- Abdominal X-Ray
- Chest X-Ray
- Cervical Spine X-Ray
- Pelvic X-Ray
- Wrist X-Ray
Abdominal X-Ray
Rapid Review
- 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
- Small Bowel Obstruction
Pearls
Chest X-Ray
Rapid Review
- 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
- Aortic Dissection
Pearls
Cervical Spine X-Ray
Rapid Review
- 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
- Anterior Cervical Subluxation
Pearls
Deep Dive
Pelvic X-Ray
Rapid Review
- 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
- Acetabular Fracture
Pearls
Wrist X-Ray
Rapid Review
- 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
- Scaphoid Fracture
Pearls
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