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Surface anatomy of the Stomach

The cardiac orifice is opposite the 7th left costal cartilage about 2.5 cm. from the side of the sternum; it corresponds to the level of the tenth thoracic vertebra.
The pyloric orifice is on the transpyloric line about 1 cm. to the right of the middle line, or alternately 5 cm. below the 7th right sternocostal articulation; it is at the level of the first lumbar vertebra.
A curved line, convex downward and to the left, joining these points indicates the lesser curvature. In the left lateral line the fundus of the stomach reaches as high as the 5th interspace or the 6th costal cartilage, a little below the apex of the heart.

To indicate the greater curvature a curved line is drawn from the cardiac orifice to the summit of the fundus, thence downward and to the left, finally turning medialward to the pyloric orifice, but passing, on its way, through the intersection of the left lateral with the transpyloric line. The portion of the stomach which is in contact with the abdominal wall can be represented roughly by a triangular area the base of which is formed by a line drawn from the tip of the 10th left costal cartilage to the tip of the 9th right cartilage, and the sides by two lines drawn from the end of the 8th left costal cartilage to the ends of the base line.

Note That: This measurements given refer to a moderately filled stomach with the body in the supine position !!!  Why we say that.........
As The shape of the stomach is constantly undergoing alteration; it is affected by the particular phase of the process of gastric digestion, by the state of the surrounding viscera, and by the amount and character of its contents. Its position also varies with that of the body.
With the patient in the erect posture.
With the patient lying down.

Visceral surface of the liver

This an image of the visceral surface of the liver.
Identify the following structures:
* right lobe
* fundus of the gall bladder
* cystic duct
* portal vein
* hepatic arteries
* common bile duct
* quadrate lobe
* ligamentum teres
* left lobe
* ligamentum venosum and its groove
* caudate lobe
* groove for the inferior vena cava and the cut hepatic veins within it
* porta hepatis outline in yellow. The area where the arteries, ducts and portal vein enter and leave the liver.

Pneumocystis Carnii-CT



The hallmark finding of PCP on HRCT scans is ground-glass attenuation, which is present in more than 90% of patients and represents an exudative alveolitis. The term ground-glass refers to parenchymal opacification, which does not obscure the underlying pulmonary architecture. This usually occurs in a bilateral, symmetric, predominantly perihilar distribution and may be geographic or mosaic in appearance, with areas of normal lung adjacent to areas of affected lung. Thickening of interlobular septa (due to edema) and foci of consolidation may be associated.

Bicipital Groove

The bicipital groove is an osseous groove formed in the humeral head by the medial and lateral tuberosities. It serves to retain the long head of the biceps brachii. In this project, we investigate the relationship between the 3D shape of the bicipital groove and the incidence of pathology of the long biceps tendon.


Bicipital groove segmentation from CT data.


Two views of a humeral head extracted from MRI, with the bicipital groove indicated.

A 40-year-old man with a jugular foramen tumor


A 40-year-old man presented with a one-year history of progressive hoarseness and swallowing difficulty. In the previous three months, he also complained of episodic headaches, mild unsteadiness, and decreased hearing on the right. He was a heavy drinker and a smoker but reported no weight loss or fevers. Physical examination findings included a diminished gag reflex, a tongue which was deviated to the right and atrophied, and a decreased shoulder shrug on the right. Basic labs and a chest X-ray were unremarkable. A computed tomography (CT) scan of the brain showed a destructive mass involving the skull base on the right side measuring about 6 x 4 cm (Figure 1). A CT scan of the neck showed a right jugular foramen mass with associated atrophic changes in the right genioglossus muscle (Figure 2).
The patient was taken to the operating room, and a highly vascular, solid tumor in the region of the right jugular foramen which encased cranial nerves IX, X, and XI was resected

ultrasound in trauma

video

Is Evidence-Based Medicine a Barrier to Cost-Effective Care?

August 29, 2007 presentation by Alan Garber for the Stanford School of Medicine Medcast lecture series.

Alan Garber, MD, PhD, professor of medicine and the director of the Center for Health Policy and of the Center for Primary Care and Outcomes Research at Stanford University, discusses the importance of distinguishing between a treatment's effectiveness and its value, and in turn what role evidence-based medicine should play in today's coverage decisions.

35 weeks pregnant ultrasound sonogram Breech baby

Epidural hematoma in CT

 Epidural hemoatomas (EDH) are almost always preceded by head trauma (as child hit in the side of head with football.And may have a "lucid interval" where he looks okay).

Epidural hemoatoma has a higher mortality than a subdural, because obviously this is an ARTERY. And so will be under high pressure- forming that "biconcave" appearence on CT.
The most common site of EDH is the temporoparietal region, where the middle meningeal arteryis lacerated.

CT Findings:
* Typical appearance is a biconvex, elliptical, extra-axial fluid collections.
* Acute EDH may contain both a hyperattenuating clot and a swirling lucency (believed to represent a mixture of active bleeding and the serum remaining after previous clot formation).
* Subacute EDH becomes homogeneously hyperattenuating.
* Chronic EDH is at least partly hypoattenuating as the clot undergoes breakdown and resorption.

