of
the shaft.
100 101
Angulation indicates an angular
deformity between the axes of the
major fragments and also describes the
position of the distal fragments with
respect to the proximal one.
103 104
Battered-Child Syndrome
The battered-child syndrome refers to
multiple, repeated, physically induced injuries
in young children caused by parents or
guardians.
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Displacement- Translation Displacement- Angulation
102
What is the Anatomic
Displacement- Shortening
Description?
105
Imaging appearance.
Common Fractures and
dislocation
The radiographic findings in this syndrome include multiple
fractures of varying age in various stages of healing, fractures
of the corners of metaphyses with or without associated
epiphyseal displacement, and exuberant subperiosteal new
bone formation along the shafts of long bones.
Skull fractures or widening of the cranial sutures are
commonly associated. Another highly suggestive finding is
one or more fractures at otherwise unusual sites (usually
fractured only by direct blows), such as the ribs, scapula,
sternum, spine, or lateral ends of the clavicles.
108
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Colles’ fracture COLLES FRACTURE Smith's fracture

is a transverse fracture through the distal radius with dorsal
angulation and often overriding of the distal fracture ‘Reverse Colles’ fracture/ Goyrand-Smith's
fragment.
General term for fractures of is a fracture of the distal radius that is caused by a
is a complete fracture of the radius bone of the forearm
close to the wrist resulting in a posterior displacement of
the distal radius with dorsal direct blow to the dorsal forearm or falling onto flexed
the radius and obvious deformity. displacement, with or without an ulnar wrists, as opposed to a Colles' fracture which occurs as a
result of falling onto wrists in extension.
It is commonly called a “broken wrist” in spite of the fact
styloid fracture.
that the distal radius is the location of the fracture, not the Smith's fractures are less common than Colles' fractures.
carpal bones of the wrist

109 110 111

Navicular (scaphoid)
fractures Boxer’s fracture

A boxer fracture is a transverse fracture of

are the most common fractures involving the the neck of the fifth metacarpal with volar
carpal bones. They are usually transverse and (palmar) angulation of the distal fragment .
occur through the central part of the bone. This injury is typically the result of a blow
struck with the fist.

112 113 114

BOXER’S FRACTURE BARTON’S FRACTURE Barton’s Fracture

This is a distal intra-articular radial with dislocation

of the radio-carpal joint.

It can be dorsal or volar depending on the direction

Fracture of the fifth metacarpal neck Fracture on distal radius of dislocation.

Basically it is a Colles' or Smith's fracture with

dislocation.

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Bennett fracture dislocation
is an intra-articular fracture of
the base of the first metacarpal
with resultant dislocation of the
first carpometacarpal joint
Bennett fractures usually result
from falling on an extended or
abducted thumb or an impact
onto a clenched fist.
118
ROLANDO’S FRACTURE
Y-shaped intraarticular fracture of the
thumb metacarpal.
121
MONTEGGIA’S
FRACTURE
Fracture of the proximal third of the
ulna with associated dislocation of the
radial head.
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BENNETT’S FRACTURE Rolando fracture
is now applied to many comminuted fractures of the
oblique fracture of the base of the first metacarpal but ideally should be
first metacarpal base separating a small reserved for Y- or T-pattern fractures that include the
volar-ulnar Bennett fragment in addition to a dorsal
triangular fragment
radial fragment
119 120
Chauffeur's /Hutchinson
fracture Monteggia fracture
Isolated fracture of the radial styloid.
Usually undisplaced. A Monteggia fracture is an isolated
fracture of the shaft of the ulna associated
The injury is caused by compression of with anterior dislocation of the radius at the
the scaphoid bone of the hand against elbow.
the styloid process of the distal radius.
122 123
GALEZZI’S FRACTURE
A Galleazzi fracture is the
Fracture of the radius in the distal third
combination of a fracture of the shaft of
the radius and a dorsal dislocation of associated with subluxation of
the distal ulna.
the ulna at the wrist.
125 126
14

127 128
Type I Salter-Harris fractures occur when there is a
complete separation of the entire physis and the
surrounding bone is not involved.
This fracture is commonly seen when considering
growth plate injuries and tends to occur more frequently
in younger children.
Any radiographic images obtained will more likely than
not appear normal due to the physis being radiolucent.
130 131
Type IV fractures start above the growth plate (in the
metaphysis) and cut all the way through the epiphysis.
These fractures are usually caused by axial loading or
shear stress, comminution is common
133 134
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Salter Harris Fracture
Fracture in the lower
extremities A Salter–Harris fracture or growth plate
fracture is a fracture that involves
the epiphyseal plate or growth plate of a
bone. It is thus a form of child bone fracture.
129
Type II fractures are the most commonly diagnosed and
“are usually easily identified on routine radiographs”
Type III fractures run along the joint surface and persist
deep into the epiphyseal plate.
The fracture exists along the physis and continues up
through a small section of the metaphysis.
While this fracture is uncommon when they are
This fracture is triangle-like and the periosteum is torn diagnosed, it is usually found in the distal tibia of an
adolescent whose growth plate is nearly finished.
on the opposite side to where the metaphysis is
fractured, but it is still intact on the adjacent side.
132
S-A-L-T-R
Type V fractures are diagnosed as a crushing of the
epiphysis. 1 SLIP OF PHYSIS
This is the hardest fracture type to diagnosis and the 2 ABOVE THE PHYSIS
most difficult to heal.
3 LOWER THAN PHYSIS
This injury is most likely to occur in the weight-bearing
4 THROUGH THE PHYSIS
joints of the knee and ankle.
5 RAMMED PHYSIS
135
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Pott’s Fracture Trimalleolar fracture

I t involves both malleoli with dislocation of the ankle
joint.
Bimalleolar fracture/ broken ankle
Refers to one involving both the lateral and medial
malleoli.
Because of the mechanism of the injury, the fracture on
one side Is transverse and other is oblique or spiral.
Involve the posterior lip of the tibia in addition to
the medial and lateral malleoli and usually represent Transverse Fracture/Jones Fracture
fracture dislocations.
The most frequent injury of the foot occur
a fracture of the ankle that involves the lateral at the base of the fifth metatarsal.
malleolus, the medial malleolus, and the posterior
malleolus. The trauma is sometimes accompanied
by ligament damage and dislocation.

136 137 138

JONES FRACTURE AVIATORS ASTRAGALUS BOSWORTH FRACTURE

it is the compression fractures of the talar neck,

fractures of the body, posterior process or fracture It refers to a fracture-dislocation of the
Fracture of the base of the dislocation injuries. ankle in which there was fracture of the
fifth metatarsal. The talus is the second most injured bone in the foot fibula and posterior dislocation of the
after calcaneus. Neck of talus is the most frequently talus.
injured site.

139 140 141

LISFRANC FRACTURE
Fractures and
Dislocations of the Spine A Jefferson fracture/ Atlas fracture a
comminuted fracture of the ring of the
atlas, involves both the anterior and the
posterior arches and causes
displacement of the fragments.
one or more of the metatarsal bones are
displaced from the tarsus.
The hangman’s / AXIS fracture is the result
of acute hyperextension of the head on the
neck.
Unstable fracture of C2 pedicles

142 143 144

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JEFFERSON’S FRACTURE HANGMAN’S FRACTURE Clay shoveler’s fracture

is an avulsion fracture of a spinous process in the lower

Comminuted fracture of the ring of the atlas
due to axial compressive forces. Fractures
usually occur anterior and posterior to
the lateral facet joints.
cervical or upper thoracic spine.
Fracture through the neural arch of the
Fracture of spinous process C6-T1.
second cervical vertebra (axis).
Spinous process fracture on the lateral view and
ghost sign in AP.

145 146 147

CLAY-SHOVELERS
CHANCE FRACTURE BURST FRACTURE
FRACTURE
Spinous process fracture of the lower cervical
or upper thoracic vertebrae. Injury initially fracture of the thoracolumbar vertebral Fracture of the vertebral body, usually
attributed to workers attempting to throw body with horizontal disruption of the with outward displacement of the
upward a full shovel of clay, but the clay,
spinous process, neural arch, and fragments. May occur in the cervical,
adhering to the shovel, would cause a
sudden flexion force opposite to the neck vertebral body. thoracic, or lumbar spine.
musculature.

