Others X-rays
Protocols
1.ground glass (ঘষা কাচ)appearances of the shafts of the bones with
pencil-point thinness of the cortex.
2. a dense white line of calcification (Fraenkel line) appears at the epiphyseal ends of
the long bones.
3. often there is a subepiphyseal zone of translucency (fracture zone-area of rarefaction) due to an
incomplete transverse fracture immediately proximal and
parallel to Fraenkel line. The lateral spurring (projection) of
the white line is known as corner sign.
4.The epiphyseal centers also have a ground glass appearance and are surrounded by a
white ring-ringing of epiphyses (Wimberger sign).
5.Periosteal elevation from subperiosteal bleeds may
later form callus.
Maxillary sinusitis:
X-ray PNS 1: Occipitomental (OM) or Waters view showing Complete opacification of the maxillary sinus
X-ray PNS 2: Maxillary sinusitis with Air-fluid levels and mucosal thickening
Type of X-ray: X-ray PNS 1 & 2, Occipitomental view showing different paranasal sinuses.
Findings:
1.Mucosal thickening of maxillary sinuses
2. Air-fluid levels of maxillary sinuses
3. Complete opacification of the maxillary sinus (arrow)
Diagnosis: Maxillary sinusitis.
Acute laryngotracheobronchitis (Croup):
CXR-2: Narrow air column
Pic: Church steeple
Type of X-ray: Plain X-ray chest including neck, AP view.
Findings:
Sharp uniform narrowing of the air column in the upper part of neck (trachea) giving the
shape of church steeple (steeple sign). It is also called the wine bottle sign.
Diagnosis: Viral croup (Acute Laryngotracheobronchitis).
Mechanism of image findings: Inflammatory edema of the wall of upper respiratory tract causing
narrowing of the intra-tracheal air column, which may extend for 5-10 mm.
Type of X-ray: Plain X-ray neck, lateral view.
Findings: Thumb sign/Thumbprint sign.
Diagnosis: Acute epiglottitis.
Mechanism of finding: Thumb sign is due to swelling (thickening) of epiglottis from
inflammatory edema.
X-ray Nasopharynx lateral(Adenoid):
Type of X-ray: Plain X-ray nasopharynx lateral view.
Findings: Enlargement of adenoid gland with indenting and narrowing of the naso-pharyngeal air
column. (X-ray 2 – shows a very narrow and X-ray 3 shows absent nasopharyngeal air column due
to enlarged adenoid)
Diagnosis: Enlarged adenoid.
Mechanism of the finding: Adenoid is enlarged because of chronic bacterial or viral infections or
allergy and with increasing size, it encroaches upon the nasopharyngeal air column, causing difficulty
in respiration, through nose.
X-ray nasopharynx lateral view 2: Narrow naso-pharyugeal air column due to enlarged adenoid
X-ray Retropharyngeal abscess:
Pic-1: Retropharyngeal & Prevertebral spaces
Type of X-ray: X-ray neck lateral view.
Findings: Widening of the soft tissue in the retropharyngeal space (RPS).
Mechanism of finding: This is due to the infection and collection of pus in the RPS.
Retropharyngeal space (RPS): It is a potential space in the head and neck bounded superiorly by base of the skull,
inferiorly superior mediastinum, laterally carotid sheath, anteriorly buccopharyngeal fascia
(muscles of pharynx) and posteriorly alar fascia (pre-vertebral fascia).
Prevertebral space: it is a potential space bounded anteriorly by pre-vertebral fascia,
alar fascia and posteriorly cervical vertebra.It extends from base of the skull to the coccyx.
X-ray Hemolytic Anaemia/Thalassemia:
X-ray of Hemolytic Anaemia/Thalassemia:
X-ray skull lateral view
1. Skull is enlarged
2. Widening of the diploic space
3. Thinning of the outer table
4. Thickening & coarsening of the trabeculae giving the appearance of
"hair on end
So my radiological diagnosis is hereditary haemolytic anaemia.
x-ray Eventration of diaphragm:
CXR-1: Elevated left dome of diaphragm
CXR-2: Plain CXR right lateral
CXR-3: Contrast X-ray of upper gut
Type of X-ray:
1. Plain X-ray abdomen AP and left lateral view
2. Contrast X-ray of upper GIT
Findings:
CXR-1 & 2
1. Elevated left dome of diaphragm with fundic gas below it.
2. Shifting of the mediastinum to the right hemithorax (evident in AP view)
CXR-3
1. Radiopaque shadow on the left side of the chest representing displaced stomach
Diagnosis: Eventration of left dome of the diaphragm.
Mechanism of image findings: Due to poor development of the muscles of left dome of
diaphragm, the left dome remains weak and is being easily pushed up by the abdominal contents
because of high intra-abdominal pressure.
Hirschsprung disease:
CXR-A findings:
Barium enema showing small narrow rectum with dilated sigmoid colon above the narrow segment.
Diagnosis: Hirschsprung disease.
Q: How to confirm the diagnosis?
- A: Full-thickness rectal biopsy to see the absence of ganglion cells in submucosal plexus.
- Histochemical staining for acetylcholinesterase, which is high in Hirschsprung disease.
- Anorectal manometry shows failure of relaxation of internal anal sphincter.
- Q: What is Hirschsprung disease?
- A: It is a disease characterized by congenital absence of ganglion cells, usually in the rectum that
- causes constipation and intestinal obstruction. This disease is also called congenital megacolon.
- Family history may be present in one-third of cases. Ganglion cells are absent from nerve plexus,
- commonly in a small segment of rectum and/or sigmoid colon. As a result, internal anal sphincter fails to relax.