CSH057 - Image Interpretation (Images)

Describe the abnormality demonstrated.

Transverse fracture of distal third phalanx

Describe the abnormality demonstrated.

Transverse fracture of the patella, with minor anterior shift

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Oblique fracture of mid-shaft of the left tibia, with posterior displacement

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Oblique fracture of the right olecranon with possible intra-articular involvement and associated haemarthrosis.

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Spiral fracture of the proximal left femur with posterior displacement

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Comminuted fracture of the left distal radius, with intra-articular involvement and avulsion fractures of both the ulnar and radial styloid processed.

Describe the abnormality demonstrated.

Dorsal soft tissue swelling associated with a posterior avulsion fracture of the triquetrum.

Describe the abnormality demonstrated.

Boxer’s fractures of the midshaft of the (right) fourth metacarpal and proximal (right) fifth metacarpal with associated soft tissue swelling medially.

Describe the abnormality demonstrated.

Fracture and disruption of the proximal growth plate of the fifth middle phalanx (Salter-Harris 5?)

Describe the abnormality demonstrated.

Salter-Harris type 1 fracture of the left shoulder with complete medial displacement.

Also left ACJ widening and an incomplete mid-shaft fracture of the left clavicle.

Describe the abnormality demonstrated.

Salter-Harris type 2 fracture (involvement of physis and metaphysis) of the distal radius with posterior displacement.

Describe the abnormality demonstrated.

Salter-Harris type 1 fracture of the distal fifth phalanx with dorsal displacement.

Describe the abnormality demonstrated.

Salter-Harris type 2 fracture (involvement of physis and metaphysis) of the distal radius with dorsal displacement.

Describe the abnormality demonstrated.

Salter-Harris type 4 fracture (involvement of physis, epiphysis and metaphysis) of the proximal phalanx of the index finger with lateral angulation.

When the right hemi-diaphragm and cardiophrenic angle is ill-defined, which lobe is involved?

RLL

When the right heart border and right hilum is ill-defined, which lobe is involved?

RML

When the right upper mediastinum is ill-defined, which lobe is involved?

RUL

When the left heart border and aortic knuckle is ill-defined, which lobe is involved?

LUL

When the left heart border and medial aspect of the left hemi-diaphragm is ill-defined, which lobe is involved?

LLL

Describe the abnormality demonstrated.

Right-sided pneumothorax (loss of lung markings)

Describe the abnormality demonstrated.

Left-sided pneumothorax and left-sided pleural effusion (costophrenic blunting).

Describe the abnormality demonstrated.

Right-sided pneumothorax

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Consolidation in the lower zone of the right lung. Obscuration of the right heart border (silhouette sign) and preservation of the right hemidiaphragm alludes to consolidation in the right middle lobe.

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Consolidation in the lower zone of the right lung with obscuration of the right hemi-diaphragm (silhouette sign), alluding to right lower lobe consolidation.

Describe the abnormality demonstrated on this supine CXR.

Right-sided deep sulcus sign and loss of lung markings ipsilaterally (collapse) indicate a right-sided pneumothorax. An ICC can be seen over the right lung.

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Left-sided deep sulcus sign and loss of lung markings ipsilaterally (collapse) indicate a left-sided pneumothorax.

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Mediastinal shift to the left and significant loss of lung markings on the left hemithorax, indicative of a left-sided tension pneumothorax.

Describe the abnormality demonstrated.

Left-sided pneumothorax with mediastinal shift to the right as flattening of the left hemidiaphragm, suggeting a tension pneumothorax.

Describe the abnormality demonstrated on this trauma radiograph.

• Subcutaneous emphysema of the left chest wall

• Bilateral posterior rib fractures

• Flail segment of the 5-8 left ribs

• Mediastinal shift to the right

• ICC pointed inferiorly

These combined findings suggest a left haemothorax and external introduction of air (subcutaneous emphysema) due to a penetrating injury.

Describe the abnormality demonstrated.

• Right-sided flail chest involving the third to ninth right posterior/lateral ribs

• Comminuted right clavicle fracture (inferior displacement?)

• Significant right-sided pleural effusion

• Collapse of right lower lobe

Describe the abnormality demonstrated.

• Air seen tracking up from the left cardiac border, adjacent to both hila and resulting in subcutaneous emphysema at medial supra-clavicular region

• Continuous diaphragm sign

These findings are indicative of pneumomediastinum.

Describe the abnormality demonstrated.

Continuous diaphragm sign with subdiaphragmatic gas, indicative of a pneumoperitoneum.

