Radiology Made Simple For NRE NLE Step 2 – BilalMD

A radiological investigation to find certain pathologies in the chest.

Look for ABCD

1. A: Airway (Trachea)
2. B: Breathing or Bony Fracture
3. C: Cardio-phrenic, costo-phrenic angle
4. D: Diaphragm Status

The best way to perform an X-ray is PA-view

1. Pleural Effusion:

Excess fluid accumulation in the pleural cavity of more than 50 ml.

X-ray Finding:

1. White opacity in the lung.
2. Silhotte sign
3. Costo-Phrenic and cardiophrenic angle obscured

Types of pleural effusion are as follows;

1. Transudative
2. Exudate

Treatment:

1. Thoracocentesis (USG guided)
2. NSAID
3. Antibiotics

Location:

The best is the mid-axillary line at the 6th, 7th, and 8th ICS space.

2. Pneumothorax (excess air in the pleural space)

Finding:

1. Lack of lung marking
2. Collapsed lung
3. Trachea deviation

Types:

There are three types of Pneumothorax are as follows:

1. Spontaneous Pneumothorax
   1. Primary pneumothorax
   2. Secondary pneumothorax
2. Traumatic Pneumothorax
   1. Gunshot injury
   2. Chest trauma
3. Tension Pneumothorax
   1. Cause Hemodynamic instability

Treatment:

• Thoracocentesis

3. Hydropneumothorax

Accumulation of excess air and fluid in the pleural space.

X-ray Finding:

1. Lack of bronchial line (Black lines)
2. Hyper-density
3. Straight line dullness and pointing toward the pleura

Treatment:

• Intercostal drainage

4. Lung Abscess

Pus-filled cavity (usually>2cm) containing necrotic debris or fluid caused by microbial infection.

X-ray finding:

A thick, irregular wall with an air fluid level.

Treatment:

1. Broad-spectrum antibiotics (3-6 weeks)
2. Oral antibiotics
3. Drainage

Finding:

Multiple lung masses (cannonball metastasis)

Differential diagnosis:

• Infection (TB, fungal infection)
• Neoplasm (metastasis of cancer)

Treatment:

Depend upon the cause.

5. Cardiomegaly

A condition in which the heart size is enlarged.

Finding:

Cardiothoracic ratio is more than 0.5

CTR < 0.5 is 𝑁𝑜𝑟𝑚𝑎

Formula:

Width of heart / Width of chest cavity

Treatment:

• Depend upon the cause

6. Shaft of Humerus Fracture

Nerve Damage:

• Radial Nerve

Treatment:

1. Supportive: Bed Rest, Analgesic
2. Non-Surgical:
   1. Splint or Brace (elbow Bent)
   2. Physical Therapy
3. Surgical Treatment:
   1. oRIF
   2. Rod: A Rod inserted inside the bone

7. Shoulder Joint Dislocation

Nerve Damage:

• Axillary Nerve

Treatment:

1. Reduction
2. Immobolization
3. Medication (Wear a sling)
4. Surgery

8. Radius & Ulna Fracture

Supportive:

• Bed Rest, analgesic

Specific:

A splint should be placed for 6 weeks. ORIF + IF with metal plates. Forearm fractures usually take 3-6 months to heal.

9. Femoral Neck Fracture

Supportive:

1. Analgesic
2. Bed Rest

Specific treatment:

• Open Reduction and Internal Fixation. It involves fixing the fracture with a plate and screws.

Hemi arthroplasty:

• It is used for displaced fractures in less active patients.

Total Hip Arthroplasty

1. It is done for more active patients.
2. Healing usually takes 4-6 months.

10. Epideural Hematoma

On CT, there is a Biconvex density. The middle meningeal artery is the vessel involved.

Management:

1. A, B, C, D
2. Craniotomy & Evacuation of hematoma

11. Subdural hematoma

On CT, a crescent-shaped hematoma is visible. The bridging veins are involved.

Symptoms:

1. Headache
2. Fluctuating level of consciousness treatment

Management:

1. A, B, C, D
2. Burrhole & drainage of hematoma

12. Fracture of Skull

Treatment:

Craniotomy & Elevation of depressed segment