This image displays a large left sided haemothorax with mediastinal displacement to the opposite side. Clinically the patient would be in respiratory distress - percussion of the left side of the chest would be dull and breath sounds and vocal resonance would be reduced. A Haemothorax such as this falls into the category of life threatening chest injuries (ATOMFC) and requires emergent treatment using a chest drain in the 5th intercostal space, mid-axillary line and treatment according to ALS or ATLS protocols. ATOMFC = A = airway obstruction, T = tension pneumothorax, O = open pneumothorax, M = massive haemothorax, F = flail chest, C = cardiac tamponade.
In this X-Ray you can see the faint outline of a very large AAA. It is important that you specifically look for this feature on an Abdominal X-Ray as this can be a potentially life threatening condition.
This image is a contrast enhanced CT Scan of the abdomen. The contrast is sitting in the arterial system and displays the aorta. As we can see the aorta is grossly dilated and almost as large as the vertebral bodies showing that it is anueysmal. An aneurysm over 7cm wide has a 20% chance of rupture each year and if this happens the outcome is catastrophic
This is a contrast enhanced CT image of the abdomen with the contrast in the arterial phase highlighting the aorta. We can see what appears to be two seperate lumens on this image and this is because this is an aortic dissection.
This PA Chest X-Ray demonstrates a left sided pleural effusion. In this condition fluid collects between the parietal and visceral pleura and appears as a shadowy fluid level on the X-Ray with obliteration of the costophrenic angles. If you were to examine this patient they might be in respiratory distress from reduced oxygen uptake (so have low sats, high resp rate, possible cyanosis and accessory muscle useage) - they may have reduced chest expansion on the affected side and it would be stony dull to percussion. Fluid transmits sound poorly so breath sounds would be decreased as would vocal resonance/fremitus. Someone with consolidation may have very similar clinical findings but the underlying area of lung is almost solid due to pus from the infective process - as sounds travel well through solids they would have increased vocal fremitus which is how you can clinically differentiate between the two conditions. Clinical examination and understanding of conditions is paramount to practice effective medicine. Before you recieved this X-Ray you should be able to diagnose the condition and use the X-Ray to confirm your suspicions.
Small bowel obstruction can be identified by the dilated loops of centrally placed bowel with the venae commitantes (circular bands of muscle) that span the entire width of the bowel as opposed to tenae coli in the large bowel which only span part of it.
This image shows dilated loops of large bowel. It can be identified as large bowel because of the tenae coli which form bands that never cross the whole width of the bowel unlike the venae commitantes of small bowel
In this Chest X-Ray we can identify a left sided pneumothorax - there is absence of lung markings in the periphery and we can also see a shadow which outlines the edge of the lung. A pneumothorax is caused when air enters the potential space between the viceral and parietal pleura and causes the lung to collapse down under the pressure of it's elsatic recoil. In this case it is likely that the pneumothorax has been caused by trauma as we can see air in the soft tissues on the left side (surgical emphysema - clinically feels like bubble wrap). A pneumothorax can be a life threatening condition. The patient presents in respiratory distress with decreased expansion on the affected side. There will be hyperresonance to percussion on that side but absent breath sounds. The emergency treatment is decompression with a large bore cannula in the 2nd intercostal space mid-clavicular line followed by insertion a chest drain in the 5th intercostal space mid-axilllary line
This image shows the cardinal sign of a perforated abdominal viscus. There is air under the diaphragm indicating air within the peritoneal cavity which can occur from a perforated abdominal viscus, following a laparoscopic abdominal procedure (where air is pumped into the peritoneal cavity to improve the views) and after more obscure events such as vigorous waterskiing in a female. When this appearance is seen it should be treated as a surgical emergency until proved otherwise.
This image shows a dislocated shoulder with a fracture through the surgical neck of humerus. The patient is at high risk of axillary nerve injury. The axillary nerve supplies deltoids but this is difficult to test in these conditions - luckily it also supplies an area of skin over the shoulder known as the regimental badge - this must be tested before and after any procedure involving the shoulder.
This image demonstrates a fracture of the scaphoid bone. Fractures of the scaphoid are clinically important decause the blood supply enters the bone distally and then moves proximally. If the blood supply is distrupted then there is potential for the patient to develop avascular necrosis of the scaphoid.