Describe the abnormality demonstrated.

• Subcutaneous emphysema over bilateral supraclavicular regions and left chest wall

• Continuous diaphragm sign

• Lucency (air) outlining left cardiac border

Findings consistent with pneumomediastinum.

Describe the abnormality demonstrated (gunshot wound).

• Subcutaneous emphysema over right axillary and right supraclavicular regions

• Two ICCs (one per hemithorax) pointing superiorly, suggesting drainage of fluid from pleural space

• Costochondral separation of bilateral eight, ninth, tenth and eleventh ribs

• Mediastinal shift to the right

• Small left-sided pneumothorax

• Pulmonary consolidation in right mid-zone, likely to be a pulmonary contusion

• Bullet remnant in right axillary region

Describe the abnormality demonstrated.

Consolidation of the right middle lobe, with obscuration of the right cardiac border and right cardiophrenic recess (positive silhouette sign) and air bronchograms.

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Volar plate avulsion fracture of the base of the middle (fifth) phalanx

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Volar plate avulsion fracture of the middle phalanx of the left second phalanx.

Describe the abnormality demonstrated.

Dorsal avulsion fracture of the proximal aspect of the distal phalanx (Mallet deformity)

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Dorsal avulsion fractures of the proximal aspects of the third and fourth distal phalanges

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Radial collateral avulsion fracture of the proximal phalanx of the rightT thumb

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Transverse fracture of the distal radius and dislocation of the distal radio-ulnar joint (Galeazzi)

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Comminuted fracture of the distal radius and widening of the distal radio-ulnar joint (Galeazzi)

Describe the abnormality demonstrated.

Oblique fracture of the proximal ulna and disruption of the radio-capitellar joint (Monteggia?)

Describe the abnormality demonstrated.

Oblique fracture of the mid-shaft ulna and dislocation of the radio-capitellar joint (Monteggia)

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Avulsion of attachment of ulna collateral ligament of proximal phalanx of the right thumb (Skier’s thumb)

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Avulsion of attachment of ulna collateral ligament of proximal phalanx of the thumb (Skier’s thumb)

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Transverse fracture of the neck of the fifth metacarpal with palmar angulation (Boxer’s)

Describe the abnormality demonstrated.

Oblique fracture of the neck of the fifth metacarpal with palmar angulation (Boxer’s). The fracture extends into the fifth MCPJ.

Describe the abnormality demonstrated.

Oblique fracture through the articular surface of the base of the first metacarpal (Bennett’s)

Describe the abnormality demonstrated.

Intra-articular fracture-dislocation of the base of the left first metacarpal (Bennett’s)

Describe the abnormality demonstrated.

Comminuted intra-articular fracture of the base of the first metacarpal (Rolando)

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Comminuted intra-articular fracture of the base of the firts metacarpal (Rolando), and a comminuted mid-shaft fracture of the second metacarpal.

Describe the abnormality demonstrated.

Buckle/Torus fracture of the dorsal aspect of the distal radius

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Buckle/Torus fracture of the dorsal aspect of the distal radius

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Buckle fracture of the anterior aspect of the proximal left tibia

Describe the abnormality demonstrated.

• Fracture through the physis and epiphysis of the base of the proximal first phalanx (SH3)

• Oblique fracture of the head of the proximal first phalanx

• Fracture through the physis and epiphysis of the distal first phalanx (SH3)

Describe the abnormality demonstrated.

Oblique fracture through the physis and epiphysis of the base of the proximal fifth phalanx (SH3)

Describe the abnormality demonstrated.

Oblique undisplaced fracture through the metaphysis, physis and epiphysis of medial aspect of the distal right tibia (SH4). Also widening of the medial mortise.

Describe the abnormality demonstrated.

Transverse fracture through the waist of the left scaphoid.

Describe the abnormality demonstrated.

Fracture of the distal pole of the scaphoid.

Describe the abnormality demonstrated.

Irregular fracture of the dorsal aspect of the right triquetrum

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Avulsion fracture of the dorsal fracture of the right triquetrum. Also incomplete, undisplaced fracture of the volar aspect of the distal right radius.

Describe the abnormality demonstrated.

Dissociation of the right scapholunate joint. Also fracture of the radial aspect of the distal right radius.

Describe the abnormality demonstrated.

Dissociation of the left scapholunate joint.

