Emergency Radiology

Emergency Radiology Indian Medical PG Question 1: Best imaging modality for acute pulmonary embolism

• A. V/Q scan
• B. CT pulmonary angiogram (Correct Answer)
• C. Chest X-ray
• D. MRI

Emergency Radiology Explanation: ***CT pulmonary angiogram*** - This is the **gold standard** imaging modality for diagnosing acute pulmonary embolism due to its high sensitivity and specificity in visualizing pulmonary arteries. - It rapidly provides detailed images of the pulmonary vasculature, allowing for direct visualization of **thrombi**. *V/Q scan* - A **V/Q scan** measures ventilation and perfusion of the lungs and is less definitive than CTPA, especially in patients with pre-existing lung disease. - It is often considered when **CTPA is contraindicated**, such as in cases of severe renal impairment or contrast allergy. *Chest X-ray* - A **chest X-ray** is generally used to rule out other causes of chest pain and shortness of breath, such as pneumonia or pneumothorax, rather than to diagnose PE directly. - It has **low sensitivity and specificity** for pulmonary embolism, as findings are often non-specific or normal even in the presence of PE. *MRI* - **Magnetic resonance angiography (MRA)** can be used, but it is typically reserved for patients who cannot undergo CTPA or V/Q scan due to contraindications like **pregnancy** or **renal failure**. - It often takes longer to perform and has lower spatial resolution compared to CTPA for pulmonary artery visualization.

Emergency Radiology Indian Medical PG Question 2: Investigation of choice in an unstable patient with suspected intra-abdominal injury is -

• A. USG (FAST) (Correct Answer)
• B. CT scan
• C. X-ray abdomen
• D. DPL

Emergency Radiology Explanation: ***USG*** - **Focused assessment with sonography for trauma (FAST) exam** is the investigation of choice in an **unstable patient** due to its rapid, non-invasive nature and ability to detect free fluid (blood) in the peritoneal, pericardial, and pleural spaces. - It can be performed at the **bedside** without moving the patient, making it ideal for hemodynamically unstable individuals with suspected intra-abdominal injury. *CT scan* - While a **CT scan** provides detailed anatomical information, it requires the patient to be stable enough for transport to a radiology suite and prolonged scanning time. - It is often difficult to obtain in **unstable patients** who may require continuous resuscitation and monitoring. *X-ray abdomen* - An **X-ray abdomen** has limited utility for detecting intra-abdominal injuries and primarily identifies issues like free air under the diaphragm (suggesting hollow organ perforation) or foreign bodies. - It is **not sensitive** for detecting free fluid (hemoperitoneum) or solid organ injuries, which are critical in trauma. *DPL* - **Diagnostic peritoneal lavage (DPL)** is an invasive procedure that involves inserting a catheter into the peritoneal cavity to detect blood or other fluid. - While sensitive, it is **invasive**, can complicate subsequent imaging, and has largely been replaced by the FAST exam due to the latter's non-invasive nature and comparable diagnostic accuracy for free fluid.

Emergency Radiology Indian Medical PG Question 3: The imaging modality primarily used in FAST (Focused Assessment with Sonography for Trauma) exam is:

• A. X-ray
• B. CT
• C. MRI
• D. USG (Correct Answer)

Emergency Radiology Explanation: **USG** - **Focused Assessment with Sonography for Trauma (FAST)** exam specifically uses **ultrasound (USG)** to rapidly detect free fluid (blood) in pericardial, perihepatic, perisplenic, and pelvic spaces. - Its quick, non-invasive nature and portability make it ideal for **point-of-care assessment** in trauma settings. *X-ray* - While X-rays are useful in trauma for detecting **fractures** and some pneumothoraces, they are not the primary modality for detecting free fluid in the peritoneal or pericardial cavities during a FAST exam. - X-rays do not provide real-time, dynamic imaging of soft tissues and fluid accumulation as effectively as ultrasound. *CT* - **Computed Tomography (CT)** is a highly detailed imaging modality used in trauma for comprehensive assessment of injuries to organs, bones, and vessels. - However, it involves **radiation exposure**, takes longer to perform, and is typically reserved for hemodynamically stable patients after initial resuscitation and FAST exam. *MRI* - **Magnetic Resonance Imaging (MRI)** provides excellent soft tissue contrast, but its use in acute trauma is very limited due to its **long scan times**, high cost, and incompatibility with many metallic medical devices. - MRI is not suitable for rapid assessment of free fluid in hemodynamically unstable trauma patients.