148 149 150

ABNORMAL
Vertebral Curvature
CURVATURES
Lordosis
The vertebral column has four curves that arch anteriorly and The cervical and thoracic curves merge smoothly.
posteriorly from the midcoronal plane of the body.
The lumbar and pelvic curves join at an obtuse angle termed the lumbosacral angle.
W hen viewed posteriorly, the normal lumbar curve can The thoracic and pelvic curves are called primary curves because they are present at birth.
correctly be referred to as “concave posteriorly.”
The cervical and lumbar curves are called secondary or compensatory curves because
Exaggerated lumbar curvature
they develop after birth.
W hether the curve is described as “convex anteriorly” or
“concave posteriorly,” The cervical curve, which is the least pronounced of the curves, develops when an infant
begins to hold the head up at about 3 or 4 months of age and begins to sit alone at about 8 or 9
“Swayback”
The cervical and lum bar curves, which are convex months of age.
anteriorly, are called lordotic curves. The lumbar curve develops when the child begins to walk at about 1 to 1 1/2 years of age. Increase anterior convexity or
The thoracic and pelvic curves are concave anteriorly and The lumbar and pelvic curves are more pronounced in females, who have a more acute angle
are called kyphotic curves at the lumbosacral junction. posterior concavity

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Scoliosis
Kyphosis Lateral curvature

Exaggerated thoracic curvature S-shaped

Imaging appearance. Full spine images should be acquired in the upright
This condition also causes the vertebrae position with the patient standing using normal stance and weight
distribution.
Humpback or hunchback to rotate toward the concavity.
The technologist must include the iliac crest while shielding the gonad region and the
The vertebral column develops a second breast tissue.
Increase anterior concavity or posterior or compensatory curve in the opposite The spinal curvature will be measured each visit to determine whether the curvature is
convexity direction to keep the head centered over
the feet.
progressing or remaining constant.

This evaluation is important in helping to determine the treatment necessary.

Curvatures that are considered normal are less than 20 degrees, whereas curvatures of
40 to 50 degrees and greater need the most extensive treatment.

154 155 156

Skull Fracture

Skull Fractures
Imaging appearance.

A linear skull fracture appears on a plain radiograph as a sharp lucent line that is often irregular or jagged and occasionally branches

The fracture must be distinguished from suture lines, which generally have serrated edges and tend to be bilateral and symmetrical, and

vascular grooves, which usually have a smooth curving course and are not as sharp or distinct as a fracture line.

The location of a linear skull fracture can indicate possible complications. A fracture that crosses a dural vascular groove may cause vessel

laceration, leading to an epidural hematoma.

157 158 159

Linear Fractures Linear skull fracture Depressed Fractures

Appears in a plain radiograph

A fracture that must be distinguish from a suture lines

which has serrated edges and tend to be bilateral

160 161 162

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Depressed fracture
Often stellate with multiple fracture lines radiating
outward from the central point.

In children, There are two types: Le Fort Classifications Pure Le Fort I, II, and III fractures are rare.

SIMPLE DEPRESSED They are commonly associated with other multiple midface
fractures.
PINGPONG BALL FRACTURE
The classical description of all Le Fort fractures represents
symmetrical fractures on the right and left side of the
midface.

163 164 165

Three Types
Le Fort I
Le Fort I: Low Maxillary
Le Fort II: Pyramid Le Fort I is also known as a horizontal maxillary
Low Maxillary fracture
fracture.
Le Fort III: Craniofacial dysjunction Involves floor of the nose lower third of the maxilla,
The fracture lines of a Le Fort I fracture may be linear
palate and pterygoid plate
(simple) or comminuted (complex).

166 167 168

Fracture Healing
Le Fort II
The radiographic evidence of fracture healing is a continuous
external bridge of callus. that extends across the line of fracture and
unites the fracture fragments . The callus uniformly ossifies and
approaches the density of normal bone.
Pyramidal fracture/ Subzygomatic
It is essential that at least two views be taken (preferably 90 degrees
to each other) to ensure that there is callus about the fracture line in
caused by superiorly directed force all directions.

Maxilla is separated from the skull base Proper exposure of the radiograph is required because underexposed
images may produce the illusion of obliteration of the fracture line by
bony trabeculae, whereas a properly exposed image would
demonstrate the continued presence of the fracture line and a lack of
healing.

169 170 171

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Malunion is the healing of fracture
fragments in a faulty position. It leads to
impairment of normal function or a
cosmetic appearance that may require
surgical correction
172
BENIGN BONE TUMORS
175
Appearance
Radiograph is the preferred method to demonstrate
that the cortex of an osteochondroma blends with that
of normal bone. The long axis of the tumor
characteristically runs parallel to the parent bone and
points away from the nearest joint.
The best modality to demonstrate the thickness of the
cartilaginous cap and thus rule out malignant
conversion is MRI with long TR pulses (increased
signal).
178
Delayed union is an ill-defined term arbitrarily
applied to any fracture that takes longer to
heal than the average fracture at that
anatomic location. Delayed union may result
from infection, inadequate immobilization,
limited blood supply, or loss of bone at the
fracture site.
173
Benign bone neoplasms generally displace
soft tissue, whereas malignant bone tumors
produce true soft tissue swelling.
When there is bone expansion, an intact
cortex with a sclerotic margin usually
indicates a benign lesion. Benign bone
neoplasms occur much less often than bone
metastases.
176
Enchondromas
Enchondroma begins as a slow-growing benign
cartilaginous tumor arising in the medullary canal .
This tumor destroys normal bone by erupting as a mixture
of calcified and uncalcified hyaline cartilage.
Enchondromas are most frequently found in children and
young adults, and they involve primarily the small bones of
the hands and feet. These tumors are often multiple.
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Nonunion refers to a condition in which the fracture
healing process has completely stopped and the
fragments remain ununited even with prolonged
immobilization. Radiographically, nonunion
characteristically appears as smooth, well-defined
sclerosis about the fracture margins with occlusion of the
medullary canal by sclerotic bone.
A persistent defect, consisting of fibrous tissue and cartilage,
appears between the fragments. Nonunion occurs predominantly
in adults, is rare in children, and requires operative intervention to
reinitiate the healing process.
174
Osteochondromas
Osteochondroma (exostosis) is a benign projection of bone with a
cartilaginous cap that arises in childhood or the teen years, especially
about the knee.
The exostosis occurs in the epiphyseal plate (the ring of Ranvier) and
grows laterally from the epiphysis. A true osteochondroma must exhibit
the cortex and medullary portion (spongiosa) as continuous bone growth.
The cartilaginous cap of the lesion may convert to a malignancy if the
cartilage cap becomes thicker and contains disorganized calcifications
(chondrosarcoma or osteosarcoma). Ultrasound is a safe, quick, and
inexpensive method to evaluate the thickness of the cartilaginous cap. A
hereditary form of osteochondroma (autosomal dominant) produces
multiple lesions and has an increased risk of malignancy
177
Imaging appearance. As the well-demarcated
tumor grows, it expands bone locally, causing
thinning and endosteal scalloping of the cortex. This
process often leads to a pathologic fracture with
only minimal trauma
A characteristic finding in enchondroma is stippled,
speckled, and ringlike or arclike calcifications within the
lucent matrix because of the tumor composition. This
radiographic appearance is also seen on CT images.
180
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Giant Cell Tumors Osteomas

Giant cell tumor (osteoclastoma) typically

arises at the end of the distal femur or
Imaging appearance. A few giant cell tumors
proximal tibia of a young adult after
may be premalignant or actually malignant.
epiphyseal closure (20 to 40 years old). It Osteomas most often arise in the outer table of the skull, the
As the tumor expands toward the shaft, it paranasal sinuses (especially frontal and ethmoid), and the
begins as an eccentric lucent lesion in the mandible. Detection of these tumors may be incidental on
produces the characteristic radiographic radiographs taken because of the pain produced by bone
metaphysis, and it characteristically extends expansion.
appearance of thin strips of bone.
to the immediate subarticular cortex of the
Imaging appearance. Osteomas appear radiographically as
bone but does not involve the joint. well-circumscribed, extremely dense, round lesions that are
rarely more than 2 cm in diameter.

