MBBS Review

Chest Radiology
 SVC
Aortic arch

Pulmonary trunk

Right atrium : right heart border Left ventricle : left heart border

Right ventricle: base of heart

 Differences
PA view AP view

Clavicles obliquely placed horizontally placed

Scapula laterally placed overlapping the
lung fields
Spine faintly visible IVD spaces clearly visible IVD
spaces
Heart size Normal appears enlarged

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 RUL Collapse

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 Airspace nodules
Butterfly pattern

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 Air bronchogram
• Visualization of bronchi with in a
lesion as a result of either
alveolar air replacement by fluid,
solid or airlessness of alveoli
• Presence of air bronchogram
indicates the lesion is
intrapulmonary (applicable to
differentiate from mediastinal
lesions)

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 Compressive collapse

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 Pleural effusion

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 Pneumothorax

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Multiple bilateral cavitary lesions with air-fluid levels c/w pulmonary
abscesses

Tuberculosis
 RML pneumonia

RML consolidation that appears wedge shaped on lateral view

 Left lung opacity

Later diagnosed as lung cancer

What do the arrows indicate?
Kerley B Lines

Short (1 -2 cm) white

lines at the lung bases,
perpendicular to the
pleural surface
representing distended
interlobular septa
Cavity DD-???
 Congenital
Diaphragmatic Hernia
Lung Abscess
 Chamber Enlargement

• Left Ventricular Enlargement

– PA View: lateral and
downward displacement of
the cardiac apex
 Chamber Enlargement

• Left Atrial Enlargement

– PA view:
• Double density
• Enlargement of LA appendage
• Upliftment of left mainstem
bronchus
• Widening of carinal angle
 Chamber Enlargement

• Left Atrial Enlargement

– Lateral view:
• Prominent posterosuperior
cardiac border
• Posterior displacement and
upliftment of left mainstem
bronchus
 Pulmonary Vascular Pattern

Alveolar Edema

VENOUS
CONGESTION
 Tetralogy of Fallot

• Decreased vascularity
• Normal or enlarged
cardiac size
• right ventricular
prominence
• Concave main pulmonary
artery segment
• Prominent aorta
• right aortic arch (in 20-
25%)
 MITRAL STENOSIS

• Normal to slightly
enlarged heart
• Chamber prominence:
– left atrium
– right ventricle
• Equalization or
cephalization of
pulmonary blood flow
• Prominent main
pulmonary artery
segment
• Small aorta
GIT
 Abdominal X-Rays:

AXR-4
AXR-3
 Assess the Film in Detail:
Intra-luminal Gas:
Low Small Bowel
Obstruction

Small Bowel obstruction.

 Assess the Film in Detail:
Extra-luminal Gas:
When an bowel is
obstructed, or any other gas
containing structure
perforates, its contained gas
becomes extra-luminal.
Extra-luminal gas is never
normal, but may be seen
following intra-abdominal
surgery or endoscopic
retrograde cholangio-
pancreatography (ERCP).

Extra-luminal gas seen on erect

CXR.
Esophogram
UGI
SBFT
Barium Enema
Cholangiogram
Single-contrast esophagram. A
moderate-sized hiatal
hernia is present with
esophageal shortening and
narrowing beginning at the
gastroesophageal junction.
The margins of the stricture
taper gradually.
Differential Diagnosis
1. Chronic reflux-induced
stricture
2. Caustic ingestion-induced
stricture
Single-contrast
esophagram. Fixed,
smooth narrowing
is present in distal
esophagus. Proximal
esophagus is dilated.

At fluoroscopy, narrowing
remained unchanged,
even after esophagus was
half filled with contrast
material.
Differential Diagnosis
• Primary achalasia
 Chagas’ disease
 Amyloidosis
 Diabetes
Secondary achalasia
 Vagotomy
 Carcinoma of the
gastric cardia/fundus
 Hematogenous
metastases
 Lung cancer: anti-Hu
antibodies
 Lymphoma
Single-contrast esophagram. A
large, centrally ulcerated
mass with an irregular luminal
contour and an abrupt
inferior edge is present in the
mid esophagus.
Differential Diagnosis
1. Primary esophageal
carcinoma
2. Metastases
3. Lymphoma
Double-contrast barium enema. A
stricture is present in the region of
the ahaustral splenic flexure of the
colon.

