+

EMERGENCY
RADIOLOGY

Felicia Pilar G.Gunadi.,dr. SpRad

Instalasi Radiologi
RSUD Al Ihsan
+ Case 1 : What you see?
 +
Answer :

• Multiple rib fracture

• Pulmonary
contusio
+ Case 2 :

Patient with Clinical

features:

 Dyspnoea

 Tachycardia

 Cyanosis

 Tachypnoea

 Hypotension

 Chest wall bruising

palpable abnormal
movement or rib crepitus
+ Answer:

Radiological features

 Multiple rib fractures.

 Air space shadowing

may be seen with
pulmonary
contusions
+ Case 3 :

Post trauma

• Dyspneu

• Mild febris

• Hemoptisis
+ Answer:

• Lung Contusio
• Subcutis
emphysema
• Ribs fracture
+ Case 4 :

• Post trauma
• Dyspneu
• Right chest
pain
+
Answer :

Pneumothorax
dekstra
+ Case 5

Patient Data:
Age: 85
Gender: Male

Presentation:

Shortness of breath
+Case Discussion:
This case demonstrates typical
features of a white-out
hemithorax due to a large
pleural effusion in a supine
patient.

Key features that lead to the

diagnosis are:

being aware that the patient is

supine (note the label)

mediastinal shift away from

the white-out

lung marking seen through the

density indicate that it is
adjacent to, rather than within
the lung.
+
Answer :

In the supine film, an effusion will appear as a graded

haze that is denser at the base.

The vascular shadows can usually be seen through

the effusion.

An effusion in the supine view can veil the lung tissue,

thicken fissure lines, and if large, cause a fluid cap
over the apex.

There may be no apparent blunting of the lateral

costophrenic sulci.
Case 6

Sudden onset headache,

unexplained confusion,
altered level of consciousness
and focal motor weakness.
Risk factors: Hypertension,
blood +
disorders,
anticoagulants and amyloid
microangiopathy.

And you do the brain Ct scan

without contrast
+Findings Answer
1. Homogeneous and high density intraparenchymal
hematoma with well-defined margins. Clot retraction
may result in perihematoma low-density rim.
2. Extension of blood into dependent occipital horns
seen as blood/CSF level or as complete opacification.
3. Look for hydrocephalus and features of tentorial
herniation.

• A cerebellar hematoma needs urgent neurosurgical intervention as the raised

pressure in the posterior fossa predisposes to tentorial herniation. Be sure to
evaluate for tonsillar herniation (downward through the foramen magnum) and
upward transtentorial herniation in these patients.
• Exclude underlying aneurysm or vascular malformation in a young patient.
• Thalamic hemorrhage is most likely due to systemic hypertension.
• The most common locations of hypertensive bleeds are the putamen, subcortical
white matter, cerebellum, thalamus and pons.
Case 7

5 years old, boy with

abdominal pain after 5 days of
fe ver,abdominal distended,
+
poor oral intake and emesis
+Findings Answer
1. Presence of free gas within the
peritoneal cavity
2. The ‘football’ sign
• Massively air-filled peritoneum
• Likens the american football

Presence of free gas within the peritoneal cavity (Pneumoperitoneum)

Most often caused by perforated abdominal hollow viscus and can present an acute
medical emergency.
Signs of pneumoperitoneum are both diverse and sometimes difficult to identify
E/:
Trauma
Peptic ulcer
Appendicitis
Severe obstructive ileus
Case 8
11 y/o female, s/p gun shot wound, presents
with shortness of breath and chest pain

Radiological finding?

1 2 3
+ Answer
Findings
1. Hematothorak
2. Bullet fragment
3. Rib fracture
Case 9
50 y/o male, hipertensi, presents with
shortness of breath and chest pain

Radiological finding?

+
+ Answer

1. Bilateral perihilar consolidation in a 'bat's wing'

configuration.
2. Cardiomegaly.
3. No pleural effusions

Pulmonary edema
Case 10

What do you see?

+
+ Answer
• Small bowel and large bowel are
differentiated from
• Valvula conniventes
• Location
• Step ladder appearance
• Diameter of the bowel
• Distribution of air
• Air fluid level
• Coil spring appearance
• Herring bone appearance

High level intestinal

obstruction