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Teachingseries: BasicImaging AbdoandMSKx -ay DeliveHossein Abolmohammadpour Bonab DeliveDr Alireza SherafatDisclaimer BIDA SW teaching is led by students with supervision of junior doctors and consultants across the UK. These teachings are created to support students’ learning but should not replace your local Medical School teaching material. Objectives • Review the basic principles of interpreting a plain film radiograph of the Abdomen and the MSK system • Describe and be able to recognise the key features of a plain film radiograph of the Abdomen and the MSK system. • Recognise some of the common pathologies on an Abdominal x-ray • Recognise some of the common pathologies on a plain radiograph of MSK system Details • Patient • Date of Radiograph • Previous Radiograph Normal Abdominal X ray (1, 2, 4) Adequacy • AP erect/supine • Exposure • Rotation Normal Abdominal X ray (1, 2, 4) BBC Approach • Bowel • Bone • Calcifications Normal Abdominal X ray (1, 2, 4) Case 1 72 year old male patient complains of sudden onset abdominal pain, nausea, and vomiting. He is unable to pass gas. He reports a lack of appetite and reports a low-grade fever. Examination reveals abdominal distention, tympanic to percussion, with high-pitched bowel sounds. The patient's history is significant for previous abdominal surgeries.Case 1 Small bowel obstruction (6)Case 2 78 year old male patient complains of ongoing abdominal pain, discomfort, and distension. The patient is unable to pass gas or have a bowel movement. Examination reveals abdominal distention. The patient's history is significant for previous abdominal surgeries.Case 2 Large bowel obstruction (7)Case 3 56 year old male patient complains of worsening abdominal pain, distention, and bloating. The patient reports a decrease in frequency of bowel movements and an increase in the volume of stools. The patient reports a high fever and malaise. The patient has a history of inflammatory bowel disease. Examination reveals some abdominal distention, tympanic to percussion, and tender to palpation. He seems to be dehydrated as well.Case 3 Toxic mega colon (8)Case 4 65 year old male patient complains of abdominal pain, discomfort, and distension. The patient is unable to pass gas or have a bowel movement. Examination reveals abdominal distention.Case 4 Sigmoid Volvulus (9)Case 5 60 year old female patient complains of abdominal pain, discomfort, and distension. The patient is unable to pass gas or have a bowel movement. Examination reveals abdominal distention.Case 5 Caecal Volvulus (10)Case 6 52 year old female patient complains of sudden severe abdominal pain. She is pyrexic and feels unwell. Examination reveals abdominal distention which is tender on palpation. Patient is also tachycardic.Case 6 Pneumoperitoneum (11)Case 7 52 year old male patient complains of worsening severe abdominal pain. The pain is most severe in the epigastric region. He has a previous history of excessive alcohol consumption.Case 7 Chronic pancreatitis (12)Case 8 68 year old male patient complains of sudden onset abdominal pain and vomiting. He is unable to pass gas. Examination reveals abdominal distention, tympanic to percussion, with high-pitched bowel sounds. The patient's history is significant for a previous laparoscopic appendicectomy. The operation had some complications and the patient ended up having an open bowel surgery.Case 8 Gastrografin study (19) Details • Patient • Date of Radiograph • Previous Radiograph • 2 different views Normal femur X ray (3, 5) Adequacy • Area (joint above & below) • Rotation • Exposure Normal femur X ray (3, 5) ABCS approach • Alignment • Bones • Cartilage • Soft tissues Normal femur X ray (3, 5)Case 9 82 year old female patient presented with severe, constant right hip pain that radiates to the knee. The pain is worse with weight-bearing activities, such as walking or climbing stairs. On examination, the patient has a decreased range of motion in the right hip, with tenderness and crepitus over the right hip joint.Case 9 Osteoarthritis (13)How to report a fracture • Location => metaphysis?/epiphysis?/articular surface? • What is the type of fracture? (Transverse?/Oblique?) • Is this Open vs Closed • Any pathological changes present? How to report a fracture (17)Case 10 65 year old female patient presented with severe sudden pain and angulation at the upper arm after a road accident. On examination, her left upper arm is swollen and painful to touch.Case 10 Transverse midshaft humeral fracture (14) + medial displacementCase 11 68 year old male patient presented with severe sudden pain at the right hip after a fall. On examination, her right leg is shortened and externally rotated.Case 11 #NOF (15)Case 12 68 year old male patient presented with severe sudden pain at the left hip after a fall. He has a past history of prostate cancer.Case 12 Pathological fractures (16)Case 13 78 year old male patient presented with pain over his finger joints. He has a past history of psoriasis.Case 13 Pencil in cup deformity (17) Rheumatological presentationsUseful resources • Geeky medics • OSCEstop • Radiology master class • Radiopaedia (for all the cases)References Available from: https://radiopaedia.org/cases/normal-abdominal-x-ray-1?lang=gbg RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. Available from: https://oscestop.education/interpretation/abdominal-radiograph-interpretation/Estop. 2022 [cited 2023Jan29]. 3. Samuel. Musculoskeletal radiograph interpretation - generic approach (2023): OSCEstop: OSCE Learning [Internet]. OSCEstop. 2022 [cited 2023Jan29]. Available from: https://oscestop.education/interpretation/musculoskeletal-radiograph-interpretation/ 4. Daniel Ward and Dr Lewis Potter·Radiology Interpretation·. Abdominal X-ray interpretation (AXR): Radiology: OSCE [Internet]. Geeky Medics. 2021 [cited 2023Jan29]. Available from: https://geekymedics.com/abdominal-x-ray-interpretation/ 5. Gołofit P. Normal femur radiographs: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. Available from: https://radiopaedia.org/cases/normal-femur-radiographs-3?lang=gb 6. Adam Eid Ramsey MD. Small bowel obstruction: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/small-bowel-obstruction?lang=gb 7. Niknejad M. Large bowel obstruction: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/large-bowel-obstruction?lang=gb 8. Kusel K. Toxic megacolon: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2021 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/toxic-megacolon?lang=gb 9. Iqbal S. Sigmoid Volvulus: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/sigmoid-volvulus?lang=gbReferences Available from: https://radiopaedia.org/articles/caecal-volvulus?lang=gbadiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. 2023Jan29]. Available from: https://radiopaedia.org/articles/pneumoperitoneum?lang=gbg RSS. Radiopaedia.org; 2022 [cited 12. Niknejad M. Chronic pancreatitis: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2023 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/chronic-pancreatitis-2?lang=gb 13. Niknejad M. Osteoarthritis: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2023 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/osteoarthritis?lang=gb 14. Knipe H. Humeral shaft fracture: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/humeral-shaft-fracture-1?lang=gb 15. Hartung MP. Proximal femoral fractures (summary): Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2018 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/proximal-femoral-fractures-summary?lang=gb 16. Batta NS. Osseous metastases from prostatic carcinoma: Radiology case [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. Available from: https://radiopaedia.org/cases/osseous-metastases-from-prostatic-carcinoma-1?lang=gb 17. uwade Eehizogie. Pencil-in-cup deformity: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2021 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/pencil-in-cup-deformity-1?lang=gb 18. Vadera S. Describing a fracture (an approach): Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2020 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/describing-a-fracture-an-approach?lang=gb 19. Bell DJ. Water-soluble contrast challenge: Radiology reference article [Internet]. Radiopaedia Blog RSS. Radiopaedia.org; 2022 [cited 2023Jan29]. Available from: https://radiopaedia.org/articles/water-soluble-contrast-challenge?lang=gbFOR FEEDBACK AND QUERIES: Email @ info@bidasw.com