181 182 183

Osteogenic sarcoma is a
mixed destructive and

MALIGNANT BONE Osteogenic Sarcoma sclerotic lesion associated

with a soft tissue mass,
irregular periosteal
TUMORS Osteogenic sarcoma generally occurs in the end of
a long bone in the metaphysis (especially about the
reaction, and reactive new
bone formation
knee). This tumor consists of osteoblasts, which In the classic sunburst
produce osteoid and spicules of calcified bone.
pattern, horizontal bony
spicules extend in
radiating fashion into the
soft tissue mass .

184 185 186

Chondrosarcoma Imaging appearance. In

addition to the bone
C hondrosarcom a is a m alignant tum or
of cartilaginous origin that m ay
destruction seen with all
malignant tumors,

Ewing’s Sarcoma
Ewing’s sarcoma is a primary
malignant tumor arising in the bone
marrow of long bones.
originate anew or w ithin a preexisting
cartilaginous lesion chondrosarcoma often
contains punctate or
amorphous calcification
within its cartilaginous Matrix.

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Some sources describe pathologies, including those in the chest, as additive, that is,
they are harder than normal to penetrate or subtractive (destructive), that is, they
Imaging appearance.
are easier than normal to penetrate.
The classic radiographic
appearance of Ewing’s
sarcoma is an ill-defined
In the respiratory system, any condition that adds fluid or tissue to the normally
permeative area of
aerated chest requires an increase in technical factors to afford proper
bone destruction that
involves a large central penetration and exposure. Similarly, any condition that increases the aeration of
portion of the shaft of a the chest reduces the amount of radiation required for proper exposure to be
long bone RESPIRATORY SYSTEM achieved. Most experts agree that when chest radiography.

190 191 192

CHEST RADIOGRAPHY
Chest Radiography

On a normal erect PA chest image, the costophrenic and cardiophrenic

Patient position and projection are also critical exposure conditions that may
distort the final image.
The standard projections for chest radiography are the erect posteroanterior (PA)
and left lateral.
When combined with a standard 72-inch source-to-image distance (SID),
magnification of the heart is minimized.
Other projections of the thorax are used less frequently than the erect PA and left
angles are demonstrated, with the right hemidiaphragm appearing 1 to 2
lateral projections.
cm higher than the left because of the position of the liver.
The AP projection is the method of choice for mobile radiography when the
When a patient is radiographed in the recumbent position, the lower lung
patient is too ill to tolerate a visit to the department and assume an erect position.
fields may be obscured because of abdominal pressure raising the level of
As much as possible, it is important that mobile chest radiographs be taken with
the diaphragm.
the patient sitting in bed in the erect position to demonstrate any air–fluid levels
present. Maintenance of the beam perpendicular to the plane of the image
receptor is essential to avoid any foreshortening of the heart.

193 194 195

CHEST RADIOGRAPHY
The AP and PA projections of the patient lying in the lateral decubitus position are
useful under specific conditions such as diagnosing free air in the pleural space or
pleural fluid.
The adequate inspiration should provide visualization of 10 posterior ribs within the
lung field.
In addition, all thoracic vertebrae and intervertebral disk spaces should be faintly
visible through the mediastinum on an adequately penetrated chest radiograph. The
average movement of the lungs and diaphragm between inspiration and expiration is
approximately 3 cm
Oblique projections of the thorax are useful in separating
superimposed structures such as the sternum, esophagus, and thoracic
spine.
A lordotic chest radiograph is useful in demonstrating the apical
regions of the lung, which are normally obscured by bony structures
on the standard PA projection .
In an ideal image of the lungs, the 10 posterior
ribs should be visualized.
To obtain the full-inspiration radiograph, deep
breath, exhale and inhale again.
This technique is to avoid the valsava effect
which is a force expiration against the closed
glottis that increases the intrapulmonary
pressure.

196 197 198

22

INTERNAL DEVICES
199
Approximately 10% to 20% of endotracheal
tubes require repositioning after insertion.
A tube positioned too low usually extends
into the right mainstem bronchus, where it
eventually leads to atelectasis of the left lung.
A tube positioned excessively high or in the
esophagus causes the inspired air to enter the
stomach, causing severe gastric dilation and a
high likelihood of regurgitation of gastric
contents and aspiration pneumonia.
202
Pulmonary Artery Catheter
(Swan-Ganz catheter)
A pulmonary artery catheter
(Swan-Ganz catheter) is usually
inserted via the subclavian vein,
but other injection sites include
the antecubital vein, jugular vein,
and femoral vein.
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ENDOTRACHEAL
TUBE Chest radiograph should always be obtained immediately
after endotracheal intubation to ensure proper positioning
of the tube because clinical evaluation does not allow
detection of the majority of malpositioned tubes.
An endotracheal (ET) tube is a large
Daily radiographs are usually taken to ensure that the
plastic tube inserted through the tube has not been inadvertently displaced by the weight
of the respiratory apparatus, the patient’s coughing, or
patient’s nose or mouth into the trachea. other unforeseen events.
It helps to manage the patient’s airway,
allows frequent suctioning, and allows
In addition, imaging permits prompt detection of
complications of intubation and barotrauma such as
pneumothorax and pneumomediastinum. The relationship
between the tip of the tube and the carina must be
mechanical ventilation. carefully assessed.
Its proper position is below the vocal When the head and neck are in a neutral position, the
endotracheal tube tip ideally should be approximately 5
cords and above the carina . to 7 cm above the carina.With flexion and extension of the
neck, the tip of the tube will move approximately 2 cm
caudally and cranially, respectively.
200 201
Chest tube Central venous pressure
A is a large plastic tube inserted through the chest
(CVP)
wall between the ribs. It allows drainage of air (e.g., Central venous pressure (CVP) lines
pneumothorax) or fluid (e.g., pleural effusion or are usually inserted via the
hemothorax) from the thoracic cavity and allows the subclavian vein, but they may also
lungs to inflate to help the patient breathe normally. be placed through the jugular vein,
antecubital vein, or femoral vein.
203 204
Transvenous Cardiac Pacemakers
Transvenous endocardiac pacing is the method of choice for maintaining cardiac
rhythm in patients with heart block.
206 207
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CONGENTIAL/HEREDITARY
DISEASES
Cystic Fibrosis

Cystic fibrosis (mucoviscidosis) is a hereditary

disease characterized by the secretion of
Cystic Fibrosis excessively viscous mucus by all the exocrine
glands.
Hyaline Membrane Disease
Cystic fibrosis is the most common clinically important
genetic disorder among Caucasian children. The
disorder also affects the pancreas and digestive system.

208 209 210

Cystic Fibrosis Cystic Fibrosis

Treatment
The mucus.. In Pancreas,

Imbalance of Sodium and Chloride production Blockage of ducts by mucous plugs prevent
and reabsorption pancreatic enzymes from entering the Prophylactic Antibiotics
duodenum
Plugs that lead to focal regions of lung collapse Chest Physiotherapy
Impairs the digestion of fat
Recurrent Pulmonary infections are common Improved Airflow
Failure to gain weight
Children age 10 will have a widespread
bronchiectasis with large cyst and abscesses Large, bulky and foul-smelling stools

211 212 213

INFLAMMATORY DISORDERS OF THE

Imaging appearance
Hyaline Membrane Disease UPPER RESPIRATORY SYSTEM

also known as:

Radiographically, cystic fibrosis causes generalized irregular N E O N A T A L R E S P IR A T O R Y D IS T R E S S S Y N D R O M E

thickening of linear markings throughout the lungs that, when ID IO P A T H IC R E S P IR A T O R Y D IS T R E S S S Y N D R O M E ( IR D S ) Croup

combined with the almost invariable hyperinflation, produces an
appearance similar to that of severe chronic lung disease in adults
Computed tomography (CT) screening to detect structural lung
damage and assess disease progression is becoming more
IN F A N T R E S P IR A T O R Y D IS T R E S S S Y N D R O M E ( IR D S )
R E S P IR A T O R Y D IS T R E S S S Y N D R O M E O F N E W B O R N Croup is primarily a viral infection of young children that
S U R F A C T A N T D E F IC IE N C Y D IS O R D E R produces inflammatory obstructive swelling localized to
is one of the most common causes of respiratory distress in the newborn. the subglottic portion of the trachea.
18-20 weeks of gestational stage

accepted by clinicians. There is a concern regarding the radiation

dose if CT were used on a routine basis (yearly), especially
because people with cystic fibrosis are now living into their 30s.
occurs in premature infants, especially those who have diabetic mother or who have been delivered by cesarean section. The edema causes inspiratory stridor or a barking cough,
Hypoxia and increasing respiratory distress may not be immediately evident at birth, but almost always appear within 6 hours of
delivery. depending on the degree of laryngeal obstruction.
In which a membrane composed of proteins and dead cells lines the alveoli making gas exchange to be difficult or impossible.

