Emergency Radiology Practice Questions

Q: A 25-year-old corporate executive was stabbed in the abdomen in a discotheque. In the emergency room, CXR and CT chest were performed. The radiologist then put an NG tube in the patient, injected contrast and repeated the scan. What is the diagnosis?

Diaphragmatic injury. ***Diaphragmatic injury*** - The chest X-ray (**A**) shows opacification in the left lower lung field with a **raised hemidiaphragm**, and the CT scan (**B**) reveals **herniated bowel loops** and **stomach** (appearing as a gas-filled structure) in the left hemithorax. - The insertion of an **NG tube and contrast injection** to confirm the stomach's presence in the chest is a classical diagnostic approach for **diaphragmatic rupture** following penetrating trauma. *Hemothorax* - Hemothorax would primarily show **fluid collection** in the pleural space, which appears homogeneous on CT, typically without specific organ herniation. - While plausible with penetrating trauma, the images specifically show **organ herniation**, not just blood. *Pneumothorax* - Pneumothorax is characterized by **air in the pleural space**, resulting in lung collapse and a visible pleural line. - The images show solid/fluid-filled structures (bowel, stomach) rather than free air and lung collapse. *Cardiac Tamponade* - Cardiac tamponade involves **fluid accumulation in the pericardial sac**, leading to impaired cardiac filling. - This condition primarily affects heart function and is identified by specific echocardiographic findings, which are not depicted in these chest imaging studies.

Q: FAST (Focused Assessment with Sonography for Trauma) is used to detect free fluid in which of the following areas?

All of the options. ***All of the options*** - The **FAST (Focused Assessment with Sonography for Trauma)** exam is a rapid ultrasound done at the bedside in trauma patients to look for **free fluid** (blood) in several key areas. - The standard FAST views include the **pericardial sac**, **right subcostal (hepatorenal)**, **left subcostal (splenorenal)**, and **pelvic (suprapubic)** regions. *Hepatic* - The **hepatorenal recess (Morison's pouch)** is one of the primary areas assessed in a FAST exam to detect free fluid adjacent to the liver. - Free fluid in this area can indicate significant intra-abdominal bleeding, often associated with **hepatic trauma**. *Splenic* - The **splenorenal recess** is another critical view in the FAST exam, looking for free fluid around the spleen. - This area is frequently checked for bleeding associated with **splenic injury**, which is common in blunt abdominal trauma. *Pericardial* - The **pericardial sac** is evaluated in the FAST exam to detect the presence of **pericardial effusion**, particularly **hemopericardium**. - Hemopericardium can lead to **cardiac tamponade**, a life-threatening condition requiring urgent intervention in trauma settings.

Q: A 25-year-old patient presents in emergency with abdominal trauma. Why is FAST done?

Detection of free fluid in the abdomen (hemoperitoneum). ***Detection of free fluid in the abdomen (hemoperitoneum)*** - **FAST (Focused Assessment with Sonography for Trauma)** is primarily used to rapidly identify the presence of **free fluid**, typically blood, within the peritoneal, pericardial, or pleural spaces. - In abdominal trauma, the detection of **hemoperitoneum** guides immediate management decisions, such as the need for surgical intervention. *Detection of aortic injury* - While FAST can sometimes identify large pericardial effusions or mediastinal hematomas which might suggest aortic injury, it is **not sensitive or specific enough** to definitively diagnose an aortic injury. - **CT angiography** is the gold standard for diagnosing aortic injuries. *Detection of mesenteric injury* - **Mesenteric injuries** involve damage to the blood supply of the intestines and are difficult to detect with FAST. - These injuries might cause **intraperitoneal bleeding** detectable by FAST, but FAST cannot directly visualize the mesenteric damage itself. *Detection of bowel perforation* - **Bowel perforations** release air and contents into the peritoneal cavity, but FAST is generally **poor at detecting free air**. - While it might indirectly show some free fluid as a result of inflammation, it is not the primary diagnostic tool for perforation; **plain radiographs** or **CT scans** are more effective.

Q: In a hemodynamically stable patient with abdominal trauma, which imaging modality is considered the gold standard for diagnosing and grading solid organ injuries?

