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http://www.cambridge.org/9780521870542

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Clinical Emergency Radiology

As recent technological advances have revealed, imaging repre-
sents the most dynamic subdiscipline of emergency medicine.
The use of ultrasound, MRI, and CT scans has revolution-
ized the way that acute injuries and conditions are managed
in the ED. More sophisticated imaging modalities are com-
monplace now, enabling acute conditions such as cardiac arrest,
aortic aneurysm, and fetal trauma to be diagnosed within sec-
onds. Clinical Emergency Radiology is a new clinical resource in
the field of emergency radiology. It thoroughly addresses both
the technical applications and the interpretation of all imag-
ing studies used in the ED, including x-rays, MRI, CT, and
contrast angiography. The full spectrum of conditions diag-
nosed within each modality is covered in detail, and exam-
ples of normal radiological anatomy, patterns, and anomalies
are also included. This book is designed to be a standard ref-
erence for emergency physicians and contains more than 2,000

images to comprehensively cover every aspect of radiology in
the ED.

J. Christian Fox (M.D. University of California, Irvine) grad-
uated from Tufts University School of Medicine in 1997 and
completed his residency at the University of California, Irvine,
in emergency medicine. Dr. Fox currently teaches at the Uni-
versity of California, Irvine, School of Medicine, where he has
received the American Academy of Emergency Medicine’s Young
Educator Award. He is Associate Clinical Professor of Emergency
Medicine, Chief of the Division of Emergency and Trauma Ultra-
sound, and Director of the Emergency Ultrasound Fellowship.
Dr. Fox has lectured and written extensively on emergency imag-
ing locally and internationally and formerly held the post of
Co-Chair of the American Institute of Ultrasound in Medicine’s
Emergency Ultrasound Section.

Page 331

318 Lambert

Figure 21.18. Endovaginal right sagital view of the UT with a GS and
FP outside the endometrial echo of the UT. Three hyperechoic extrem-
ity buds are visible.

Figure 21.20. Endovaginal coronal view of the UT without evidence
of a GS within the endometrial echo of the UT.

Figure 21.22. Same patient as in Figure 21. Transabdominal sagital
view left of the midline with suspicious mass superior and anterior to
the UT.

Figure 21.19. Endovaginal coronal view of the UT without evidence
of a GS within the endometrial echo of the UT. The right adnexa reveal
a poorly visible FP better seen in the more anterior coronal image in
Figure 20.18.

Figure 21.21. Transabdominal view of the UT without evidence of a
GS within the endometrial echo of the UT.

Figure 21.23. Same patient as in Figure 21. Transabdominal sagital
view left of the midline with GS and FP superior and slightly anterior
to the UT.

Page 332

Figure 21.24. Same patient as in Figure 21. Transabdominal
view of the UT without evidence of a GS within the endometrial
echo of the UT.

Figure 21.26. Same patient. The EMS is pointing to the right
side of the UT. This is commonly referred to as the “endometrial
line sign.”

Figure 21.28. Endovaginal sagital view of the pelvis with evi-
dence of a live EUG posterior to the UT. The saclike structure
within the UT has no DDS sign nor does it meet criteria for an
IUP. This is commonly referred to as a PGS.

Figure 21.25. Endovaginal coronal view of the UT without evi-
dence of a GS within the endometrial echo of the UT. Adjacent
to the right border of the UT is a GS with FP.

Figure 21.27. Same patient as in Figure 26. The EMS is point-
ing to the right adnexa. This is commonly referred to as the
“endometrial line sign.” Notice that the GS is partially within
the myometrium of the UT. This pregnancy is within the fallo-
pian tube as it passes through the myometrium. This is com-
monly referred to as a “cornuate” or “interstitial ectopic.”

319

Page 661

648 Index

ultrasound. (Continued)
of gallbladder, 214, 215, 216, 219–227,

228, 230, 231
gallstones under, 221–222
image artifacts for, 213–214, 215,

216–217
imaging limitations of, 218–219
indications for, 218
of intrauterine pregnancy, 215
of median nerve block, 216
MI in, 211
M-mode, 212
physics of, 217

principles of, 209
for soft tissue pathology, 3
system controls for, 209–212
TI in, 211
transducer selection in, 212–213, 216
of urinary bladder, 215, 217

for DVT, 247
abscesses and, 253
Baker’s Cyst and, 252
cellulitis and, 252
diagnostic capabilities of, 246–247
femoral vessels under, 247, 249, 252
imaging limitations with, 247
indications for, 246
probe placement for, 248
proximal, 251
PV and, 247, 250, 251
SDI in, 250–251
techniques for, 247

emergency cardiac, 254–256
apical views in, 258, 260, 261, 263
CDI in, 262, 265
consultant v. physician performed,

254–255
diagnostic capabilities of, 254–255
echo in, 254
effusion in, 255
experience recommendations for use

of, 255
global LVF in, 255
imaging modalities for, 255–256,

257–258, 262
indications for, 254
parasternal axis views in, 257–258, 259,

260, 261, 262–265
for PE, 254
right ventricular strain in, 255
subxiphoid view in, 259, 260, 261,

262
TTE v. TEE, 255

emergency renal, 268–279
for acute trauma, 272
diagnostic capabilities of, 268–269,