Emergency Radiology Indian Medical PG Question 4: While performing triage in response to a disaster emergency, commonly an internationally accepted four-colour code system is used. Which one among the following four-colour categories represents the highest priority for emergency response ?

• A. Green
• B. Red (Correct Answer)
• C. Black
• D. Yellow

Emergency Radiology Explanation: ***Red*** - The **red** category is assigned to patients with **immediate, life-threatening injuries** who have a high probability of survival with prompt medical intervention. - This color signifies the **highest priority** for medical treatment and transport to maximize their chances of survival. *Green* - The **green** category is for patients with **minor injuries** that are not life-threatening and can wait for medical attention. - These individuals are often referred to as walking wounded and can typically self-evacuate or wait for more critical patients to be treated. *Black* - The **black** category is reserved for patients who are either **deceased** or have injuries so severe that survival is unlikely, even with immediate medical care. - In a mass casualty situation, resources are generally not allocated to these individuals to prioritize those with a higher chance of survival. *Yellow* - The **yellow** category is for patients with **significant injuries** that are not immediately life-threatening but require definitive medical care within a few hours. - These patients are considered "delayed" and their treatment can be postponed until after red-category patients have been managed.

Emergency Radiology Indian Medical PG Question 5: In which of the following conditions is emergency radiotherapy indicated?

• A. Neoplastic cardiac tamponade
• B. Acute epidural spinal cord compression
• C. Superior vena cava syndrome (Correct Answer)
• D. Tumor lysis syndrome

Emergency Radiology Explanation: ### Superior vena cava syndrome - **Emergency radiotherapy** is indicated in SVC syndrome, especially if caused by radiation-sensitive tumors, to rapidly reduce tumor burden and relieve **venous compression**. [3] - Rapid intervention is crucial due to the potential for **life-threatening compromise** of venous return from the head and upper extremities. [2] *Neoplastic cardiac tamponade* - The primary emergency treatment for **cardiac tamponade** is **pericardiocentesis** to urgently relieve fluid pressure around the heart. - Radiotherapy is not the immediate intervention for acute tamponade, though it may be used later to manage the underlying malignancy. *Acute epidural spinal cord compression* - **Acute spinal cord compression** requires immediate intervention, often with **high-dose corticosteroids** to reduce edema and emergent surgical decompression to prevent permanent neurological damage. [1] - Radiotherapy may be used as an adjunct or for less acute cases, but surgery is usually prioritized for acute compression. [1] *Tumor lysis syndrome* - **Tumor lysis syndrome** is a metabolic emergency managed with aggressive **hydration**, **allopurinol**, or **rasburicase** to prevent renal failure and electrolyte abnormalities. - Radiotherapy is not a treatment for the acute metabolic derangements of tumor lysis syndrome.

Emergency Radiology Flashcard 1 of 5

Question: What is the best modality to identify cocaine packets in a body packer?_____

Answer: CT imaging

Emergency Radiology Flashcard 2 of 5

Question: In FAST, Longitudinal view of the left upper quadrant: assess for _____ injuries and left kidney injury

Answer: splenic

Emergency Radiology Flashcard 3 of 5

Question: FAST is least useful for diagnosing _____ hematomas as the sensitivity for detection is very poor

Answer: retroperitoneal

Emergency Radiology Flashcard 4 of 5

Question: _____ sign on the x-ray is suggestive of acute epiglottitis.

Answer: Thumb

Emergency Radiology Flashcard 5 of 5

Question: extended FAST incorporates _____ and right thoracic views to assess for pneumothorax and haemothorax.

Answer: Left