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Fellowship ExamX-Rays

XRays

23/01/2023

Question

1. A 72 yo male presents with abdominal pain and some vomiting.
His PMHx includes AF, HT and AMI. He is on Aspirin and Amlodipine.
What does this Abdo XR show?
Name 3 causes:

Answer

Question

A 68 yo male presents with abdominal distension and vomiting.
You perform an Xray, in the middle of the night.
What is the diagnosis?
What part of the bowel is probably involved?

Answer

Question

A 60 yo woman presents with increased shortness of breath. What does the Xray show?
All X-rays are taken from the European Society of Radiology
What is the answer?
(a) Right Pleural Effusion
(b) Left Pleural Effusion
(c) Bilateral Pleural effusions R>L
(d) Bilateral Pleural Effusions L>R

Answer

(d)- look at the gastric bubble. The Xray has been labelled incorrectly i.e. wrong side shown.

Question

A patient presents with trauma to the wrist and wrist pain. You do an x-ray. What do you think?

Answer

The typical case is a patient presents with trauma to the wrist and wrist pain. You do an x-ray. What do you think?This is a Scapholunate dissociation, also called rotatory subluxation of the scaphoid and sometimes knows as the Terry Thomas sign. It is a disruption of the scapholunate ligament with resultant instability. The cause is usually trauma and the complication is degenerative arthritis of the joint. The x-ray of the wrist will demonstrate a widened scapholunate space, usually greater than 4mm. This is best seen on a clenched fist view.
Image from www.radiopaedia.com
The scapholunate ligament is U shaped and divided into three compartments. A complete fear of the dorsal part, results in dissociation.This is known as the Terry Thomas Sign for obvious reasons.

Treatment is by surgical repair. If this isn’t repaired there Is a migration of the capitate between scaphoid and lunate which results in longer term degenerative disease.

Question

This 5 yo child fell in the playground and is now complaining of a painful elbow.

Answer

Anterior fat pad sign or ‘sail sign’, plus there is a posterior fat pad sign.There is elevation of the anterior fat pad which indicates an elbow joint effusion.
The anterior fat pad is usually concealed within the coronoid fossa or seen paralleling the anterior humeral line. When there is a joint effusion, the anterior fat pad (which is intra-articular, but extra-synovial) becomes elevated.
In adults: the fracture is usually of the radial head.
In children: it is usually a supracondylar fracture.
Where a fat pad is raised and no fracture is demonstrated, an occult fracture should be suspected.

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