Complete rightsided pneumothorax Lung is compressed against mediastinum

Shift of heart and trachea to left

Tension pneumothorax

Streaky, linear densities due to air in the mediastinum

Streaky, linear densities due to air in the mediastinum

Pneumomediastinum

Air surrounding esophagus in mediastinum

Pneumomediastinum CT scan

Extraluminal contrast from perforation along left lateral wall of distal esophagus

Air outlines under surface of right hemidiaphragm

Air outlines under surface of left hemidiaphragm

Pneumoperitoneum

Air outlines both sides of the wall of the stomach-a sign of free air in the peritoneal cavity

Pneumoperitoneum

Free air Free air

CT scans on 2 different people show a small and large amount of free air in the peritoneal cavity which rises to the highest point (anterior abdomen with the person lying on their back) and is not contained within bowel

Pneumoperitoneum - CT

Effect of Position - Layering

Supine

Erect

In the supine position, the fluid layers out posteriorly and produces a haziness, especially near the bases (since the patient is actually semirecumbent). In the erect position, the fluid falls even more to the bases.

Size (not number) of vessels at the apex exceeds size of vessels at the base in this upright person. This is called cephalization. Normally the vessels at the base exceed the size of the vessels at the apex

Pulmonary Venous Hypertension from Mitral Stenosis

Pulmonary interstitial edema produced by Kerly A and C lines

Pulmonary Interstitial Edema

Bilateral, diffuse airspace disease more marked centrally than at the periphery of the lung (bat-wing appearance)

Pulmonary Alveolar Edema

Linear lucency in the contrastfilled descending aorta is the intimal flap of an aortic dissection

Aortic Dissection

 Widened mediastinum Left pleural effusion Chest pain Should make you think of an aortic dissection

Aortic Dissection

Classification of Dissecting Aneurysms

Widened mediastinum

Left pleural effusion

Chest pain

Stanford classification

Red arrows point to active extravasation of contrast from the aorta into the retroperitoneum

Red arrows point to active extravasation of contrast from the aorta into the retroperitoneum

Aorta Aorta

Thrombus inside the lumen of the aorta

Aortic rupture

Ruptured Aortic Aneurysm

Enlargement of abdominal aorta > 3cm

Usually 2 to atherosclerosis Below renals, above iliacs

About 20-25% rupture

<4cm~10%; >10 cm~60% Retroperitoneal, usually on left Into GI tract: massive hemorrhage Into IVC: rapid cardiac decompensation

Heart and trachea are displaced to right by bowel in opposite hemithorax

Left hemithorax contains multiple lucencies--air in the lumen of bowel, now located in the chest

Diaphragmatic Rupture

Diaphragmatic Rupture
General

5% of all diaphragmatic hernias

Most (90%) are left-sided

Central and posterior >10cm in length Contain stomach, colon, small bowel, omentum, spleen

Half have no initial abnormal radiographic findings Half are missed clinically

36 year-old with acute abdominal pain. Why?

Multiple air-containing and dilated loops of small bowel

Multiple airfluid levels in small bowel

No gas in rectosigmoid

Small Bowel Obstruction

Obstructed, dilated sigmoid has a coffeebean shape

Sigmoid twists around this point

Sigmoid Volvulus

Dilated loop in LUQ is cecum which has twisted on itself

Dilated loops of small bowel from small bowel obstruction at ileocecal valve

Cecal Volvulus

Cecum twists at this point producing Birds-Beak sign

Sigmoid Volvulus Barium Enema

74 year-old with change of bowel habits

Dilated large bowel

Barium enema shows annular constricting carcinoma of sigmoid producing obstruction

Dilated loops of large bowel with abrupt cut-off in sigmoid

Rectum

Large bowel obstruction Sigmoid carcinoma

Ascites is lower in attenuation than adjacent, contrastenhanced liver

Ascites

Ascites

Massive ascites (red arrows) in a patient with a pseudocyst of the pancreas (green arrow)

R3

Massive ascites on CT

R3

Tip of central venous catheter coils back on itself in right brachiocephalic vein (red arrow).

Tip of endotracheal tube is in right mainstem bronchus (red arrow) leading to atelectasis of the right upper lobe and entire left lung

Crescentic area of increased attenuation on non contrastenhanced CT with convexity toward brain is characteristic of an epidural hematoma

Traumatic intracranial hemorrhage Epidural Hematoma

Crescentic low attenuation lesion at periphery of brain containing a fluid-fluid level from blood

Traumatic intracranial hemorrhage Subdural hematoma

Intraparenchymal hemorrhage

Traumatic intracranial hemorrhage Intraparenchymal hemorrhage

R3

R3

Acute hemorrhage in the basilar cisterns (red arrows) and Sylvian fissures (green arrows) in two patients with ruptured aneurysms

Subarachnoid hemorrhage from ruptured aneurysm

Markedly enlarged frontal horns

Colloid Cyst obstructing third ventricle

Choroid plexus (normal)

R3

Colloid Cyst of 3rd ventricle producing obstructive hydrocephalus

Lateral ventricles anterior and posterior horns

Large mass represents a choroid plexus papilloma

R3

Hydrocephalus from Choroid Plexus Papilloma

Lateral ventricles anterior and posterior horns

Hydrocephalus from Cerebral Atrophy

58 year-old woman with breast cancer and headache

A
Spinolaminar white line of C2 does not align with other vertebral bodies

Fracture through posterior elements of C2

Forward displacement of the body of C2 (red arrows)

Fracture of C2 - Hangmans Fracture

Hangmans Fracture
l

Most common fracture of C2

n

Most common cervical spine fracture

l l

Hyperextension/compression fracture Fractures through the pedicles of C2 with anterior slip of C2 on C3 Not associated with neuro deficit

The inferior articular facet of C5 (red arrow) has slipped forward and lies anterior to the superior articular facet of C6 (green arrow) a condition known as a locked facet

C5 C6

Locked facets

Fractures of the metaphysis (red arrow) and epiphysis (green arrow) (SalterHarris IV) extend into joint

Fracture of radial styloid (yellow arrows) extends into wrist joint5

Fractures extending into joints

Fracture of radial head

Posterior fatpad sign indicates fluid in the joint

Fracture of the radial head with traumatic joint effusion

Humeral head (red arrow) lies inferior to the coracoid process of the scapula (green arrow)

Humeral head (red arrow) lies inferior to the glenoid fossa of the scapula (yellow arrow)

Humeral head (red arrow) lies inferior to the coracoid process of the scapula (green arrow) and anterior to the glenoid (yellow oval)

Anterior Dislocation of the Shoulder

Humeral head (red arrow) lies posterior to the glenoid fossa of the humerus (yellow arrow)

Humeral head (red arrow) lies beneath the acromion process of the scapula (green arrow) and posterior to glenoid (yellow oval)

Humeral head (red arrow) assumes the shape of a lightbulb because it is fixed in internal rotation

Posterior Dislocation of the Shoulder