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Extra-articular fracture of the distal radius with dorsal angulation (Colles)

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Extra-articular fracture of the distal radius, with dorsal angulation (Colles)

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Fracture through the distal radius, with palmar angulation (Smith’s)

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Transverse fracture of the distal radius, with palmar angulation (Smith’s)

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Intra-articular fracture of the distal right radius, with volar displacement and volar radio-carpal dislocation (Reverse Barton’s). Also subluxation of the first metacarpophalangeal joint?

Describe the abnormality demonstrated.

Comminuted intra-articular fracture of the distal radius with volar angulation (Reverse Barton’s)

Describe the abnormality demonstrated.

Dislocation of the lunate with volar displacement. Oblique fracture of the ulnar styloid process.

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Dislocation the right lunate with volar displacement and loss of radiolunate articulation

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Dislocation of the capitate and lunate with dorsal displacement (perilunate dislocation)

Describe the abnormality demonstrated.

Dislocation of the right capitate and right lunate with dorsal displacement and potential fracture of the scaphoid (trans-scaphoid perilunate dislocation)

Describe the abnormality demonstrated.

Blunting of the right costo-phrenic recess (and no air bronchogram sign) indicates a right-sided pleural effusion (meniscus sign).

Describe the abnormality demonstrated.

Blunting of the left costo-phrenic recess and no air bronchogram sign) indicates a left-sided pleural effusion

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Opacity in the anterior mid-zone with presumed right oblique and horizontal fissure encapsulating the collapse of the right middle lobe (?)

Describe the abnormality demonstrated.

Right upper lobe opacification (no air bronchogram sign) with a sharp inferior margin, likely the horizontal fissure displaced superiorly and medially. Some volume loss in the right hemithorax (mediastinal and tracheal shift to the right) in keeping with a right upper lobe collapse.

Describe the abnormality demonstrated.

Loss of definition of the left cardiac border due to opacification in the left upper lobe and elevation of the right hemidiaphragm, in keeping with a left upper lobe collapse.

Describe the abnormality demonstrated.

Diffuse (and ‘fluffy’) bilateral consolidation in keeping with the Batwing sign which suggests pulmonary oedema.

Describe the abnormality demonstrated.

Bilateral perihilar consolidation (Batwing sign) causing loss of visualisation of the right cardiac border and left hemidiaphram (silhouette sign) - pulmonary oedema

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Enlarged, globular cardiac silhouette indicative of a pericardial effusion.

Describe the abnormality demonstrated.

Diffuse perihilar consolidation, enlarged heart, cephalisation of pulmonary vessels bilaterally - suggests congestive heart failure

Describe the abnormality demonstrated.

Enlarged heart, Kerley B lines at both lung bases, left-sided pleural effusion, subtle cephalisation - all in keeping with congestive heart failure

Describe the abnormality demonstrated.

Globular enlargement of heart with well-defined cardiac contour —> pericardial effusion

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Anterior and posterior fat pad sign indicating a joint effusion, likely from a radial neck fracture

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Undisplaced fracture of the radial neck (but no fat pat signs)

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Anterior and posterior fat pad signs, indicating a joint effusion, likely associated with the minimally displaced intra-articular radial head fracture

Describe the abnormality demonstrated.

Intra-articular right radial head fracture

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Minimally displaced supracondylar fracture, with disruption of the anterior cortical margin

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Posterior fat pad sign indicating joint effusion, anterior breach in the cortical margin indicating a supracondylar fracture

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Lucency proximal to the unfused capitellum indicative of a right lateral condyle fracture

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Lucency proximal to the unfused capitellum suggests an undisplaced lateral condyle fracture

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Inferiorly displaced fracture of the medial humeral condyle ossification center (now sitting in line with the coronoid process)

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Oblique fracture of the medial humeral condyle with slight proximal displacement

Describe the abnormality demonstrated.

Subtle undisplaced fracture of the (right) radial neck and disruption of the distal radio-ulnar joint with (at least) distal displacement (Essex-Lopresti fracture-dislocation)

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Mid-shaft fracture of the left clavicle, with inferior displacement (?).

Describe the abnormality demonstrated.

Dislocation of left glenohumeral joint inferiorly and medially on AP indicates an anterior dislocation of the left shoulder

Describe the abnormality demonstrated.

Abnormal contour of the supero-lateral aspect of the left humeral head consistent with a Hills-Sachs defect.

Describe the abnormality demonstrated.

Bony fragment on the inferior surface of the (right) glenoid, consistent with a bony Bankart lesion. Increased opacity on the supero-lateral surface of the (right) humeral head may indicate a Hills-Sachs deformity.