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Croup/laryngotracheobr
Three Larynx Subsites onchitis
Epiglottitis

Epiglottitis is an acute inflammation in

the supraglottic region of the
oropharynx with inflammation of the
epiglottis, vallecula, arytenoids and
aryepiglottic folds.
Infection caused by Haemophilus
influenzae

217 218 219

Imaging appearance. On lateral

projections of the neck using soft tissue

techniques, a rounded thickening of the

epiglottic shadow gives it the

configuration and approximate size of an

adult’s thumb in contrast to the normal,

narrow epiglottic shadow resembling an

adult’s little finger.

220 221 222

INFLAMMATORY DISORDERS OF THE

LOWER RESPIRATORY SYSTEM
Alveolar Pneumonia

Pneumonia
Alveolar, or air-space, pneumonia, exemplified by
Acute pneumonia is an inflammation of the lung that can be caused by pneumococcal pneumonia, is produced by an
a variety of organisms, most commonly bacteria and viruses. organism that causes an inflammatory exudate
AB that replaces air in the alveoli so that the affected
Regardless of the caused pneumonias tend to produce one of the three part of the lung is no longer air containing but
basic radiographic patterns. rather appears solid, or radiopaque. The
ALVEOLAR PNEUMONIA
inflammation spreads from one alveolus to the
next by way of communicating channels, and it
BRONCHOPNEUMONIA may involve pulmonary segments or an entire lobe
(lobar pneumonia)
INTERSTITIAL PNEUMONIA

223 224 225

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Alveolar Pneumonia Bronchopneumonia

Imaging appearance. Consolidation of the lung paren- Bronchopneumonia, typified staphylococcal

chyma with little or no involvement of the airways
Chest Radiographs associated with fluid filling produces the characteristic air bronchogram sign
infection, is primarily an inflammation that
of the air spaces The sharp contrast between air within the bronchial tree
originates in the bronchi or the bronchiolar
and the surrounding airless lung parenchyma permits the
mucosa and spreads to adjacent alveoli.
Alveolar patterns results from flooding of the normally invisible bronchial air column to be seen
end air spaces with fluid radiographically Because alveolar spread of the infection in the
peripheral air spaces is minimal, the
“Fluffy” density inflammation tends to produce small
patches of consolidation.

226 227 228

Interstitial Pneumonia There are four BASIC

patterns:

is most commonly produced by viral and Linear-Septal Lines (Kerley Lines)

mycoplasmal infections. In this type of
pneumonia, the inflammatory process Reticular- mesh
predominantly the walls and the lining of the Nodular
alveoli and the interstitial supporting structures
of the lung, the alveoli septa. Reticonodular

229 230 231

Linear-Septal Lines (Kerley Lines) Reticular- mesh Nodular Pattern

232 233 234

26

Reticulonodular pattern
235
Lung Abscess
A lung abscess is a necrotic area of pulmonary parenchyma
containing purulent material lung abscess may be a
complication of bacterial pneumonia, bronchial obstruction,
aspiration, a foreign body, or the hematogenous spread of
organisms to the lungs either in a patient with diffuse
bacteremia or as result of septic emboli.
Aspiration, which is the most common cause of lung
abscesses, frequently occurs in the right lung because the
right main bronchus is more vertical and larger In diameter
than left.
238
Primary Tuberculosis
Primary pulmonary tuberculosis has traditionally
been considered a disease of children and young
adults.
However, with dramatic decrease in the prevalence
of tuberculosis (especially in children and young
adults), primary pulmonary disease can develop at
any age. The current decline is the result of wider
screening and prevention programs.
241
Aspiration pneumonia
The aspiration of esophageal or gastric contents
into the lung can lead to the development of
pneumonia. Aspiration of esophageal can occur
in patients with esophageal obstruction,
diverticula, or neuromuscular swallowing
disturbances.
236
Tuberculosis
Tuberculosis is caused by Mycobacterium
tuberculosis a rod-shaped bacterium with a
protective waxy coat that permits it to live outside
the body the body for a long time.
Tuberculosis spreads mainly by droplets in the air,
which are produced in huge numbers by coughing of
an infected patient.
239
Ghon’s Lesion
Ghon’s Focus
It represent a calcified tuberculous
granuloma and represents the sequelae of
primary tuberculosis infection
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Anthrax
Anthrax is caused by the sporelike microbe known as
Bacillus anthracis.
Anthrax is considered a highly volatile microbe because
of this ease of transmission a high fatality rate. The
organism can survive for decades in the soil extreme
conditions (hot and cold) without the need for a host.
237
Primary Tuberculosis
Primary pulmonary tuberculosis has traditionally been considered a disease of children and
young adults. However, with dramatic decrease in the prevalence of tuberculosis (especially
in children and young adults), primary pulmonary disease can develop at any age. The current
decline is the result of wider screening and prevention programs.
Secondary (reactivation) Tuberculosis
Reactivation of organisms from previously dormant tubercles is termed a secondary lesion or
reinfection tuberculosis. At times, the tuberculosis bacillus may remain inactive for many
years before a secondary lesion develops, often because of a decrease on the body’s immune
defense.
240
243
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Radiographic Appearance Secondary Tuberculosis Tuberculoma

The infiltrate may be seen in lobular or segmental air-space
consolidation that is usually homogenous, dense and well-
defined Most commonly affects the upper lobes
(APICAL and posterior segments) A tuberculoma is a sharply circumscribed parenchymal
Associated enlargement of hilar and mediastinal lymph
nodes nodule, often containing viable tuberculosis bacilli that
It is initially seen as a nonspecific, hazy, poorly
marginated alveolar infiltrate that often can develop in either primary or secondary disease
Pleural effusion is evident
radiates outward the hilum.
Combination of Focal parenchymal lesion and enlarged
hilar or mediastinal lymph nodes.

244 245 246

Pulmonary Mycosis

Histoplasmosis Coccidioidomycosis
The term pulmonary mycosis means fungal
infection of the lung. Histoplasmosis, caused by the fungus commonly known as "cocci", "Valley fever", "California fever“

The two most common systematic fungal are:

Histoplasma capsulatum, is a common Coccidioidomycosis is caused by a fungus, Coccidioides immitis,
disease that often produces a radiographic which is found in the desert soil.

HISTOPLASMOSIS appearance simulating that of tuberculosis.
The primary form of histoplasmosis is usually
COCCIDIOIDOMYCOSIS
relatively benign and often passes unnoticed.
Coccidioidomycosis can develop from an acute infection to chronic
or disseminated forms.
This infection is transmitted through fungal spores in the air.

247 248 249

Chronic Obstructive
Emphysema Asthma

Pulmonary Disease
Includes several conditions in which chronic obstruction of the airways
leads to an ineffective exchange of respiratory gases and makes breathing
difficult.
Two (2) disease processes coexist to cause obstruction:
CHRONIC BRONCHITIS
Characterized by excessive tracheobronchial mucus
production leading to obstruction of small airways.
EMPHYSEMA
Refers to distention of distal air spaces result of the destruction
of alveolar walls and obstruction of small airways.
Emphysema is a crippling and debilitating condition in
which obstructive and destructive changes in small airways
lead to a dramatic increase in the volume of air in lungs.
In many patients, the development of emphysema is
closely associated with heavy cigarette smoking.
Other predisposing factors are chronic bronchitis, air
pollution, and long term exposure to irritants of the
respiratory tract.
Asthma is a very common disease in which widespread
narrowing of the airways develops because of an increase
responsiveness of the tracheobronchial tree to various
stimuli.
Common allergens include house dust, pollen, molds,
animal dander, certain fabrics, and various foods (extrinsic
asthma).
Exercise, heat or cold exposure, and emotional upset can
also cause an asthma attack (intrinsic asthma).

