JAs MedImaging

• The acute abdominal series is a common set of abdominal radiographs obtained to evaluate bowel gas.

INDICATIONS
•The acute series is used for a variety of indications including:
☑️determine the amount of bowel gas, with
possible bowel distention
☑️assess air-fluid levels
☑️query pneumoperitoneum

PROJECTIONS
☑️AP supine view
☑️PA erect view
☑️PA erect chest view

•The majority of the information is obtained from the AP supine view. The erect view adds more information about air-fluid levels. The erect PA chest radiograph is the more sensitive view for pneumoperitoneum (and chest pathology can sometimes present as abdominal pain).

NOTE: In order to adequately evaluate for free intraperitoneal gas, the patient should be positioned in the erect and decubitus views for enough time to allow small amounts of free gas to drift up to the diaphragm or lateral liver edge, respectively. This often takes ~5-10 minutes.





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▪︎Represent a classification for vertebral body endplate MRI signal changes.

▪︎It is widely recognised by radiologists and clinicians and is a useful shorthand for reporting MRIs of the spine.

▪︎There are 3 types based on their T1 and T2 MRI appearance.

■Modic type 1: represents bone marrow oedema and inflammation
》T1: low signal
》T2: high signal
》T1 C+ (Gd): enhancement

■Modic type 2: represents normal red haemopoietic bone marrow conversion into yellow fatty marrow as a result of marrow ischaemia
》T1: high signal
》T2: iso to high signal

■Modic type 3: represents subchondral bony sclerosis
》T1: low signal
》T2: low signal






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● OSTEOMYELITIS
-is an infection of the bone.Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs.

●AETIOLOGY
-Most causes of osteomyelitis are caused by staphylococcus bacteria They enter the bone through the bloodstream, nearby infection or by direct contamination

-Other causes include: Recent injury or orthopedic surgery, Circulatory disorder(sickle cell disease), etc

●SIGNS & SYMPTOMS
-Fever/chills
-Pain in the area of infection
-Swelling, warmth and redness over the area of the infection

●COMPLICATIONS
-Bone death(osteonecrosis)
-Septic arthritis
-Impaired growth
-Skin cancer(squamous cell cancer)

●LOCATIONS
-lower limb (most common)
-vertebrae: lumbar > thoracic > cervical
-radial styloid
-sacroiliac joint

>The location of osteomyelitis within a bone varies with age, on account of changes in vascularization of different parts of the bone

▪︎neonates: metaphysis and/or epiphysis

▪︎children: metaphysis

▪︎adults: epiphyses and subchondral regions

●PLANE RADIOGRAPH
-The earliest changes are seen in adjacent soft tissues +/- muscle outlines with swelling and loss or blurring of normal fat planes.

-Osteomyelitis must extend at least 1 cm and compromise 30 to 50% of bone mineral content to produce noticeable changes on plain radiographs. Early findings may be subtle, and changes may not be obvious until 5 to 7 days from the onset in children and 10 to 14 days in adults.

-On radiographs taken after this time period, a number of changes may be noted:
▪︎regional osteopenia

▪︎periosteal reaction/thickening (periostitis): variable; may appear aggressive, including the formation of a Codman's triangle

▪︎focal bony lysis or cortical loss

▪︎endosteal scalloping

▪︎loss of trabecular bone architecture

▪︎new bone apposition

▪︎eventual peripheral sclerosis




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