Differential Diagnosis
Colitic cancer
Single-contrast barium enema. A
short focal segment of
narrowing is present in the
sigmoid colon. The margins of
the focal abnormality are
abrupt. Normal mucosal
markings are difficult to identify.

Differential Diagnosis
1. Diverticulitis
2. Serosal metastases
3. Carcinoma
Double-contrast barium enema.
Multiple polypoid filling defects
are present throughout the colon.

These findings are characteristic

of a polyposis syndrome.
Single-contrast barium enema. A follow-up barium enema showed a
polypoid colon cancer acting as the lead point for the reducible
intussusception.
A contrast enema remains the gold standard,
demonstrating the intussusception as an occluding
mass prolapsing into the lumen, giving the "coiled
spring” appearance .
Main contra-indication for an enema is a perforation
Meniscus and coiled spring signs. (a) Image from a barium enema study shows
the meniscus sign in the contrast material-filled distal colon.
(b) Image from a barium enema study performed after partial reduction of the
intussusception shows the coiled spring sign. Contrast material outlines the
facing mucosal surfaces of the intussuscipiens and the intussusceptum.
T-tube cholangiogram. A. A meniscus is formed from a filling defect in the distal
common bile duct. B. The filling defect is no longer seen.

Differential Diagnosis
1. Passage of a common bile duct stone
2. Ampullary carcinoma
3. Pseudocalculus
 STANDARD PROCEDURE for INTRAVENOUS
UROGRAPHY
• Step 1 Preliminary imaging

• Step 2 Contrast material administration

• Step 3 Nephrographic images

• Step 4 KUB radiograph

 STANDARD PROCEDURE for INTRAVENOUS
UROGRAPHY
• Step 5 Abdominal compression

• Step 6 Pyelographic image

• Step 7 Ureter-bladder images

• Step 8 Bladder image

 STANDARD PROCEDURE for INTRAVENOUS
UROGRAPHY
• Step 1
– Preliminary radiograph
– Scout film
– Plain KUB
• Indispensable part of the sequence
IVP-Scout and Nephrographic phase
IVP-5 & 15
Full Bladder + Post void
Figure 1:Importance of full coverage at KUB radiography (URETHRAL CALCULUS)
Figure 47:MULTIPLE BLADDER DIVERTICULA,WITH WALL THICKENING * NEUROGENIC BLADDER
Figure 53FILLING DEFECT W/ A PAPILLARY CONFIGURATION ALONG THE RIGHT NLADDER WALL
 VCUG
Voiding Cysto-UrethroGram
Grading of Vesicoureteral Reflux
 Vesicoureteral reflux can be seen on oblique radiograph
just before voiding and can be graded after voiding with
the
INTERNATIONAL REFLUX SYSTEM
GRADE I – reflux into the ureter
Grade II – reflux into a nondilated ureter and non dilated
pelvicaliceal system
Grade III- reflux into mildly dilated ureter and
pelvicaliceal system
- the forniceal angles and paillary reflux
impressions remains
Grade IV – reflux into a tortous ureter and dilated
pelvicaleceal sytem
- the forniceal angles become blunted while the
papillary impressions remain distinct.
GRADE V – reflux into marked dilated and tortous ureter
- marked dilation of the pelvicaliceal system
- both the forniceal angles and the papillary
impressions are obliterated.
ANATOMY CONTD……
 Retrograde Urethrography contd

veromantanum
Membranous urethra
cone

focal smooth indentation (arrow) on the Cowper gland and duct. oblique
anterior aspect of the proximal bulbous position shows the left Cowper gland
urethra by the compressor nudae muscle. (straight arrow) and duct
 Voiding Cystourethrography

• Most commonly used imaging method in the evaluation of the female

urethra and male posterior urethra

• Bladder is filled with contrast material via a transurethral or suprapubic

catheter

• Transurethral catheter is withdrawn, the patient voids under fluoroscopic

observation and spot radiographs of the bladder and urethra are
obtained

• Membranous urethra remains the narrowest segment between these

parts of the urethra, even though it may dilate up to 6 or 7 mm in
diameter during voiding
 Voiding Cystourethrography contd…..