272–273, 275, 276, 277, 278
for horseshoe kidney, 279
imaging limitations of, 269–270
indications for, 268
for normal kidney, 270
for renal disease, 275
for renal stones, 274

grayscale, 330

guided procedures for, 287–310
of CVC, 290–293
for foreign body detection, 294–295
for LP, 299–300
for paracentesis, 301–304
for pericardiocentesis, 304–310
for thoracentesis, 297–299
of urinary bladder, 287–289

biliary, 217, 269
emergency renal, 277

for musculoskeletal system, 347–357
for bone, 349
for fractures, 350–353
imaging limitations of, 357
indications for, 350–356
for joints, 349
for ligaments/nerves, 349
for muscle, 348
sonographic anatomy of, 348–349
technical considerations for, 347
for tendons, 348–356

ocular, 325–329
applications for, 327–328
diagnostic capabilities of, 325
for ICP, 325, 327
for lens dislocation, 328
for optic neuritis, 328
sonographic anatomy of, 325, 326
sonographic techniques for, 325–327
for vitreous hemorrhage, 328

in resuscitation, 367–369
for AAA, 389–390
for acute cholecystitis, 391–392
for appendicitis, 391
for bowel obstruction, 391
cardiothoracic disease etiologies for,

368–369
diagnostic capabilities of, 367–368
ectopic pregnancy, 382
for fluid status, evaluation of,

379–382
for gallbladder, 391–392
for hydronephrosis, 392
for hypervolemia, 379, 380
imaging limitations for, 369, 388–390
indications for, 367
for pacemaker insertion, 393
for pancreatitis, 391
for pneumonia, 377, 392
for pneumothorax, 383–387
for pulmonary embolism, 375, 378,

379
thoracic disease etiologies for, 368
TTE v. TEE approach for, 369, 388
for vascular access, 392–393

for soft tissues, 358–361
diagnostic capabilities of, 358–359
for foreign bodies in, 359–360
imaging for, 359
infection indications for, 358
for peritonsillar abscesses, 360–361

testicular, 330–335
clinical images of, 331, 332, 333, 334,

335

diagnostic capabilities of, 330
imaging limitations of, 330–331
indications for, 330, 332

Triplex, 330
upper extremities, plain radiography for, 3–9

acute trauma in, 3
in elbow/forearm, 6–8

AP view of, 7
diagnostic capabilities of, 7
dislocations in, 7, 8
Galeazzi fractures, 7, 8
Galeazzi fractures in, 7, 8
for “golfer’s elbow,” 6
imaging limitations for, 7
indications for, 6
lateral view of, 7
posterior fat pad in, 7
radial head fractures in, 7
supplementary views of, 7
for “tennis elbow,” 6

for elderly, 181, 197–200
for chondrocalcinosis of the knee, 199
for DJD, 200
for fractures, 197
for osteoarthritis, 197–198

foreign body wounds in, 3
in hand/wrist injuries, 9

for acute trauma, 9
Boxer’s fracture, 9, 13
carpal tunnel disease and, 9
Colles fractures, 9, 10
diagnostic capabilities of, 9
dislocations, 9, 11–12
FOOSH, 9
imaging limitations for, 9
indications for, 9
interphalangeal dislocation, 3
Mallet finger, 9
scaphoid fractures, 9, 11
scapho-lunate disassociation, 9, 11
Smith’s fracture, 9, 10
Tuft fracture, 9, 13

in shoulder, 3–6
AC separation in, 4
for acute trauma, 3
AC view of, 4
anterior dislocations of, 4, 5
apical oblique view of, 4
AP view of, 4
axillary view of, 4
Bankart fractures in, 4, 6
for chronic pain, 3
clavicle fractures, 4
diagnostic capabilities for, 4
Hill-Sachs deformity in, 4, 6
humeral head fractures of, 4, 6
indications for, 3–4
lateral view of, 4
limitations of, 4
luxatio erectae of, 4, 5
posterior dislocations of, 4, 5
postreduction radiography for, 3–4
prereduction radiography for, 3–4

ureteral stones, 67, 84–85

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Index 649

ureterolithiasis, 479
urinary bladder, ultrasound for

biliary, 215, 217, 269
for tumors, 277

bladder stones and, 86
carcinomas in, 277
emergency renal, 269, 277
guided procedures for, with

catheterization, 287–289
anatomic considerations for, 287
disadvantages of, 288
images of, 288–289
indications for, 287
success rates for, 287

urinary tract, ultrasound for
bladder for, 215, 217, 269

for tumors, 277
emergency, 268–279

urolithiasis, 173
development of, 171
indications for, 171
with renal colic, 171, 173
staghorn calculus and, 171–173

uterine cancer, 416
uterus, 314–315

FF in, 323
in pouch of Douglas, 323
in uterovesicular pouch, 323

fibroid calcifications in, 81
incarcerated, during pregnancy, 324

vaginal stripe, 314
vascular system, calcification in, 89
venous thromboembolism, 489
ventral wall hernias, 338
vertebral fractures, 470
vitreous hemorrhage, 328
volvulus

cecal, 73
midgut, 157–160

definition of, 157
sigmoid, 74

wounds, by foreign bodies
in brain, 536
CT for, 3

in feet, 41–42
by gunshot, 103
MRI for, 3
plain radiography for, 3
ultrasound for, 3

wrist. See also hand/wrist injuries, plain
radiography for

MRI for, 600–606
for bony injuries, 601
for edema, 601–602
for Gamekeeper’s thumb, 604
for rheumatoid arthritis, 605
for sprains, 603
for tears, 604

x-rays. See chest radiography, with plain film

ZMC. See zygomaticomaxillary complex
zygoma fractures, under CT, 440

indications for, 440
ZMC and, 440

zygomaticomaxillary complex (ZMC),
440

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