Title: Clinical Radiology Made Ridiculously Simple Views: Favorites: Formats: pdf | epub | djvu | audio | kindle avg rating: /10 - (04 ratings). ISBN Clinical Radiology Made Ridiculously Simple - dokument [*. pdf] Clinical Radiology made ridiculously simple Hugue Ouellette, M.D. Patrice. In summary, Clinical Radiology Made Ridiculou. Download PDF Clinical MedMaster Inc. Radiology Made Ridiculously Simple, June by Ouellette and.
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The strengths of this text lie mainly in its back-to-basics approach. There are three main aspects of this book that should make it attractive to medical students. First, it is a simple text in terms of its general approach and assumed prior knowledge base, which is useful for those who either slept through or were overwhelmed by the breadth of knowledge presented in some radiology lectures. Second, it is brief, which is important since students are required to master knowledge in many fields of medicine, and hence do not have significant time to devote intense study to single areas.
Clinical Radiology Made Ridiculously Simple is only pages in length and can be read thoroughly in one weekend. The text, however, has some significant problems that must be University of Toronto Medical Journal mentioned.
Most notably, it lacks comprehensiveness because of its simple approach. There is little insight offered into any illnesses other than the most common. Second and less important is the issue of portability. While this book is short, not bulky, and can easily fit into a backpack, at 8. In summary, Clinical Radiology Made Ridiculously Simple is an excellent book for the medical student who is learning to read Xrays. Bones are brighter structures because they are composed of calcium.
Experiment 2: Put your finger near your desk.
Notice how sharp the shadow is. Now move the finger away from your desk toward the light. Notice how the shadow be- comes bigger and more blurred. Similarly, the closer an ob- ject is to the film, the sharper the borders are. The farther away from the film it is, the more magnified and fuzzy is the shadow of the object. Experiment 3: Put your index fingers one against the other and observe the shadow they cast. The bor- 1 der between them cannot be seen. Therefore, when two struc- tures of the same density are in anatomical contact with each other, the border between them cannot be seen.
For example, if pneumonia fluid density is affecting the lung adjacent to the heart also fluid density , the border or silhouette of the heart will not be seen. CT scan and MRI Imagine now that while you are doing the above experi- ments, the lamp and the desk start spinning rapidly around your finger.
This situation is analogous to a CT scan Com- puted Tomography. The x-ray tube and the detector spin rapidly around the patient. Information is transferred to a computer and multiple images are reconstructed. CT images give the impression of looking at cross-sectional slices of the patient. No x-rays are used. General approach Although there is a specific approach to each radio- graphic examination, the following principles hold true for all of them.
Labels There is nothing more embarrassing than making the right diagnosis on the wrong patient. One must always look at the label for the proper identification of the patient. Previous exams If possible, have a previous exam for comparison.
This is extremely important to determine if a problem is chronic old or acute new. Plain x-ray film I I. General approach A. Labels B. Previous exams C. Quality of the film D. Don't quit! Quality of the film A good quality film can really improve the precision of a diagnosis.
A film should not be too dark over exposed; Fig. Key concept. The five ra- diographic densities are in order of increasing brightness: Air, 2. Fat, 3. Fluid, 4. Bone, 5. Over exposed film. The long ex- posure time results in a much darker film.
The border between air and fat is lost. Chest Radiograph I. Radiographic anatomy A. Basic views 1. Posteroanterior view PA view Remember that the closer an object is to the film, the sharper are the borders. The further away it is from the film, the more magnified and fuzzy is the shadow of the object The Basics; experiment 2.
Most of the important structures in the chest such as the heart and great vessels are located an- teriorly. Therefore it is not surprising that the best way to take a chest radiograph is with the patient's front against the film.
The X-ray is shot from the patient's back and is therefore 4 called the posteroanterior view or PA view. On such a film, the heart size is minimally magnified and the heart borders are sharp Fig. In this case, a lower quality AP view is taken.
A film is placed under the patient's back and an X-ray is shot through the patient from the front. In this view, the heart is farther from the film. Therefore, it appears larger than it re- ally is and its borders are fuzzier, just like the finger in our experiment The Basics; experiment 2 , I. Basic views B.
Mediastinum C. Chest wall E. Diaphragm II. Approach A. Basics B. Specific signs C. Lung disease patterns Ill. Specific problems A. Mediastinum 1. Aortic laceration 2. Pneumomediastinum 3. Enlarged cardiac silhouette B. Too white!
