Tag Archive | xray

SALTR – a useful memonic to help remember the five types…

SALTR – a useful memonic to help remember the five types of growth plate fracture (Salter-Harris classification). Fortunately the order also directly relates to prognosis from best to worse.

  • S – slipped = type I
  • A – above = type II
  • L – lower = type III
  • T – through or transverse or together = type IV
  • R – ruined or rammed = type V

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QUIZ: Six elbows from six different patients. Can you identify…

QUIZ: Six elbows from six different patients. Can you identify which of them have joint effusions? Click for ANSWER

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Scotty dog sign – refers to the normal appearance of the lumbar…

Scotty dog sign – refers to the normal appearance of the lumbar spine posterior elements when seen on oblique views:

  • the transverse process being the nose
  • the pedicle forming the eye
  • the inferior articular facet being the front leg
  • the superior articular facet representing the ear
  • the pars interarticularis (the lamina between the facets) equivalent to the neck.

If a spondylolysis is present, the pars interarticularis will have a defect and look like the Scotty dog has a collar – or doggy decapitation for those with a bloodier imagination!

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QUIZ: 12yo boy who fell whilst playing football. Can you spot…

QUIZ: 12yo boy who fell whilst playing football. Can you spot the important injury? Click for ANSWER.

HINT: Our CRITOE post from a few weeks ago may come in handy. Skip video to 3:32 for discussion of this specific case.

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QUIZ: 8 month old boy with 10 day history of wrist swelling….

QUIZ: 8 month old boy with 10 day history of wrist swelling. What is the ‘not-to-be-missed’ diagnosis? Click for ANSWER

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Arcuate sign – a subtle but important avulsion fracture of the…

Arcuate sign – a subtle but important avulsion fracture of the proximal fibula at the site of arcuate ligament complex insertion. It is associated with cruciate ligament injury in around 90% of cases and represents an unstable posterolateral corner injury. When detected, the arcuate sign should prompt further evaluation with MRI and referral to an orthopaedic surgeon. 

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Pneumoretroperitoneum – presence of gas within…

Pneumoretroperitoneum – presence of gas within the retroperitoneal space. Typically the air outlines structures like the kidneys, psoas muscles and retroperitoneal portions of the bowel (duodenum, ascending colon, descending colon and rectum). It is almost always due to perforation of a hollow retroperitoneal viscus such as may occur in duodenal ulcer disease, abdominal trauma, diverticulitis, ischemic colitis, colorectal cancer and following endoscopy. Residual air from urological or spinal surgery is another possible cause.

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Lead pipe sign – describes the rigid and featureless appearance…

Lead pipe sign – describes the rigid and featureless appearance of the colon in chronic ulcerative colitis. The sign is due to a complete loss of haustral markings and usually a degree of uniform luminal narrowing due to chronic bowel wall thickening. It is classically described on barium enema studies however it is also often seen with CT, MRI and plain radiography. 

CLEUDO summary: ULCERATIVE COLITIS in the COLON with the LEAD PIPE 

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Football sign – of massive pneumoperitoneum on a supine…

Football sign – of massive pneumoperitoneum on a supine abdominal radiograph. Normally the margins of the abdominal cavity are only faintly visible due to the density difference between intraperitoneal fat and the abdominal wall. However in the setting of pneumoperitoneum, air makes the outline of the distended abdominal cavity extremely distinct and somewhat football-shaped. Sometimes the falciform ligament is outlined centrally like the football’s seam. The sign is most frequently seen in infants with advanced necrotising enterocolitis (as was the case above) but may be seen with any cause of free gas. 

Update: Aussie rules football Grand Final 29 September 2012. GO HAWKS!

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