Epidural hematoma in CT


Anatomy of the Heart and the Aorta

Information about the anatomy of the heart and the aorta. Provided by the Bicuspid Aortic Foundation to increase understanding of the heart valves and the aorta in the chest.

Radiograph findings in Rickets


Radiograph findings in Rickets



*Widening and cupping of the metaphyseal regions (the below x-ray)
Anteroposterior and lateral radiographs of the wrist of an 8-year-old boy with rickets demonstrates cupping and fraying of the metaphyseal region.

*Fraying of the metaphysis (the below x-ray)
Radiographs of the knee of a 3.6-year-old girl with hypophosphatemia depict severe fraying of the metaphysis.

*Craniotabes
*Bowing of long bones (see the images below)
Radiograph in a 4-year-old girl with rickets depicts bowing of the legs caused by loading.

*Development of knock-knees, or genu valgum (see the images below)
Radiograph of a leg with the patient in a standing position demonstrates knock-knees. The patient is an 11-year-old boy with treated vitamin D–resistant rickets.

*Development of scoliosis
*Impression of the sacrum and femora into the pelvis, leading to a triradiate configuration of the pelvis
*In healing rickets, the zones of provisional calcification become denser than the diaphysis. In addition, cupping of the metaphysis may become more apparent.
Source:www.emedicine.medscape.com

Achilles Tendon Ultrasound Technique

As the strongest tendon of the human body, the Achilles tendon originates from the soleus and gastrocnemius muscles, and inserts onto the posterior calcaneal tuberosity. The tendon is surrounded by a paratenon rather than a synovial sheath. Sonography is an efficient and accurate way to assess the Achilles tendon. Advantages of sonographic evaluation include cost, widely available equipment, ease of contralateral comparison, and the ability to image during joint motion.

Description of Ultrasound machine

Description of Ultrasound machine for ultrasound guided nerve block

Counting Ribs in CT Scan by Clavicle

In 1990, Bhalla et al presented a useful method for counting ribs on CT scans in which the bilateral clavicles were used as anatomic landmarks. The first step was to identify the first rib on the axial image that demonstrated the medial third of the clavicle (the Figure below). Bhalla et al also used the costovertebral articulation as a landmark for counting vertebral bodies.
Rib counting at CT with the clavicle as an anatomic landmark. Axial CT scan shows the medial third of the clavicle (*) and the relative position of the first two ribs (1, 2).

Identifying the first rib in relation to the clavicles is easy and precise; however, counting ribs from the clavicles is tedious for middle and lower rib lesions. Furthermore, counting thoracic vertebrae may be imprecise owing to partial volume effect.

Other methods: We can also use the xiphoid process, or the sternal angle as an anatomic landmark to determine the precise location of the ribs.

Musculoskeletal Ultrasound: How to Evaluate for Mortons Neuroma

The use of musculoskeletal ultrasound has been increasing. Ultrasound is well-established as a safe, cost-effective imaging tool in diagnosing and treating common musculoskeletal disorders. A musculoskeletal ultrasound program can enhance radiology practices by creating an environment that increases both patient and clinician satisfaction. The purpose of this new video article is to show that ultrasound is well-suited to evaluate for Mortons neuroma.

Pneumonia, on chest x-ray.

I

Causes of Vertebral scalloping

Causes of Vertebral scalloping






What is Vertebral scalloping ?
It is a concavity to the posterior (or less commonly anterior) aspect of the vertebral body when viewed in a lateral projection. A small amount of concavity is normal, as is concavity of the anterior vertebral body (see vertebral body squaring).

Posterior scalloping causes:
1- achondroplasia
2- an intraspinal masses, such as:
                                                           -spinal astrocytoma
                                                           -ependymoma
                                                           -spinal schwannoma
                                                           -neurofibroma as seen in neurofibromatosis type 1
3- dural ectasia as seen in:
                                               -neurofibromatosis type 1
                                               -a hereditary connective tissue disorder such as
  •  Marfan disease
  •  Ehlers-Danlos disease
  •  osteogenesis imperfecta tarda
4- mucopolysaccharidoses
5- acromegaly

Honeycomb Lung mneumonic

BIG HIPS

  • Bleomycin
  • Idiopathic
  • Granulomas
  • Histiocytosis X
  • Interstitial pneumonia
  • Pneumoconiosis
  • Sarcoid

Posterior Shoulder Dislocation-3D CT

Posterior Shoulder Dislocation- posterior dislocation is rare & should raise possibility of seizure as cause; other causes include an electric shock or ECT without muscle relaxants. Radiographs may reveal Reverse Hill Sach Lesion - compression fracture of the anteromedial portion of the humeral head is produced by the posterior cortical rim of the glenoid as in this case of 28 year old male, with posterior dislocation seen on 3D CT images.



Parotid Abscess

Right parotid gland is bulky and shows central necrotic area with air loculi within measuring around 3.8cm x 2.3cm. Surrounding fat planes with massetric space are lost.Findings indicate parotid abscess as described. Patient is 70 year old male, alcoholic.


64 Slice CT Scanner

Ochsner's 64 Slice Computed Tomography scan helps physicians diagnose and pinpoint heart attacks and strokes. Unlike an angiogram, the 64 slice CT Scan is non-invasive.