Pneumonia b. Too black! Rib fracture 2. Subcutaneous emphysema D. Diaphragm 1. Rupture of the diaphragm 2. Hiatus hernia A d. This fluid collection may be serous fluid pleural effusion , blood hemothorax , or pus empyema.
In the case of empyema, there may be small bubbles of air in the pus. On an upright PA film, fluid collects in the lateral costophrenic angle due to gravity, giving it a blunted ap- pearance Fig. The posterior costophrenic angle is the deepest, and fluid collects there first.
This angle is hidden by the dome of the diaphragm on a PA view. However, it is well seen on the lateral view Fig. For this reason, the upright lateral view is superior to the PA for demonstrating small amounts of pleural fluid. When patients are too sick to have an upright PA view of the chest, then an AP supine view is taken. Recall that pa- tients in this view are lying on their back. If an effusion is present, it will layer between the posterior chest wall and the lung due to gravity.
When in doubt, order a decubitus view with the patient ly- ing down on the side of the suspected effusion. This will bring the fluid between the lung and the chest wall where it is easy to see Fig.
Sometimes the parietal and visceral pleura are stuck to each other adhesion. In this situation, a pleural effusion may not be able to move when the patient changes position. The fluid may even be stuck in one of the fissures mimick- ing the appearance of a lung mass pseudo-tumor. Immobile pleural fluid is called a loculated effusion. Congestive heart failure CHF CHF occurs when the heart becomes unable to pump out the same amount of blood that it is receiving.
The heart be- comes enlarged cardiomegaly. When there is left ventricu- lar failure, fluid backs up in the pulmonary veins and lung. Fluid seeps out into the interstitium first and then eventually into the alveoli and pleural space.
Left pleural effusion. PA chest radiograph demonstrat- ing fluid f in the left costophrenic angle. Lateral chest radiograph demonstrating fluid around the left lower lobe and in the left oblique fis- sure black arrow heads. Left lat- eral decubitus view of the chest demonstrating fluid between the chest wall and the left lung black ar- row heads. Vascular redistribution: Congestive heart failure CHF.
Common find- ings in CHF on a chest radiograph are vascular redistribution, Kerly B lines, peribronchial cuffing, pleural effusions and a batwing dis- tribution of air space disease.
PA chest radiograph demonstrat- ing a typical batwing distribution of air space disease. Chronic lung disease honeycomb pattern. Mag- nified view of a PA chest radiograph demonstrating an honeycomb pattern representing lung scarring. This is obviously an emergency, which requires immedi- ate pressure relief e.
Emphysema Emphysema is caused by chronic airway obstruction re- sulting in destruction of alveoli. Lungs contain more air than 2. Interstitial pattern and Kerly B lines 3. Peribrochial cuffing: Pleural effusions 5. Batwing pattern symmetrical air space disease in the lung adja- cent to the hila f. Chronic interstitial lung disease A discussion of chronic lung diseases is beyond the scope of this book. Remember that if an abnormal white area has not changed compared to a remote previous exam, there is likely chronic lung disease.
Also, remember that the honey comb pat- tern previously discussed is suggestive of scarring Fig. If the lesion measures less than 3 cm, it is called a nodule. If it is larger than 3 cm, it is called a mass. Primary lung cancers tend to have ill-defined, spicu- lated borders, and grow over time.
Metastases tend to produce multiple smooth round lung nodules, often of vari- able size. Benign lesions tend to be small, well defined, smooth, round and maybe calcified. They usually are stable in size when compared to prior films. Remem- ber that air has a tendency to rise to the highest point in the chest contrary to fluid. In an upright PA film, look for a black crescent over the apex of the lung.
In addition, the visceral pleura is often seen as a thin white line under the black crescent, since it is flanked by air on each side Fig. One should not be able to see branching white blood vessels peripheral to this line. Taking a film during expiration often makes a pneumo- thorax more visible, because the amount of pleural air re- mains the same although the lungs become smaller.
On a supine AP, the air rises to the anterior and lateral costophrenic angles sulci. This is no surprise since they are the highest region in the pleural cavity when the patient is ly- ing down. This makes the lateral sulcus look abnormally dark and deep i.
In the case of tension pneumothorax, a lung injury causing leakage of air into the pleural space may form a one-way valve. This valve lets air escape into the pleural cavity during inspiration only. With every breath the pa- tient takes, more air seeps into the pleural cavity, and becomes trapped. Pneumothorax and tension pneumothorax.