Shift of heart

and trachea to
left

Complete rightsided
pneumothorax
Lung is
compressed
against
mediastinum

Tension pneumothorax

Streaky, linear
densities due
to air in the
mediastinum

Streaky, linear
densities due
to air in the
mediastinum

Pneumomediastinum

Air
surrounding
esophagus in
mediastinum

Pneumomediastinum CT scan

Extraluminal
contrast from
perforation
along left
lateral wall of
distal
esophagus

Air outlines
under surface of
right
hemidiaphragm

Air outlines
under surface of
left
hemidiaphragm

Pneumoperitoneum

Air outlines both

sides of the wall
of the stomach-a
sign of free air in
the peritoneal
cavity

Pneumoperitoneum

Free air

Free air

CT scans on 2 different people show a small and large amount of free air in the
peritoneal cavity which rises to the highest point (anterior abdomen with the
person lying on their back) and is not contained within bowel

Pneumoperitoneum - CT

Effect of Position - Layering

Supine

Erect

In the supine position, the fluid layers out posteriorly and produces a
haziness, especially near the bases (since the patient is actually semirecumbent). In the erect position, the fluid falls even more to the bases.

Size (not
number) of
vessels at the
apex exceeds
size of vessels
at the base in
this upright
person. This is
called
cephalization.
Normally the
vessels at the
base exceed the
size of the
vessels at the
apex

Pulmonary Venous Hypertension from Mitral Stenosis

Pulmonary interstitial edema produced by Kerly A and C lines

Pulmonary Interstitial Edema

Bilateral,
diffuse
airspace
disease more
marked
centrally than
at the
periphery of
the lung
(bat-wing
appearance)

Pulmonary Alveolar Edema

Linear lucency
in the contrastfilled
descending
aorta is the
intimal flap of an
aortic dissection

Aortic Dissection

 Widened
mediastinum
Left pleural effusion
Chest pain
Should make you think
of an aortic dissection

Aortic Dissection

Classification of Dissecting Aneurysms

Widened mediastinum
Left pleural effusion
Chest pain

Stanford classification

Red arrows
point to active
extravasation of
contrast from
the aorta into
the
retroperitoneum

Red arrows
point to active
extravasation of
contrast from
the aorta into
the
retroperitoneum

Aorta
Aorta

Thrombus inside
the lumen of the
aorta

Aortic rupture

Ruptured Aortic Aneurysm

Enlargement of abdominal aorta > 3cm

Usually 2 to atherosclerosis

Below renals, above iliacs

About 20-25% rupture

<4cm~10%; >10 cm~60%

Retroperitoneal, usually on left

Into GI tract: massive hemorrhage

Into IVC: rapid cardiac decompensation

Heart and
trachea are
displaced to
right by bowel in
opposite
hemithorax

Left hemithorax
contains
multiple
lucencies--air in
the lumen of
bowel, now
located in the
chest

Diaphragmatic Rupture

Diaphragmatic Rupture
General

5% of all diaphragmatic hernias

Most (90%) are left-sided

Central and posterior >10cm in length

Contain stomach, colon, small bowel,
omentum, spleen

Half have no initial abnormal

radiographic findings
Half are missed clinically

36 year-old with acute abdominal pain. Why?

Multiple air-containing
and dilated loops of
small bowel

Multiple airfluid levels

in small
bowel

No gas in rectosigmoid

Small Bowel Obstruction

Obstructed,
dilated sigmoid
has a coffeebean shape

Sigmoid twists
around this
point

Sigmoid Volvulus

Dilated loop in
LUQ is cecum
which has
twisted on itself

Dilated loops of
small bowel
from small
bowel
obstruction at
ileocecal valve

Cecal Volvulus

Cecum twists at
this point
producing
Birds-Beak
sign

Sigmoid Volvulus Barium Enema

74 year-old with change of bowel habits

Dilated large bowel

Barium enema
shows annular
constricting
carcinoma of
sigmoid
producing
obstruction

Dilated loops of
large bowel with
abrupt cut-off in
sigmoid

Large bowel obstruction Sigmoid carcinoma

Rectum

Ascites is
lower in
attenuation
than
adjacent,
contrastenhanced
liver

Ascites

Ascites

Massive ascites (red

arrows) in a patient
with a pseudocyst of
the pancreas (green
arrow)

R3

Massive ascites on CT

R3

Tip of central venous catheter coils back on itself in right

brachiocephalic vein (red arrow).

Tip of endotracheal tube is in right mainstem bronchus (red

arrow) leading to atelectasis of the right upper lobe and entire
left lung

Crescentic area
of increased
attenuation on
non contrastenhanced CT
with convexity
toward brain is
characteristic of
an epidural
hematoma

Traumatic intracranial hemorrhage

Epidural Hematoma

Crescentic low
attenuation
lesion at
periphery of
brain containing
a fluid-fluid level
from blood

Traumatic intracranial hemorrhage

Subdural hematoma

Intraparenchymal
hemorrhage

Traumatic intracranial hemorrhage

Intraparenchymal hemorrhage

R3

R3

Acute hemorrhage in the basilar cisterns (red arrows) and Sylvian fissures
(green arrows) in two patients with ruptured aneurysms

Subarachnoid hemorrhage from ruptured aneurysm

Markedly
enlarged
frontal horns

Colloid Cyst
obstructing
third
ventricle

Choroid
plexus
(normal)
R3

Colloid Cyst of 3rd ventricle producing obstructive

hydrocephalus

Lateral
ventricles
anterior and
posterior
horns

Large mass
represents a
choroid
plexus
papilloma

R3

Hydrocephalus from Choroid Plexus Papilloma

Lateral
ventricles
anterior and
posterior
horns

Hydrocephalus from Cerebral Atrophy

58 year-old woman with breast cancer and headache

Spinolaminar
white line of C2
does not align
with other
vertebral bodies

Fracture through
posterior
elements of C2

Fracture of C2 - Hangmans Fracture

Forward
displacement of
the body of C2
(red arrows)

Hangmans Fracture

Most common fracture of C2

Most common cervical spine fracture

Hyperextension/compression fracture
Fractures through the pedicles of C2 with
anterior slip of C2 on C3
Not associated with neuro deficit

The inferior
articular facet of
C5 (red arrow) has
slipped forward
and lies anterior to
the superior
articular facet of
C6 (green arrow)
a condition
known as a
locked facet

Locked facets

C5
C6

Fractures of the
metaphysis (red
arrow) and
epiphysis (green
arrow) (SalterHarris IV) extend
into joint

Fracture of
radial styloid
(yellow arrows)
extends into
wrist joint5

Fractures extending into joints

Fracture of
radial head

Posterior fatpad sign

indicates fluid
in the joint

Fracture of the radial head with traumatic joint effusion

Humeral head
(red arrow) lies
inferior to the
coracoid
process of the
scapula (green
arrow)

Humeral head
(red arrow) lies
inferior to the
glenoid fossa
of the scapula
(yellow arrow)

Humeral head
(red arrow) lies
inferior to the
coracoid
process of the
scapula (green
arrow) and
anterior to the
glenoid (yellow
oval)

Anterior Dislocation of the Shoulder

Humeral head
(red arrow) lies
posterior to the
glenoid fossa
of the humerus
(yellow arrow)

Humeral head
(red arrow) lies
beneath the
acromion
process of the
scapula (green
arrow) and
posterior to
glenoid (yellow
oval)

Humeral head
(red arrow)
assumes the
shape of a
lightbulb
because it is
fixed in
internal
rotation

Posterior Dislocation of the Shoulder