X-Ray

  • Abdominal X-Ray
  • Chest X-Ray
  • Cervical Spine X-Ray
  • Pelvic X-Ray
  • Wrist X-Ray

Abdominal X-Ray

  • Background
    • Abdominal X-ray typically has a limited role in emergency medicine, but can be used to work-up constipation, bowel obstructions, or perforated viscus. 
  • Common Findings
    • Small Bowel Obstruction
      • Dilated small bowel (>3 cm) containing air fluid levels
    • Large Bowel Obstruction
      • Colonic distention (>6 cm)
      • Cecal distention (>9 cm) 
    • Perforated Viscus
      • Free air under the diaphragm
Video Credit: Strong Medicine

*Deep Dive: The Abdominal X Ray: A relic or a reliable tool? (Taming the SRU)



Chest X-Ray

  • Background
    • The chest X-ray is a commonly performed test in the emergency department setting and can be used to rapidly detect a wide variety of abnormalities. It can screen for pneumothorax, pneumonia, pleural effusion, pulmonary edema, abnormal heart size/borders, and rib fracture, among other conditions.
  • Common Findings
    • Aortic Dissection
      • Widened aortic knob
    • Heart Failure
      • Kerley B-lines
      • Enlarged cardiac silhouette
    • Tension Pneumothorax
      • Air-filled pleural space (lack of vascular markings)
      • Shifted mediastinum
      • Deviated trachea
    • Pneumonia
      • Consolidation
      • Hazy heart border
      • Sharp diaphragm border
    • Pleural Effusion
      • Fluid-filled space (white
      • Meniscus sign (concave surface)
      • Obscured costophrenic angle and hemidiaphragm
    • Pulmonary Embolism
      • Westermark Sign (dilation of pulmonary vessels)
      • Hampton Hump (wedge shaped pulmonary opacity)
    • Sarcoidosis
      • Bilateral hilar adenopathy
Video Credit: Osmosis

*Deep Dive: How to read chest x-rays (International Emergency Medicine Education Project)



Cervical Spine X-Ray

  • Background
    • C-Spine X-ray can be used to evaluate cervical spine trauma. The decision to image is commonly guided by Nexus criteria and the Canadian cervical spine rule. 
  • Common Findings
    • Anterior Cervical Subluxation
      • Uneven spinous processes
    • Compression Fracture
      • Anterior and posterior heights of affected vertebra will differ by 20% or more (anterior will usually be shorter than posterior)
    • Hangman’s Fracture
      • Anterior displacement of C2, caused by bilateral fracture of the pars interarticularis.
    • Hyperflexion Teardrop Fracture
      • Injury most commonly at C5/C6
      • Fractures at anterior inferior aspect of vertebral bodies, widening spinous process, loss of normal curvature, and loss of vertebral height
    • Jefferson Fracture
      • Burst fracture of C1
      • Lateral masses of C1 will not align with masses of C2
    • Clay Shoveler’s Fracture
      • Spinous process fracture
      • Fracture line usually clearly seen. Significant displacement common
Video Credit: UCTeach Ortho

*Deep Dive: Cervical Spine Imaging in Trauma (SAEM)



Pelvic X-Ray

  • Background
    • A pelvic X-ray shows the bony structure of the pelvis. It can rapidly assess fractures in the trauma patient. It will also provide information about both proximal femurs and the hip joints.
  • Common Findings
    • Acetabular Fracture
      • Asymmetric acetabuli
    • Femoral Neck Fracture
      • Jagged contours on affected side
      • Sclerotic bone (from bone impaction)
      • Asymmetry between femoral heads
    • Main Pelvic Ring Fracture
      • Widened SI joint
      • Widened pubic symphysis
    • Posterior Hip Dislocation
      • Loss of congruence between acetabulum and femoral head
    • Pubic Ramus Fracture
      • Fracture lines through public rami
      • Disruption in contours of obturator foramen
    • Sacral Fracture
      • Broken arcuate line on affected side
Video Credit: HIPPO Education

*Deep Dive: Back to Basics: Pelvic X Rays (Taming The SRU)



Wrist X-Ray

  • Background
    • Wrist x-rays are commonly used to work-up wrist trauma, bony tenderness, non-traumatic deformities
  • Common Findings
    • Scaphoid Fracture
      • Fracture site most commonly at waist of scaphoid
      • Not always seen on X-ray
    • Perilunate Dislocation
      • Capitate dislocated dorsally from cup of lunate, but articulates normally with radius
      • Scaphoid fractures present in over 50% of cases
    • Barton Fracture
      • Intra-articular fracture of distal radius
    • Chauffeur Fracture
      • Intra-articular fracture of the radial styloid process
      • May have scapholunate dislocation and/or ulnar styloid fracture
    • Colles Fracture
      • Extra-articular distal radius fracture with dorsal angulation.
      • Commonly associated with ulnar styloid fracture
    • Galeazzi Fracture
      • Distal radius fracture w/ radio-ulnar joint dislocation
    • Greenstick Fracture
      • Fracture does not go all the way through the bone
      • Cortical break on one side, bend/angulation on other side
Video Credit: Dr. Jamie Motley

*Deep Dive: EMRad: Radiologic Approach to the Traumatic Wrist (ALiEM)


Brandon Simpson, PA-C
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