Radiology

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Aside from ultrasound, a digital radiography suite is going to be the most expensive upgrade for the private practitioner in the realm of diagnostic imaging. However, this expense will be well worth the investment from a diagnostic imaging standpoint. After more than a century of film and film screen imaging, the backdrop of diagnostic radiology has changed from hanging films on view boxes to LCD monitors.

Obvious thoracic disease need not be discussed here. Fulminating heart failure, pneumonia, advanced metastatic lung disease, severe pneumothorax and pleural effusion are reliably diagnosed radiographically. What I would like to share with you are the less obvious radiographic manifestations of acute cardio-respiratory disease and my approach to diagnosis. And remember, in the final assessment much can be learned from the presenting clinical signs. Does the patient have a cardiac murmur or history of heart disease? Was there an observed or suspected trauma?

Much can be learned about the gastrointestinal tact (GIT) by careful evaluation of survey abdominal radiographs. Survey radiographs of the abdomen in cases of GIT disease should always include the stomach, liver, and diaphragm. Stomach position, size, shape and contents are evaluated. The small intestine is assessed for position and distribution within the abdominal cavity, diameter, and luminal contents.

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Mediastinal abnormalities, including cardiac disease, are common causes of clinical signs related to the thorax. By definition, the mediastinum is the midline potential space formed between the two pleural cavities and includes the medial portions of the right and left parietal pleura (also called the mediastinal pleural) and the space formed between these serosal membranes.

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The normal thorax is well suited to radiographic evaluation because there is marked inherent contrast between the air-filled, fluid-filled, soft tissue, and bony structures that comprise the thoracic viscera and thoracic wall. As has been stated before, at least 2 orthogonal views of the thorax are required for complete and accurate interpretation. For routine evaluation of the thorax, either a right or left lateral projection, and a dorsoventral or ventrodorsal projection of the thorax are required.

Pulmonary patterns have the bane of radiology since the beginning (1896 that is). The most difficult concept to teach and the most difficult to learn, yet, the pattern itself is only part of the puzzle. The recognition that the disease is actual within the pulmonary parenchyma and not in the pleural space, extrathoracic structures or the mediastinum is the first step.

Aside from ultrasound, a digital radiography suite is going to be the most expensive upgrade for the private practitioner in the realm of diagnostic imaging. However, this expense will be well worth the investment from a diagnostic imaging standpoint. After more than a century of film and film screen imaging, the backdrop of diagnostic radiology has changed from hanging films on view boxes to LCD monitors.