250 251 252

28

Bronchiectasis
Bronchiectasis refers to permanent abnormal dilation of
one or more large bronchi as a result of destruction of
the elastic and muscular components of the bronchial wall.
Bronchitis, a destructive process, is a common compilation
of bronchiectasis and is nearly always the result of a
bacterial infection..
253
Asbestosis
Asbestosis may develop in improperly
protected workers engaged in
manufacturing asbestos products, in
handling building materials, or in working
with insulation composed of asbestosis.
256
Disorders of the Pleura
Pneumothorax
Pneumothorax, the presence of air in the pleural cavity, results in
a partial or complete collapse of the lung.
It most commonly results from rupture of a subpleural bulla,
either as complication of emphysema or as spontaneous event in
an otherwise healthy young adult.
Other causes of pneumothorax include trauma and iatrogenic
causes, or it may be a complication of neonatal hyaline membrane
disease and require prolonged assisted ventilation.
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Pneumoconiosis
Silicosis
Greek word “ Pneuma” –AIR Common and best known work-relating lung disease
“konis”- Dust
Prolonged occupational exposure to certain irritating particulates can cause The inhalation of high concentrations of silicon dioxide
serve pulmonary disease and a spectrum of radiographic findings.
Inhaled foreign substances retained permanently in the acini cause
irreversible damage. Quartz dust the most frequent cause of inhalation silicosis
These inhaled particles cause a chronic interstitial inflammation that leads to
pulmonary fibrosis and a diffuse nonspecific radiographic lungs.
Primarily affects the workers:
Mining
Foundry work
Sandblasting
254 255
Anthracosis (Coal worker’s
Pneumoconiosis)
Miscellaneous Lung Disorders
Atelectasis
Coal miners, especially those working with
anthracite (hard coal), have increased Atelectasis refers to a condition in which there
susceptibility to developing pneumoconiosis by is diminished air within the lung associated
inhaling high concentrations of coal dust. with reduced lung volume.
Anthracite collects in the walls of the respiratory
bronchioles, causing weakened musculature Most commonly this results from bronchial
and dilatation. The deposition of anthracite obstruction, which may be attributable to a
particles changes the lung tissue to a dark color neoplasm, foreign body or mucous plug.
leading to the term black lung.
257 258
Pleural Effusion
The earliest radiographic findings in pleural effusion is
The accumulation of fluid in the pleural space is a non- blunting of the normally sharp angle between the
specific finding that may be caused by a wide variety of diaphragm.
pathologic processes.
The most common causes include congestive heart failure,
pulmonary embolism, infection, pleurisy, neoplastic
disease, and connective tissue disorders.
Pleural Effusion can also be the result of abdominal disease,
such us recent surgery, ascites, subphrenic, abscess, and
pancreatitis.
260 261
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Empyema
Esophagitis
REFLUX ( Gastroesophageal reflux disease) GERD
Empyema refers to the presence of infected liquid or frank Any symptomatic condition or structural changes caused by a rreflux of the
pus in the pleural space. stomach contents into the esophagus.

Chocolates
Usually the result of the spread of an adjacent infection.
Empyemas may also occur after thoracic surgery, trauma, Gastrointestinal System Alcohol

Caffeine
or instrumentation of the pleural space. Since the
development of antibiotics, empyemas are rare. Fatty foods

Tends to decrease pressure to the esophageal sphincter, allowing reflux to occur

262 263 264

Barrett’s Esophagus Esophageal Cancer

It is a condition related to severe reflux
esophagitis in which the normal squamous
lining of the lower esophagus is destroys and
replaced by columnar epithelium similar to
that of the stomach.
Progressive difficulty in swallowing in a person older than
40 years old must be assumed to be caused by cancer until
proven otherwise.
Most carcinomas in the esophagus are of squamous cell type
and they occur most often at the esophagogastric junction.
Often occurs in men than women
Wall thickening greater than 3 to 5 mm on a CT scan is
suggestive of esophageal cancer

265 266 267

Esophageal Diverticula
(outpouchings)
Hiatal Hernia
TRACTION or TRUE DIVERTICULA
It is the most common abnormality detected on
Lesions that contain all layers of the wall
the upper gastrointestinal examination.
PULSION or FALSE DIVERTICULA
Composed of only mucosa and submucosa herniating through the muscular layer The symptoms associated with hiatal hernia and
its complications:
Zenker’s Diverticula arise from the posterior wall of the upper ESOPHAGITIS
esophagus (cervical)
ESOPHAGEAL ULCER
Epiphrenic diverticula arise in the distal of the esophagus
(10 cm) ESOPHAGEAL STENOSIS

268 269 270

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Achalasia Gastritis
Inflammation of the stomach can be the result of a variety of Alcoholic gastritis produces a thickening of gastric folds
irritants including:
Is a functional obstruction of the distal section of Corrosive gastritis- severe narrowing of the antrum and
A LC O HO L may cause gastric outlet obstruction
the esophagus with proximal dilation caused by
incomplete relaxation of the lower esophageal C O RRO SIVE A G EN TS Bacterial gastritis – inflammatory thickening of the gastric
wall causes narrowing of the stomach
sphincter. IN FEC TIO N

Infectious gastritis- can be made if there is evidence of

Gastritis changes the normal surface patterns of the gastric gas bubbles
RAT Tail or bird beak appearance in mucosa
radiographs Chronic atrophic gastritis (nonerosive) severe mucosal
HELICOBACTER PYLORI can cause chronic gastritis that may atrophy that causes thinning and absence of mucosal
lead to peptic ulcer disease folds

271 272 273

Crohn’s disease
Peptic Ulcer
(regional enteritis)
Is a chronic inflammatory disorder of unknown cause that is often
DUODENAL ULCER involves the terminal area of the ileum.

It is most common in young adults.

Is the most common manifestation of the peptic
ulcer disease. Majority of duodenal ulcer occur in Small bowel series
the first portion of the duodenum bulb. Irregular thickened mucosal folds

GASTRIC ULCER Cobblestone appearance

String sign and skip lesions
Occurs on the lesser curvature of the stomach
CT—thick mucosal walls and “dirty fat” mesenteric appearance

274 275 276

Appendicitis Gallstones (Cholelithiasis)

It is consist of two m ajor types:
Acute appendicitis develops when the neck It can be developed whenever the bile contains insufficient
CHOLESTEROL stones bile salts and lecithin in proportion to cholesterol in
if the appendix becomes blocked by a
PIGMENT stones solution.
fecalith or by post- inflammatory scarring
5 F’s
that creates a closed-loop obstruction Cholesterol are radiolucent, they are visible in contrast
Fat examination only but some are detectable if the stones
within the organ. Female contains calcium.
Family History
Fluid accumulate sin the obstructed portion Fertile
Some stone contain nanopaque may contain a gas filled
and serves as a breeding groud for bacteria. Forty
fissures that produces a BENZ sign.

277 278 279

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ORAL
CHOLECYSTOGRAPHY
Oral cholecystography (OCG) was the traditional technique
for the diagnosis of gallstones. It is rarely used today
because it has been replaced in most institutions by
ultrasound.
Gallstones appear as freely movable filling defects in the
opacified gallbladder. They fall by gravity to the dependent
portion of the gallbladder and frequently layer out at a level
that depends on the relationship of the specific gravity of
the stone to that of the surrounding bile.
Solitary gallstones are usually rounded; multiple
stones are generally faceted. Large numbers of stones
can have a sandlike or gravel-like consistency and be visible
only when they layer out on radiographs obtained using a
horizontal beam and with the patient in an erect or lateral
decubitus position. Infrequently a gallstone is coated with
tenacious mucus and adheres to the gallbladder wall
Hemorrhoids
Varicose veins of the lower end of the rectum that
causes pain, itching and bleeding
They are caused by increase venous pressure
The most common cause is constipation with resulting
excessive muscular straining needed to empty the bowel.

