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Examples

• Sample
• Answer

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Circulation: Dissection

Stanford type A aortic dissection. Flap extends cranially into the common trunk of the innominate/left common carotid arteries and proximal right subclavian artery. Caudally, extends to the abdominal aorta below the level of the superior mesenteric artery.

• Sample
• Answer

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Circulation: Penetrating Atherosclerotic Ulcer

Penetrating atherosclerotic ulcer of the ascending aorta with mediastinal hematoma and compression of the pulmonary artery.
Case courtesy of Dr Jens Christian Fischer, Radiopaedia.org. From the case rID: 12810

• Sample
• Answer

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Circulation: Intramural Hematoma

Intramural hematoma surrounding aortic root and ascending aorta with small hemopericardium.
Case courtesy of Dr David Preston, Radiopaedia.org. From the case rID: 27746

• Sample
• Answer

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Circulation: Filling Defects

Extensive bilateral pulmonary emboli involving nearly all branches distal to left/right main pulmonary arteries.

• Sample
• Answer

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Circulation: Complications

Saddle pulmonary embolism with pulmonary artery dilation and flattening of the interventricular septum suggestive of right ventricular strain.

• Sample
• Answer

Breathing: Pleura

Pneumothorax

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CT Abdomen/Pelvis Infographic PDF 2564 downloads 7.04 MB

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CT Head Infographic PDF 1912 downloads 3.51 MB

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As with the approach detailed previously for imaging of the abdomen and pelvis, a similar structured method for interpretation of head imaging exists and follows the mnemonic “Blood Can Be Very Bad”.

Normal Neuroanatomy

Blood: Blood

Density

Acute: hyperdense (50-100HU)

1-2wks: isodense with brain

2-3wks: hypodense with brain

Types/Locations

Intraparenchymal Hemorrhage/Contusions

Sudden deceleration of the head causes the brain to impact on bony prominences (e.g., temporal, frontal, occipital poles).

Non-traumatic hemorrhagic lesions seen more frequently in elderly and located in basal ganglia.

Intraventricular Hemorrhage

White density in otherwise black ventricular spaces, can lead to obstructive hydrocephalus and elevated ICP.

Associated with worse prognosis in trauma.

Subarachnoid Hemorrhage

Hemorrhage into subarachnoid space usually filled with CSF (cistern, brain convexity).

Extracranial Hemorrhage

Presence of significant extracranial blood or soft-tissue swelling should point examiner to evaluation of underlying brain parenchyma, opposing brain parenchyma (for contrecoup injuries) and underlying bone for identification of fractures.

Can: Cisterns

Evaluating the cisterns is important for the identification of increased intracranial pressures (assessed by effacement of spaces) and presence of subarachnoid blood.

• Circummesencephalic: CSF ring around midbrain and most sensitive marker for elevated ICP
• Suprasellar: Star-shaped space above the sella
• Quadrigeminal: W-shaped space at the top of the midbrain
• Sylvian: Bilateral space between temporal/frontal lobes

Be: Brain

Evaluate the brain parenchyma, including an assessment of symmetry of the gyri/sulci pattern, midline shift, and a clear gray-white differentiation.

Very: Ventricles

Evaluate the ventricles for dilation or compression. Compare the ventricle size to the size of cisterns, large ventricles with normal/compressed cisterns and sulcal spaces suggests obstruction.

Bad: Bone

Switch to bone windows to evaluate for fracture. The identification of small, linear, non-depressed skull fractures may be difficult to identify as they are often confused with sutures – surrogates include pneumocephalus, and abnormal aeration of mastoid air cells and sinuses. The Presence of fractures increases the suspicion for intracranial injury, search adjacent and opposing parenchyma and extra-axial spaces.

Example #1

Example #2

Example #3

References

1. Perron A. How to read a head CT scan. Emergency Medicine. 2008.
2. Arhami Dolatabadi A, Baratloo A, Rouhipour A, et al. Interpretation of Computed Tomography of the Head: Emergency Physicians versus Radiologists. Trauma Mon. 2013;18(2):86–89. doi:10.5812/traumamon.12023.

The post CT Interpretation: Head appeared first on Differential Diagnosis of.

Aorta Down

Thoracic Aorta

Start with the descending thoracic aorta

Abdominal Aorta

Follow the abdominal aorta down including its branches (celiac, SMA, paired renal arteries, IMA)

Aortic Bifurcation

Continue to the bifurcation of the abdominal aorta to the left and right common iliac arteries

Veins Up

Femoral Veins

Start with the left and right femoral veins

Inferior Vena Cava

Follow the inferior vena cava up

Infrahepatic IVC

The inferior vena cava gains contrast from the renal veins

Right Atrium

The inferior vena cava empties into the right atrium

Solid Organs Down

Heart and Pericardium

Evaluate for the presence of a pericardial effusion or cardiomegaly

Spleen

Heterogenous contrast-enhancement is normal

Pancreas

The tail of the pancreas lies in the hilum of the spleen

Liver

Evaluate the intrahepatic bile ducts for dilation or pneumobilia, portal venous system for gas, and liver parenchyma for vascular abnormalities or abscesses

Gallbladder

Evaluate for radioopaque stones, pericholecystic fluid or surrounding fat stranding

Adrenal

A wishbone-shaped structure superior to the kidneys

Kidney and Ureter

Evaluate for hydronephrosis or hydroureter

Bladder

Continue down into the pelvis; in a female patient the evaluation should include the uterus and adnexa

Rectum Up

Rectum

Having reached the inferior-most portion of the image following solid organs, move upward again from the rectum

Sigmoid

Evaluate the sigmoid colon for diverticulitis

Transverse

Continue following the sigmoid colon up the descending colon to the transverse colon and the hepatic flexure

Cecum

Continue down the ascending colon to the cecum

Appendix

At the cecum, attempt to identify a small tubular structure (the appendix) - evaluate for periappendiceal fat stranding, perforation or abscess

Esophagus Down

Esophagus

Start at the esophagus, evaluate for perforation or hernia

Stomach

Continue to the stomach and duodenum

Small Bowel

Evaluate the small bowel for obstruction (dilation, air-fluid levels)

Tissue-specific Windows

Lung Window

Switch to lung window to evaluate the lung parenchyma and continue through the abdomen to identify intraperitoneal free air

Bone Window

Use the bone window to identify fractures or lytic lesions

Try It Yourself

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