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Ant. Cruciate
ligament
Ant. Cruciate
ligament
Post. Cruciate
ligament
Mx :
Rest
Ice
Compression
Elevation
Exercise
Operation vs Non op
-Pt, high deman, good ROM, done
endoscopically
Acute splint& crutches
-early active ROM
-Closed chain WB to strengthen Non
operative
-avoid high risk
-Fx bracing controversial
The two herniated discs (L4/5 & L5/S1) are "black" on this MRI
image,
which indicates disc desiccation (lack of water and proteoglycan)
and is
termed "degenerative disc disease" (DDD); this is usually a
precursor to
disc herniation for it weakens the annulus that contains the
pressurized
and irritative nuclear material.
Aortic dissection is one of the acute aortic syndromes and a type of arterial
dissection. It occurs when blood enters the
medial layer of the aortic wall through a tear or penetrating ulcer in the intima
and tracks along the media, forming a
second blood-filled channel within the wall.
Clinical presentation
Aortic dissection is arbitrarily divided into :
acute: with 14 days of first symptom onset
chronic: after 14 days
Post contrast CT (CTA preferably) gives excellent detail. Findings include 1-3,5:
intimal flap
double lumen
dilatation of aorta
complications (see below)
an atypical variant that may be seen is aortic intramural haematoma.
Treatment and prognosis
aggressive blood pressure control
immediate surgical repair (for type A dissection or complicated type B
dissection)
- Features a) Atrophy of
right lobe of liver
b) Large lobe
of caudate
c)Splenomegaly
d) Ascites
e) collateral
vessels
1. a) Name the imaging modality Axial of CT Abdomen
b) What structure
A = Ascites
B = Gall bladder
C = Inferior vena cava
D = Spleen
c) Diagnosis Cirrhosis of liver
d) Two causes
- Alcohol
- Hepatitis
Mass
Indenting
at the right
margin of
uterus
Hystero salpingogram
-Non ionic contrast, 10-15 ml max
-To check for tubal patency
-After menses, Day 5 to Day 6 because
must be sure that she is not pregnant
-Take hx allergy, if allergy, give low
dose steroids
- to confirm not pregnant, UPT
Step for hystero- salpingogram
1.
2.
3.
4.
5.
Contraindication
Recent tubal surgery
Active pelvic infection
Complication
Per vaginal spotting
Venous extravasation
Rare : pelvic infection, contrast reaction
Tubal polyp
Hydrosalpinx (air dlm salpingo)
a.
N
b.
c.
d.
e.
Cx, pancreatitis
PYLORIC STENOSIS
o
o
o
o
o
o
DUODENAL ATRESIA
DUODENAL ATRESIA
LOCATION .
[1] Usually distal to ampulla of Vater . 80%
[2]proximal duodenum 20%
Radiology :
Double bubble sign = gas/fluid levels in
duodenal bulb and gastric fundus .
Total absence of intestinal gas in small /
large bowel .
Obs / [ detected after 24 weeks gestation ]
Double bubble sign
Increased gastric peristalsis
Polyhydramnios 100 % .
Imaging findings
Acute disease most commonly affects the
terminal ileum
Plain film of the abdomen remains method in
which disease is diagnosed most often
Findings include
o Dilated loops of bowel
o Thickened bowel walls
Fixed and dilated loop that persists is especially
worrisome
o Absence of bowel gas
o Pneumatosis intestinalis
Pathognomonic of NEC in newborn
Linear radiolucency parallels bowel lumen within
bowel wall
Represents air that has entered from the lumen
o Abdominal free air
hepatomegaly
Pathology
Aetiology
It is thought to result from idiopathic destructive inflammatory process
which leads to fibrotic remnants at porta hepatis.
Associations
In 10% of cases, there is an association
with polysplenia and heterotaxy syndrome 6.
Classification
Kasai classification is used to classify the three main anatomical types
of biliary atresia.
Radiographic features
Longitudinal
Longitudinal grayscale image of right upper quadrant
performed after 3 hours of fasting shows a diminutive
gallbladder measuring 17 mm in length and 2.5 mm in width.
The gallbladder has a multiseptated look and subtly thickened
wall.
Kasai portoenterostomy
liver transplantation
Complications
Longitudinal
Longitudinal grayscale image of right
upper quadrant performed after 3
hours of fasting shows a diminutive
gallbladder measuring 17 mm in
length and 2.5 mm in width. The
gallbladder has a multiseptated look
and subtly thickened wall.
portal hypertension
Differential diagnosis
General imaging differential considerations include
neonatal hepatitis
Alagille syndrome
Caroli disease
Epidemiology
In 2001 an estimated 903,000 children were victims of
maltreatment including:
neglect: 57%
psychological maltreatment: 7%
medical neglect: 2%
Clinical features
A number of features have been recognised as
suspicious:
retinal haemorrhage
torn frenulum
Specific fractures
A number of fractures have been recognised as highly
specific to non-accidental injury (rather than accidental
injury). They include:
rib fractures
o
especially posterior ribs
o
may have no overlying bruising
o
although anterior rib fractures can
occasionally be caused by vigorous CPR,
posterior rib fractures do not occur
o
costochondral junction injuries and/or
fractures
scapular fractures
sternal fractures
Dating injuries
The ability to date injuries is critical for medicolegal
purposes, and thus must be done carefully (please refer
to specialist text for specific guidelines).
Traumatic periosteal injury can be seen up to 7 days
post injury (and therefore can be used for dating). This
can be seen on diaphyseal and rib injuries. Diaphyseal
injuries start healing at 1 week. Healing should be
complete by 12 weeks. Rib fractures are easily missed
so current practice is to repeat chest films in 2 weeks to
observe for any healing rib fractures.
Metaphyseal (and costochondral junction) injuries do
not heal with periosteal reaction and if visible are less
than 4 weeks old. Skull fractures also do not heal with
periosteal reaction and if seen are less than 2 weeks
old.
Radiographic features
Skeletal injuries
Skeletal survey is performed in cases of suspected
abuse to assess and document the extent of previous
skeletal injuries. The so-called babygram is not an
acceptable substitute.
Bone scans are also able to detect radiographically
occult fractures and should be considered when clinical
suspicion is high.
A typical skeletal survey comprises plain films of the
following:
chest x-ray
abdominal x-ray
left/right AP humeri
left/right AP forearm
left/right AP hand
left/right AP femora
left/right AP tibia/fibula
Practical points
skeletal dysplasias: one of the major, albeit
uncommon, pitfalls in diagnosing NAI (e.g Schmidtype metaphyseal chondrodysplasia, osteogenesis
imperfecta I and IV), which may lack the florid
features of full blown disease and can be easily
confused with NAI
o
features to differentiate osteogenesis
imperfecta from NAI include:
presence of osteopenia
bowing/remodelling of bones
rickets
Intracranial injuries
A subdural haemorrhage in a child should be viewed
with suspicion. On occasion, the subdurals will
demonstrate varying ages.
Figure 2. Case
2. A, T1-
weighted
shows high
signal intensity
restricted mainly in the right putamen. B, T2weighted image shows no difference in appearance from the unaffected side.
MRI