280 281 282

Hemorrhoids Porcelain Gallbladder Pneumoperitoneum

Refers to extensive calcification in the wall of the
gallbladder which forms a oval density that corresponds
to the size and shape of the organ.
On barium enema examinations, it Extensive calcium
occasionally can produce single or
Also termed as calcified gallbladder
multiple rectal filling defects
The term porcelain is used to emphasize the blue
discoloration and brittle consistency of the gallbladder
wall.
Free air in the peritoneal cavity with a significant
abdominal pain and tenderness is often cause
perforation of a gas-containing viscus and indicates a
surgical emergency.
1 cc of air
Upright/ lateral decubitus (10 minutes)
Sickle shaped lucency

283 284 285

Splenic rupture
Splenomegaly
Enlargement of the spleen Fracture by trauma
Is associated wIth several conditions: C-H-I-M-P CT—subcapsular hematoma appears as a crescentic fluid
CYTS
collection; splenic laceration appears as enlargement with
an irregular splenic border --END--
HEMATOLOGIC DISORDERS
Aggressive treatment
INFECTIONS

METABOLIC
Embolization of splenic artery

PORTAL HYPERTENSION Laparoscopic splenectomy

286 287 288

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Summary findings
Radiographic
Disorder Location The Colon
appearance
KUB—appendicolith
US—noncompressible 7mm or
more outer diameter
CT—round or oval mass,
Appendicitis Appendix
possibly containing gas, dilated
lumen with thickened
circumferentially enhancing wall
Round or oval out-pouching
projecting beyond lumen;
usually multiple
Most common in sigmoid
Diverticular perforation with
Diverticulosis possible abscess
US—hypoechoic projection
Inflammation of diverticula surrounded by inflamed fat
CT—nonspecific wall
thickening with a narrowed
bowel lumen
KUB—deep ulcers with
intraluminal gas or polypoid
changes, loss of haustral
Superficial and acute, beginning markings
in rectosigmoid area with
BE (double contrast)—fine
Ulcerative colitis
continuous involvement
throughout colon granularity of mucosa;
submucosa with broad based
ulcers have a collar-button
appearance
Treatment
Appendectomy should be
performed before perforation
Noninvasive:
--Dietary modifications and
exercise
--Antibiotics for diverticulitis
Invasive:
Irritable bowel syndrome
--Surgery for perforated
Nutritional supplements
Dietary modifications (to
decrease bulk)
Anti-inflammatory drugs
Surgical resection for severe
ulcerative colitis
Radiographic
Disorder Location
appearance
BE (double contrast)—patchy
distribution, noncontiguous
Terminal ileum and proximal
Crohn’s disease colon most often segments (skip lesion)
CT—colonic wall thickening
and abscess formation
Fine superficial ulceration
Characteristic “thumbprinting”
Ischemic colitis Entire colon Tubular narrowing and a
smooth stricture
No specific findings
Alteration of intestinal motility Rule out other disorders
Sessile lesion: irregular,
lobuated surface
Larger than 2cm: “apple-core”
or “napkin-ring” appearance
50% in rectum and sigmoid
Cancer
region CT
• Circumferential bowel wall
thickening, metastasis,
lymphadenopathy
Treatment • Virtual colonoscopy
demonstrates 8-
10mm lesions
Nutritional supplements US—transrectal; depth of
Dietary modifications (to tumor invasion into
decrease bulk) bowel wall
Anti-inflammatory drugs
PET—detection of distant
nodular metastasis
Many cases resolve
Fusion—PET/CT provides
spontaneously the most specific detail
Restrict vasoconstrictor drugs
and give supportive care Ileocecal valve competent;
Immediate surgery for large dilated colon, thin-
infractions and complications walled cecum, little small-
bowel gas
Large bowel obstruction Large bowel
No cure exists; treatments aid Ileocecal valve incompetent;
in alleviating the symptoms
gas-filled loops of colon and Surgical detorsion
Identify and avoid trigger foods of small bowel
to reduce pain Water-soluble enema may
Alternative therapies; Distended cecum, displaced be therapeutic
relaxation, meditation to reduce upward and to the left
stress Distended rectum, devoid of
Volvulus Cecal or sigmoid colon haustral markings, and a
sausage or balloon shape
Solitary lesion: surgical
Bird’s-beak appearance
resection, with or without
chemotherapy Nonsurgical—rubber-band
Single or multiple rectal ligations
Multiple or distant lesion: filling defects simulating
Hemorrhoids Distal rectum
chemotherapy and/or radiation Surgical—circumferential
polyps mucosectomy
therapy

289 290 291

Summary findings
Radiographic
Disorder The Gallbladder
Location
appearance
KUB—cholelithiasis evident if
calcified
Gallstones Gallbladder and biliary tree US—foci of high-amplitude
echoes associated with acoustic
shadowing
US—demonstrates distended
gallbladder containing
gallstones and possibly edema
of the gallbladder wall
NM cholescintigram—failure
to accumulate radioactivity
Acute cholecystitis Gallbladder and biliary tree after 4hr
MR
cholangiopancreatography—
demonstrates the cystic duct
and obstructing calculi located
in gallbladder neck
KUB—demonstrates gas in the
gallbladder lumen that dissects
into the wall to produce
Emphysematous cholecysitis Gallbladder appearance of a rim of lucent
bubbles or streaks of gas
outside of and roughly parallel
to the gallbladder lumen
Summary findings
Treatment The Liver
Radiographic
Disorder Location Treatment
appearance
KUB—haziness in ascites,
US—coarse echogenicity,
multiple nodules of
Broad continuous band of varying size and nodular Dietary modifications
calcification in the liver surface stop alcohol consumption
muscular layers, or Cirrhosis Liver cells and structure CT—fatty infiltration in Irreversible—curable only
Asymptomatic—no treatment Extensive calcification in Prophylactic
Porcelain gallbladder the wall multiple and punctuate cholecystectomy liver , portal vein by liver transplant
Noninvasive: lithotripsy;
calcifications in the involvement/obstruction
chemical dissolution
Invasive: ERCP for stone glandular spaces of mucosa ascites , extravisceral fluid
retrieval; laparoscopic collection
cholecystectomy
Poor prognosis
Previously injured liver CT—defuse infiltrate , Surgery and chemotherapy
Hepatocellular carcinoma cells are most susceptible solitary multinodular mass
are treatment of choice
CT—increased density
adjacent to normal
parenchyma when IV
contrast administered Terminal
Hepatic metastases Liver MRI—low signal intensity Treatment palliative only
on T1-weighted , high
signal intensity on T2
weighted images

292 293 294

Summary findings
The Pancreas Summary findings Summary findings
Pneumoperitoneum Splenic Disorders
Radiographic
Disorder Location Treatment Radiographic
appearance Disorder Location Treatment
US—altered echogenisity appearance
CT—diffuse or focal Supportive treatment
enlargement IV antibiotics Upright Radiographic
Acute—pancreatic ducts KUB—intrinsic echo pattern, Reduce fat/protein intake abdominal film (1st Disorder Location Treatment
Pancreatitis alteration by calcification and Pancreatic enzyme appearance
Chronic—pancreatic supplements choice) shows 1cc
parenchyma fibrosis Abdominal film—
CT—ductal dilatation, Insulin for uncontrolled blood
calcification, atrophy, and sugar levels free elevated left Treat cause
pseudocyst formation
intraperitoneal gas diaphragm, stomach
Splenomegaly Enlarged spleen displacement Limited physical
US—echo-free cyst with sharp (air) under Immediate surgery activity to prevent
posterior wall Spontaneous resolution CT—demonstrates traumatic rupture
Drainage (percutaneous or
Pseudocyst
Cyst walled off from ductal
system
CT—sharply marginated fluid-
endoscopic)
Pneumoperitoneu diaphragm for visceral tumor, abscess, or cyst
filled collection(s) best seen Abdominal cavity Left lateral causing splenomegaly
with IV contrast
Surgical correction m perforation,
decubitis (2nd IV antibiotics CT—subcapsular
US—tumor 2cm or greater, choice) air hematoma appears as a Aggressive treatment
irregular contour, and semi Survival 2% crescentic fluid
Adenocarcinoma solid pattern of intrinsic
Surgery collection between collection; splenic Embolization of
echoes Radiation therapy Splenic rupture Fracture by trauma splenic artery
Cancer Head of pancreas in 60% of
CT(most effective)—tumor
Chemotherapy lateral margin of laceration appears as Laparoscopic
case Biologic therapy enlargement with an
mass, ductal dilatation, and liver and outer splenectomy
invasiveness irregular splenic
abdominal wall border

295 296 297

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KIDNEYS

Functional unit is
NEPHRON.

URINARY SYSTEM
Filter waste products from the
blood.

Reabsorb nutrients from the

tubular fluid

Secrete excesses substances in

the form of urine.

