September 2, 2010

Gut ache or Gordian knot?

paraduodenal hernia

A 29 year-old man has recurrent abdominal pain. Can you make the diagnosis where others have failed?

CT Safety and Radiation Risk

Is a cancer epidemic be looming over the horizon? The universality of CT as the investigation du jour, and growing concerns about the risks of radiation.

DeBakey’s Dissection

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A previously well 50 year old presents with sharp severe chest pain after a long haul flight from North America. A chest X-ray and ECG are performed and reveal no abnormalities. The examination is unremarkable. The patient proceeds to a CT chest.

Sternoclavicular Joint Dislocation

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Sternoclavicular dislocation is a relatively uncommon injury that can be easily missed or misdiagnosed. The importance in determining the direction of dislocation is emphasised by the dichotomy of management. Hence, a thorough history and examination, especially looking for evidence of compression of retrosternal structures, is paramount. Specialised sternoclavicular X-ray views should be supplemented by CT/MRI if clinical suspicion is high. Posterior dislocations necessitate prompt orthopedic referral.

Gastrointestinal Gutwrencher 001

GI gutwrencher #001

A 50 year-old man presented to the ED with sharp abdominal pain localised to his left lower quadrant.

Radiological Oddity #019

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Radiological Oddity #019 – What the?

ENT Equivocation #001

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A 38 year old male with a background history of type 2 diabetes presents with fevers, rigors and pain on swallowing. There is no sign of impending airway compromise; however, marked trismus is noted. The following plain X-ray is obtained:

AAA rupture and rhabdomyolysis

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Consider a 65-year-old male presenting with flank pain radiating to the groin. The following CT scan was taken to confirm a presumed diagnosis of renal colic

Broken-hearted chest drain

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This 86 year old male presented with shortness of breath. He developed a complication after insertion of a left chest drain.

This CT scan demonstrates that complication

Trauma Tribulation 003

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A 27 year-old male was involved in head on collision at high speed. He was GCS 8 at the scene.

Not just a pulmonary embolism…

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A classic respiratory case. This 25 year old female presented with worsening breathless. She has no previous medical problems.

Neurological Mind-boggler 001

CT #2

Consider a 45 year-old HIV positive male with right hemiparesis and fluctuating conscious state. His CT head is shown below.

Quiz Radiology 021

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A head CT scan of an 83 year old woman has been performed, who has presented with a 3 day history of increasing confusion and unsteady gait following a fall. Her GCS is 12 (M5, V3, E4).

Quiz Radiology 020

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An 45 year old man presents to your emergency department with vertigo and ataxia.

Quiz Radiology 016

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A 72 year old man undergoes this investigation in your emergency department after his presentation with a first ever generalised seizure. He has normal vital signs and no focal neurological signs on examination. A CT head scan with a ring enhancing left sided lesion is shown.

Quiz Trauma 010

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A 19 year old football player presents to the emergency department complaining of abdominal pain following a tackle during a match 5 days previously. A CT scan has been performed.

Quiz Radiology 013

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A 48 year old man presents to your emergency department via ambulance following a syncopal episode. He is confused with a GCS of 12 (M – 5, V – 4, E – 3). His observations, otherwise, are within normal limits. He has had a CT scan of his head performed.

Quiz Paediatrics 007

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A 4 year old boy arrives at your urban district emergency department one hour after falling from a playground slide. He opens his eyes to speech, uses inappropriate words and obeys commands (GCS 12).

Radiology Oddity #016

Abdominal CT scan

It is another busy night in ED. The ‘Bat-Phone’ rings, gently pricking the ear to attention in anticipation of the next code…

We are bringing in a 60 year old lady with profuse diaphoresis, hypotensive with a systolic of 70 and altered conscious state…

Radiology Oddity 004

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Plombage: Treatment with Lucite balls – an early treatment for tuberculosis