Voiding Cystourethrography Retrograde Cystouretherography

Strictures of the Urethra
Hysterosalpingography
• To see if the tubes
are patent or block
or partly blocked
• To see Structure
anomaly of
endometrium
• To check of the
tubal sterilization is
successful.
Contraindications:
Pregnancy
PID
Heavy menstural bleeding
a)Early filling of endometrium – b)gradual filling (C)Depicts the interstitial, isthmic,
and ampullary portions of both fallopian tubes. (d) Spot radiograph shows
intraperitoneal contrast material spillage from the fallopian tubes. In this case, the
spillage outlines the convexity of the uterine fundus
Left hydrosalpinx. Hysterosalpingogram shows dilatation of the left fallopian tube (arrow)
with an absence of contrast material outfl ow, fi ndings indicativeof tubal occlusion, and a
patent normal right tube (arrowhead) with outfl ow of contrast material
Acute OM
earliest radiographic
signs of bone
infection: a poorly
defined osteolytic area
of destruction in the
metaphyseal segment
of the distal femur
(arrow) and soft-
tissue swelling (open
arrows).
Sequestra surrounded by involucrum

a feature of advanced
osteomyelitis

usually apparent after 6

to 8 weeks of active
infection.
Chronic Osteomyelitis
There is destruction of the
medullary portion of the
bone, reactive sclerosis, and
periosteal new bone
formation.
Note also a large
sequestrum on the medial
aspect of the humerus, the
hallmark of an active
infectious process.
Prominent zone of reactive sclerosis due to
a periosteal and endosteal reaction, which
may obscure the central nidus.
Most common presentation: ill-defined osteolytic lesion with
multiple small holes in the diaphysis of a long bone in a child
with a large soft tissue mass.
•Hallmark of osteosarcoma is the production of bony matrix,
which is reflected by the sclerosis seen on the radiograph.
•Usually typical malignant features including permeative-
motheaten pattern of destruction, irregular cortical
destruction and aggressive (interrupted) periosteal reaction.
Osteochondroma is a bony protrusion
covered by a cartilaginous cap.
 Blood Can Be Very Bad

• Blood
• Cisterns
• Brain
• Ventricles
• Bone
 Blood Can Be Very Bad

• Blood
• Cisterns
• Brain
• Ventricles
• Bone
 Blood Can Be Very Bad

• Blood
• Cisterns
• Brain
• Ventricles
• Bone
 Blood Can Be Very Bad

• Blood
• Cisterns
• Brain
• Ventricles
• Bone
 B is for Blood
• Is blood present?
– If so, where is it?
– If so, what effect is it having?
Acute blood is bright white on CT
(once it clots)

Blood becomes isodense at

approx 1 week

Blood becomes hypodense at

approx 2 weeks
 Epidural Hematoma
• Lens shaped
• Does not cross sutures
• Classically described with
injury to middle meningeal
artery
• ↓ mortality if treated prior to
unconsciousness (< 20%)
CT Scan
 Subdural Hematoma
• Typically falx or sickle-shaped
• Crosses sutures
• Does not cross midline
• Acute subdural is a marker for
severe head injury (Mortality ~
80%)
• Chronic subdural usually slow
venous bleed and well tolerated
144
145
Intracerebral hemorrhage
Tumor
3.3a. Pre-contrast Axial T1 Wtd MRI 3.3b. Axial T1 Wtd MRI (C+) 3.3c. Coronal T1 Wtd MRI (C+)

80 year-old lady had MRI A dural-based intensely

of the brain following a car
accident. enhancing (arrows) Diagnosis: Falcine
meningioma arising from Meningioma
the right side of the falx.
Neurocysticercosis
Difference between CT and MRI
 Patient with Intra-cranial
mass.

Q1. Diagnosis Please

3.1a. Pre-contrast Axial T1 Wtd MRI 3.1b. Post-contrast Axial T1 Wtd MRI

3.1c. Post-contrast Coronal T1 Wtd MRI 3.1d. Post-contrast Sagittal T1 Wtd MRI