Nephron filters about190L of

water

298 299 300

FUNCTIONS
COMPONENTS OF URINARY SYSTEM
1. Maintaining ACID-base balance

2. Maintaining WATER-base balance 2 kidneys

3. ELECTROLYTE balance
2 ureters
4. TOXIN removal
5. BLOOD Pressure control
1 urinary bladder
6. Making ERYTHROPOIETIN (Red blood cell concentration)
7. Vitamin D production 1 urethra

301 302 303

ANOMALIES OF NUMBER RADIOGRAPHIC

SIZE APPEARANCE
UNILATERAL RENAL AGENESIS
CONGENITAL/HEREDI May be associated with a variety of other congenital
IVU

malformations
TARY DISEASES Results from a failure of embryonic renal bud or renal
Hypertrophic single
functioning kidney
vascular system to form.
US
In TRUE RENAL AGENESIS, the ureter and corresponding half
of the trigone are missing also.
Size of renal parenchyma,
ULTRASOUND and CT can demonstrate the absence of renal calyses, and pelvis
tissue.

304 305 306

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TREATMENT
HYPOPLASTIC KIDNEY

Often appears as a miniature

replica of a normal kidney, with a
Usually no treatment SUPERNUMERARY KIDNEY good function and a normal
relationship between the amount
The third kidney is usually small and rudimentary and of parenchyma and the size of the
Obstruction: alleviate cause of obstruction possesses a separate pelvis, ureter, and blood supply. collecting system.

Kidneys tend to lead to secondary infections that eventually M ust be differentiated from an
Infection: antibiotics, and determine cause, if any. may require their removal. acquired atrophic kidney, which is
small and contracted because of
inflammatory disease that has
reduced the volume of renal
parenchyma.

307 308 309

ANOMALIES OF ROTATION,
POSITION, AND FUSION
COMPENSATORY
HYPERTROPHY Malrotation of one of both kidneys may produce a bizarre
appearance of the renal parenchyma, calyces, and pelvis
Is an acquired condition that develops that suggests a pathologic condition when in reality the
when one kidney is forced to perform the
function normally carried out by two kidney is otherwise entirely normal.
kidneys.

This may be followed by renal agenesis, Abnormally positioned kidneys (ectopic kidney) may be
hypoplasia, atrophy or nephrectomy. found in various position or location from the true pelvis is
above the diaphragm.
Greatest in children and diminidhes in
adulthood.

310 311 312

ANOMALIES OF RENAL
PELVIS AND URETER

HORSESHOE KIDNEY
COMPLETE FUSION DUPLICATION

Common anomaly
Most common type of fusion anomaly Rare anomaly
May vary from a simple bifid pelvis to a completely double pelvis, ureter and
Both kidneys are malrotated and their lower poles are joined by a Produces a single irregular mass that has no ureterovesical orifice.
band of normal renal parenchyma or connective tissue. resemblance to a renal structure. Can be complicated by obstruction or by vesicoureteral reflux with infection.

313 314 315

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TREATMENT OF
TREATMENT OF
CONGENITAL/HEREDITARY URETEROCELE
ANOMALIES URETEROCELES
May need to be treated to preserve kidney function and
Most cases of congenital/hereditary anomalies require A cystic dilation of the distal ureter near its insertion to reduce the risk of infection.
no treatment. into the bladder.
An ENDOSCOPIC INCISION of the ureterocele
If there will be obstruction, it is necessary to maintain ECTOPIC URETEROCELES are found almost allows normal urine drainage into the bladder.
normal urine flow exclusively in infants and children
More aggressive treatment includes surgical resection of
In cases of infection, antibiotics are required. Most are associated with uretral duplication.
the ureterocele with bladder reconstruction.

316 317 318

POSTERIOR URETHRAL
TREATMENT
VALVES
Thin transverse membranes, found
almost exclusively in males, that cause
bladder outlet obstuction and may lead
INFLAMMATORY
to severe hydronephrosis, hydroureter,
and renal damage. Surgical intervention to correct the anatomic DISORDERS
The catherization is normal but the relationships and allow normal urine flow is required to
valve prevents antegrade flow. prevent any kidney or uretral destruction.

The proximal urethra is dilated and

the thin, lucent transverse membrane
of the valve can be identified.

319 320 321

EMPHUSEMATIOUS
GLOMERULONEPHRITIS TREATMENT
PYELONEPHRITIS
A nonsuppurative inflammatory process involving the Severe form of acute parenchymal andperirenal infection with gas
tufts of capillaries that filter the blood within the kidney. forming bacteria that occurs virtually only in diabetic patients

LOCATION: Insterstitial tissue between tubules

LOCATION: Parenchyma (glomeruli and tubules) Most cases resolve completely Corticosteroids for
immunosuppression. RADIOGRAPHIC APPEARANCE:
RADIOGRAPHIC APPEARANCE:
IVU- acute produces striation in renal pelvis, chronic blunting to clubbing of calyces.
Normal contour Antibiotics for infection.
CT- changes in cortex and associated abcesses
ACUTE-normal to increased kidney size. US- large pelvis with loss of parenchyma

CHRONIC-small kidney NM- inflammation, scarring and renal distribution function

322 323 324

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TREATMENT PAPPILLARY NECROSIS CYSTITIS

LOCATION: Medullary papillae and terminal portion of renal pyramids LOCATION: Bladder
Conservative: antibiotics, fluid management RADIOGRAPHIC APPEARANCE: RADIOGRAPHIC APPEARANCE:
Cavitation of central portion of papillae
Aggressive: percutaneous drainage, antibiotics, surgery Irregularity of bladder wall
US- sloughing appears as echogenic nonshadowing structure in the collecting system.
US- thickened bladder wall
TREATMENT:
CT- bladder wall filled with gaseous material
MEDICATION INDUCED- Discontinue offending agent

PREDISPOSING CONDITIONS- Control to reduce risk TREATMENT:

OBSTRUCTION- remove endoscopically or surgically
Antibiotics or sulfa drugs

325 326 327

KIDNEY STONES TREATMENT Urinary Tract Obstruction

URINARY CALCULI
Commonly form in the kidney
Asymptomatic until they lodge in the ureter and cause partial obstruction,
resulting in extreme pain that radiated from the area of the kidney to the groin.
Cause varies and often reflects an underlying metabolic abnormality
Produces anatomic and functional changes that vary with regard to rapidity
of onset, degree of occlusion and distance between the kidney and the
obstructing lesion.
Increasing fluid intake and decreasing the intake of the
stone-forming substances. In adult : urinary calculi, pelvic tumors and enlargement of the prostate
gland are the major cause.
LITHOTRIPSY In children : congenital malformations ( ureteropelvic junction narrowing,
ureterocele, retrocaval ureter, posterior urethral valve ) are usually
responsible for mechanical obstruction.
Is a technique to break up the stone using an external source of shock waves that
shatter the hard stones into the sand-sized particles, which are then secreted in
the urine.
Blockage above the level of the bladder causes unilateral dilatation of the
ureter ( hydroureter )
If the lesion is at or below the level of the bladder. ( hydronephrosis )

328 329 330

Radiographic Appearance Treatment CYST AND TUMORS

Noncontrast helical CT scanning detects mass effects, stones, or RENAL CYST
other causes of obstruction better than excretory urography.
Vary in size, and they may occur at single or multiple sites in one or both kidneys
The radiographic study may have to be prolonged for up to 48 hours
after the administration of contrast material to determine the precise
site of obstruction.
Decompressing the urinary tract to prevent Slowly increases in size, its protruding portion elevates the adjacent edges of the
cortex
parenchymal damage and possible urethral
In the patient with acute urinary tract obstruction, the kidney is Cause focal displacement of adjacent portions of the pelvicalyceal system.
generally enlarged, and the calyces are moderately dilated. rupture because of the blockage.
UTRASOUND is the modality of choice for distinguishing fluid-filled simple cyst
As an obstruction becomes more chronic, the predominant from solid mass lesions.
urographic finding is a greatly dilated pelvicalyceal system and ureter
proximal to the obstruction. CT is also highly accurate in detecting and characterizing simple renal cyst.

331 332 333

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POLYCYSTIC KIDNEY
TREATMENT DISEASE
TREATMENT
An inherited disorder in which multiple cysts of varying
size cause lobulated enlargement of the kidneys and
progressive renal impairment,which in turn causes No cure is available.
Following needle puncture, a catheter can be placed for localized intrarenal obstruction.
Medications are prescribed to control pain, high blood
drainage if needed.
RADIOGRAPHIC APPEARANCE pressure, and infection related to the disease.
An injection of iodine or alcohol may obliterate the cyst. Enlarged kidneys with a mutilobulated contour. The pelvic and infundibular Renal failure requires dialysis and renal transplantation
structures are elongated, effaced, and often displaced around larger cyst.
may be considered.
ULTRASOUND demonstrates grossly enlarged kidneys containing multiple cyst
that vary considerably in size and are randomly distributed throughout the kidney.