CT scan. ***CT scan (Correct Answer)*** - **Contrast-enhanced CT (CECT)** is the **gold standard** for diagnosing and grading solid organ injuries in hemodynamically stable patients with abdominal trauma - Provides **high sensitivity (95-100%)** and specificity for detecting injuries to liver, spleen, kidneys, and pancreas - Enables accurate **injury grading** using the AAST (American Association for the Surgery of Trauma) classification system - Can detect **active hemorrhage** (contrast extravasation) and guide decisions between operative vs non-operative management - Recommended by **ATLS (Advanced Trauma Life Support)** protocols for stable trauma patients *Ultrasound (Incorrect)* - **FAST (Focused Assessment with Sonography for Trauma)** is excellent for rapid detection of **free intraperitoneal fluid** in unstable patients - However, it has **limited sensitivity (28-50%)** for solid organ parenchymal injuries and cannot grade injury severity - Highly **operator-dependent** with performance affected by body habitus, bowel gas, and subcutaneous emphysema - Best used as a triage tool, not for definitive diagnosis or grading *MRI (Incorrect)* - Offers excellent **soft tissue contrast** but is not suitable for acute trauma evaluation - Major limitations include **long acquisition time** (30-60 minutes), limited emergency availability, and challenges with monitoring critically ill patients - May be used in **specific scenarios** such as pregnant patients where radiation exposure is a concern, or for delayed evaluation of pancreatic/bowel injuries *X-ray (Incorrect)* - **Plain radiographs** have minimal role in evaluating solid organ injuries due to poor soft tissue resolution - Primarily useful for detecting **skeletal fractures**, **pneumoperitoneum** (free air under diaphragm), or **pneumothorax** in trauma patients - Cannot visualize parenchymal injuries, hematomas, or assess organ integrity - Has been largely replaced by CT in modern trauma protocols

Q: The most appropriate investigation to diagnose and determine the extent of renal injury in a 15-year-old boy who presents with hematuria and left-sided abdominal pain 48 hours after sustaining a blunt abdominal injury, with a pulse rate of 96/minute, blood pressure of 110/70 mmHg, hemoglobin of 10.8 gm%, and packed cell volume of 31%, would be-

Contrast enhanced computed tomography. ***Contrast enhanced computed tomography*** - **CT with intravenous contrast** is the gold standard for evaluating **renal trauma**, providing detailed anatomical information on the extent of injury, including lacerations, hematomas, and urinary extravasation, which might be missed by other modalities. - It rapidly assesses the **parenchyma**, **collecting system**, and surrounding structures, allowing for proper staging of the injury and guiding management decisions. *Sonographic evaluation of abdomen* - **Ultrasound** is useful for rapidly detecting **free fluid** (e.g., blood) in the abdomen and assessing major organ integrity, but its ability to characterize renal parenchymal injuries or urinary extravasation is limited. - It is **operator-dependent** and often insufficient for detailed staging of renal trauma compared to CT. *Intravenous pyelography* - **IVP** primarily evaluates the **collecting system** and ureteral patency but has limited sensitivity for assessing renal parenchymal injuries or perinephric hematomas. - It involves radiation exposure and a contrast load, and generally provides **less anatomical detail** than modern CT scans. *MR urography* - **MR urography** provides excellent soft tissue contrast without ionizing radiation, but it is typically **less readily available** in an emergency setting and takes longer to perform than CT. - Its role in acute trauma is usually reserved for cases where **iodinated contrast is contraindicated** (e.g., severe allergy, renal insufficiency) or when specific soft-tissue detail is crucial for follow-up.

Question 1

A 25-year-old corporate executive was stabbed in the abdomen in a discotheque. In the emergency room, CXR and CT chest were performed. The radiologist then put an NG tube in the patient, injected contrast and repeated the scan. What is the diagnosis?

Accepted Answer

Diaphragmatic injury

Answer

Hemothorax

Answer

Pneumothorax

Answer

Cardiac Tamponade

Question 2

In an unconscious patient with multiple injuries, what is the best and reliable modality for assessment of cervical spine injury?

Accepted Answer

While doing CT scan of brain take extra cuts at the cervical spine region

Answer

MRI scan

Answer

Full AP and lateral radiographs of spine

Answer

Rely only on clinical examination

Question 3

FAST (Focused Assessment with Sonography for Trauma) is used to detect free fluid in which of the following areas?

Accepted Answer

All of the options

Answer

Hepatic

Answer

Splenic

Answer

Pericardial

Question 4

A 25-year-old patient presents in emergency with abdominal trauma. Why is FAST done?

Accepted Answer

Detection of free fluid in the abdomen (hemoperitoneum)

Answer

Detection of aortic injury

Answer

Detection of mesenteric injury

Answer

Detection of bowel perforation

Question 5

In a hemodynamically stable patient with abdominal trauma, which imaging modality is considered the gold standard for diagnosing and grading solid organ injuries?

Accepted Answer

CT scan

Answer

Ultrasound

Answer

MRI

Answer

X-ray

Question 6

The most appropriate investigation to diagnose and determine the extent of renal injury in a 15-year-old boy who presents with hematuria and left-sided abdominal pain 48 hours after sustaining a blunt abdominal injury, with a pulse rate of 96/minute, blood pressure of 110/70 mmHg, hemoglobin of 10.8 gm%, and packed cell volume of 31%, would be-

Accepted Answer

Contrast enhanced computed tomography

Answer

Sonographic evaluation of abdomen

Answer

Intravenous pyelography

Answer

MR urography

Emergency Radiology — MCQs

Emergency Radiology — MCQs

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