Emergency Radiology
Emergency Radiology
This domain tests rapid recognition of life-threatening trauma and nontrauma emergencies: hemorrhage, pneumothorax, aortic injury, bowel ischemia, appendicitis, torsion, and fractures. Speed and prioritization matter.
Core rules
- Trauma: FAST detects free fluid; CT is for stable patients. Look for pneumothorax, hemothorax, lung contusion, aortic injury, and solid-organ laceration. Retroperitoneal hemorrhage may be subtle.
- Nontrauma: free intraperitoneal air suggests perforation; portal venous gas and pneumatosis suggest ischemia; appendicitis shows a dilated appendix with fat stranding.
- Vascular emergencies: aortic dissection, ruptured AAA, and pulmonary embolism require immediate communication.
- Torsion: ovarian torsion shows an enlarged ovary with peripheral follicles; testicular torsion shows absent or reversed flow and a twisted cord.
Worked example
A hypotensive patient after a motor vehicle crash has a positive FAST in Morison's pouch. Free fluid in a hemodynamically unstable trauma patient means hemoperitoneum until proven otherwise; laparotomy is indicated, not CT. CT would be appropriate only after stabilization.
Traps
Missing a subtle apical pneumothorax; overlooking retroperitoneal blood; attributing free air to recent surgery without checking; delaying surgery for imaging in an unstable patient; missing posterior fossa injury.