Category Archives: Imaging

The daily educational pearl – Chilaiditi’s syndrome

Posted on by

With thanks to Ignatius.

Your next patient is a 78 yo lady who presents with agitation. She is a nursing home resident and has a history of dementia.

This is her chest Xray:

Chilaiditi’s syndrome vs Chilaiditi’s sign

 

Chilaiditi’s syndrome = rare condition when the transposition of a loop of transverse colon between the diaphragm and the liver causes symptoms (abdominal pain or shortness of breath)

Most commonly it is an incidental finding in asymptomatic patients , as a normal anatomical variant = Chilaiditi’s sign

 

The daily educational pearl – grading renal injuries

Posted on by

Renal injuries are graded by the American Association for the Surgery of Trauma in 5 grades:

– Grade 1 – Renal contusion or nonexpanding subcapsular hematoma without a parenchymal laceration

– Grade 2 – Nonexpanding perirenal hematoma or a renal cortex laceration (< 1 cm) without urinary extravasation

– Grade 3 – Renal cortex laceration (>1 cm) and no urinary extravasation

– Grade 4 – Renal cortical laceration extending into the collecting system (contrast extravasation), or a segmental renal artery or vein injury (parenchymal infarct), or main renal artery or vein injury with a contained hematoma

– Grade 5 – Shattered kidney, avulsion of the renal pedicle, or thrombosis of the main renal artery
Injuries grade 1 – 3 are usually managed conservatively, grade 4 – 5 are usually explored / managed in theatre.

The daily educational pearl – triquetrum fracture / dislocation

Posted on by

Triquetrum fracture / dislocation

or carpal ligamentous injury stage III – stage II injury + dislocated triquetrum; can be associated with a volar triquetral fracture

– best seen on lateral views; the avulsion fragment is usually found on the dorsal surface

Isolated fractures are managed in ED with a wrist splint (generally 2 weeks for avulsion fractures, 6 weeks for undisplaced body fractures). They need Orthopaedics follow-up within 1 – 2 weeks.

Displaced body fractures (>1 mm), open fractures or those associated with perilunate dislocation need urgent Orthopaedics referral.

 

The daily educational pearl – scapholunate dislocation

Posted on by

Scapholunate dislocation

or carpal ligamentous injury stage I

 

– widening of scapholunate joint > 3 mm on the PA view (the “Terry Thomas” or “Madonna” sign)

– it can associated with rotatory subluxation of the scaphoid – “the signet ring sign” (the distal pole is viewed end-on)

If the routine Xray views are normal but the diagnosis is suspected clinically, stress views should be obtained (clenched fist + ulnar deviation).

 

ED management is a radial gutter splint or a short arm volar + dorsal POP split on the ulnar side, with the wrist in mild volar flexion and radial deviation. They need urgent (same day) Orthopaedics referral for reduction / repair as they are associated with degenerative arthritis and chronic pain.