1. Emergency Radiology in
Surgery
Dr. Upendra Bhardwaj
R.S.O. Surgery
G.R.M.C.
Guide Coguide Head of Deptt
Prof. Dr. Achal Gupta Dr. Ashish Gupta Prof. Dr. B.R. Shrivastava
(M.S. D.N.B.) (M.S.) (M.S.,M.C.H., P.H.D.)
G.R.M.C. Gwalior G.R.M.C. Gwalior
3. Normal Chest X-ray
• View
• Exposure
• Centralization
• Skeletal structure
• Lung fields including blood
vessels and pleura
• Cardiovascular silhouette
• Mediastinum
• Costophrenic and
cardiophrenic angle
• Diaphragm
• Soft tissue abnormalities
4.
5.
6. Normal Chest X-ray described as
• This is PA view of chest x-ray with normal
exposure proper centering without any
appearent bony abnormality. The lung fields
are clear with normal bronchovascular marking
cardiovascular silhouette is with in normal limit
with normal cardiothorcic ratio, mediastinum
costophrenic, cardiophrenic angles dome of
the diaphragm and soft tissue show no
abnormality.
7. Pleural effusion
• Triangular homogeneous
opacity with a curved
upper border which is
concave medial and
upward extend to ward
axilla
• Costophrenic angle is
obliterated.
• Trachea and cardiac
shadow shifted slightly to
opposite side.
8.
9. Pneumothorax
• Increased translucency
on right side of the
chest.
• Absent of lung marking
• Sharp homogenous
opacity near the hilum
which indicate the
collapsed lung.
• Trachea shifted to
opposite side.
• Dome of diaphragm
flattened.
10.
11.
12. Hydropneumothorax
• Horizontal fluid level
• Increased transluncency
above the horizontal
fluid level which is
lacking in lung markings
(pneumo component)
and homogenous
opacity is below the
horizontal fluid level
(hydro component).
• Trachea shifted to
opposite side.
• Shifting dullness
32. Normal Fluid Levels
*Stomach
– Always (except supine
film)
*Small Bowel
– Two or three levels
possible
*Large Bowel
– None normally
33. Always
air/fluid level
in stomach
A few
air/fluid
levels in
small bowel
Erect Abdomen
34. Large vs. Small Bowel
*Large Bowel
– Peripheral
– Haustral markings don't
extend from wall to wall
*Small Bowel
-Central
-Valvulae extend across lumen
35. Localized Ileus
Key Features
• One or two persistently dilated loops
of large or small bowel
• Gas in rectum or sigmoid
42. Mechanical SBO
Causes
• Adhesions
• Hernia
• Volvulus
• Gallstone ileus
• Intussusception
*Cause may be visible on plain film
43. Mechanical LBO
Key Features
• Dilated colon to point of
obstruction
• Little or no air in rectum/sigmoid
• Little or no gas in small bowel,
if…
– Ileocecal valve remains competent
53. Soft Tissue Masses
• Hepatosplenomegaly
– Plain films poor for judging liver
size
• Tumor or cyst
– Bowel displacement
*decrease of gas
*Extrinsic compression of bowel
71. Foreign Bodies
Objects that may be seen include ingested
and rectal foreign bodies, such as coins, dress
buttons and jewelry. Other objects may have
been operatively placed for example an aortic
stent, an inferior vena cava filter or a suprapubic
urinary catheter. Sterilization clips and an intra-
uterine device are common findings in women.