334 335 336

WILM’S TUMOR
RENAL CARCINOMA TREATMENT
(NEPHROBLASTOMA)
Most common renal neoplasm,
occuring prodominantly in patients
older than 40 years and often with
Nephrectomy- the most common treatment.
painless hematuria. Most common abdominal neoplasm of infancy and
Radiation and chemotherapy are ineffective in treating childhood.
RADIOGRAPHIC
APPEARANCE: renal carcinoma.
Highly malignant, must be differentiated from
The tumor initially causes elongation of adjacent calyces
RADIOFREQUENCY ablation is suggested in patients neuroblastoma, a tumor of adrenal medullary origin that
Progressive enlargement and infiltration lead to distortion,
narrowing, or obliteration of part or all of the collecting system. with bilateral lesions and those at high surgical risk. is second most common malignancy in children.
ULTRASOUND: reveals a renal carcinoma as a solid mass with
numerous internal echoes and no evidence of the acoustic
enhancement seen with renal cyst.

337 338 339

RADIOGRAPHIC CARCINOMA OF THE RADIOGRAPHIC

APPEARANCE BLADDER APPEARANCE
Causes pronounces distortion and displacement of the
pelvicalyceal system.
May produce finger-like projections into the lumen or it
ULTRASOUND is of value in distinguishing Wilm’s Originates in the epithelium and is called urothelial may infiltrate the bladder wall.
tumor from hydronephrosis, another major cause of a
palpable renal mass in a child. carcinoma.
Typically have a solid appearance with gross distortion of
the renal structure Usually seen in men. Fourth most common cancer in
men. Factor implicated are industrial chemicals.
CT can demonstrate the full extent of the tumor and can
detect any recurrence of the neoplasm after surgical
removal.

340 341 342

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RENAL VEIN RADIOGRAPHIC

TREATMENT THROMBOSIS APPEARANCE

Occurs most frequently in children who are severely

dehydrated.
Require removal of the entire bladder with
transplantation of the ureters into a loop of ileum.
In the adult, thrombosis is most often a complication of
another renal disease.

343 344 345

RADIOGRAPHIC
TREATMENT ACUTE RENAL FAILURE
APPEARANCE

Refers to a rapid deteriorationin kidney function that is

Anticoagulants are generally given to prevent new clots sufficient to result in the accumulation of nitrogen-
from forming. containing wastes in the blood and a characteristic odor
of ammonia on the breath.

346 347 348

CHRONIC RENAL RADIOGRAPHIC

FAILURE APPEARANCE
11. Foreign Bodies
Symptomatically, the patient is unable to swallow without regurgitation. M ost
metallic objects, such as pins, coins and small toys, are radiopaque are easily
My reflect prerenal, postrenal or intrinsic kidney visualized on radiographs or during fluoroscopy.
disease.

Causes includes bilateral renal artery stenosis, bilateral Radiographic Appearance

uretral obstruction, and intrinsic renal disorders.
Nonopaque foreign bodies in the esophagus, especially pieces of poorly
chewed meat can be demonstrated only after the ingestion of barium. Such
foreign bodies usually become impacted in the distal esophagus just above the
level of the diaphragm and are often associated with a distal stricture.

349 350 351

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12. Perforation of the Esophagus

Treatment
Medications are the first line of treatment to relax the
esophagus and allow the foreign body to move naturally
into the stomach. In some instances, especially for
sharper-pointed objects, retrieval of the foreign using
endoscopy may be appropriate.
Perforation of the esophagus may be a complication of esophagitis, peptic ulcer,
neoplasm, external trauma, or instrumentation. At times, perforation of a previously
healthy esophagus can result from severe vomiting or coughing, often from dietary or
alcoholic indiscretion.
Radiographic Appearance
A perforation that extends throughout the entire esophageal wall can lead to free air
in the mediastinum or periesophageal soft tissues. The administration of radiopaque
contrast material may demonstrate extraversion through perforation. CT is the
preferred modality to define the extent of the process.

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STOMACH
Treatment

Place an expandable stent and then treat the

complications (chest tube for pneumothorax; antibiotics
to prevent infection). A surgical procedure (band ligation)
can be performed to close the perforation.

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1. Gastritis Inflammatory thickening of the gastric wall causes

Inflammation of the stomach can be the result of a narrowing of the stomach that may mimic gastric cancer.
variety of irritants including alcohol, corrosive agents, The diagnosis of infectious gastritis can be made if there is
and infection. Gastritis changes the normal surface evidence of gas bubbles in the stomach wall. These types
pattern of the gastric mucosa. Helicobacter pylori can of gastritis are known as erosive or acute gastritis.
cause chronic gastritis that may lead to peptic ulcer
disease.
Chronic atrophic gastritis (nonerosive) refers to severe
mucosal atrophy that causes thinning and a relative
Radiographic Appearance
absence of mucosal folds, with the fundus or entire
Alcoholic gastritis may produce thickening of gastric folds, multiple superficial gastric erosions, or both. In corrosive
gastritis, the acute inflammatory reaction heals by fibrosis and scarring, which results in severe narrowing of the antrum and
may cause gastric outlet obstruction. In bacterial gastritis,
stomach having a bald appearance.

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Treatment 3. Duodenal Ulcer

Eliminating the causative agent, such as alcohol, reduces the changes in the
It is the most common manifestation of peptic ulcer disease. More than 90% of
mucosal lining as well as the symptoms as production of the protecting mucus is
duodenal ulcers occur in the first portion of the duodenum (the duodenal bulb).
not inhibited. Antibiotics are the appropriate medication for bacterial or
infectious gastritis.

Radiographic Appearance
2. Peptic Ulcer Disease An unequivocal diagnosis of active duodenal ulcer requires the demonstration of
an ulcer crater, which appears in profile as a small collection of barium projecting
Peptic ulcer disease is a group of inflammatory processes involving the stomach
from the lumen. When seen face on, the ulcer niche appears as a rounded or linear
and duodenum. It is caused by the action of acid and the enzyme pepsin secreted
collection of contrast material surrounded by lucent folds that often radiate toward
by the stomach and occurs most frequently on the lesser curvature.
the crater.

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4. Gastric Ulcer
Another form of peptic ulcer disease, usually occur on the lesser curvature of the
stomach. Unlike duodenal ulcer, which are virtually always benign, up to 5% of gastric
ulcers are malignant.

Radiographic Appearance
The classic sign of a benign gastric ulcer in profile is penetration, with clear
projection of the ulcer outside the normal barium-filled gastric lumen because the ulcer
represents an excavation in the wall of the stomach. When viewed face on, a gastric
ulcer appears as a persistent collection of barium surrounded by a halo of edema (the
ulcer collar).

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5. Superficial Gastric Erosions Treatment of Ulcers

Superficial gastric erosions are ulcerations that are so Lifestyle modifications are the first line of treatment
small and shallow that they are rarely demonstrated on for ulcers. Antacids aid in neutralizing stomach acid. If
conventional single-contrast upper gastrointestinal stress is the cause of the increase in acidic secretions, stress
examinations. With the increasing use of double-contrast management is appropriate. When ulceration is caused by
techniques, a superficial gastric erosion typically appears an infection (H. pylori), antibiotics are given to kill
radiographically as a tiny fleck of barium, which represents bacteria. If the acidic secretions cannot be controlled by
the erosion, surrounded by a radiolucent halo, which these methods, histamine H2 antagonists help in reducing
represents a mound of edematous mucosa. stomach acids and protecting the stomach lining.

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6. Cancer of the Stomach

Several conditions appear to predispose persons to the development of
carcinoma of the stomach. There is an increased risk of gastric cancer in
patients with atrophic gastric mucosa, as in pernicious anemia, and in persons Treatment
10 to 20 years after a partial gastrectomy for peptic ulcer disease.
In most cases, treatment consists of surgical resection
of all or part of the stomach.
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Radiographic Appearance
Tumor infiltration of the gastric wall may stimulate intense fibrosis, which
produces diffuse thickening, narrowing, and fixation of the stomach wall.

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