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Mass lesions Mass lesions in muscle and soft tissue are examined by ultra - sound, which can be diagnostic in the majority of cases, thereby avoiding the need for further imaging. This is most often the case when a lesion is purely cystic and, as most soft-ti...

Metabolic bone disease Plain radiographs should be the first images of patients with metabolic bone disease. They may detect the subperiosteal erosions in hyperparathyroidism or, more commonly , the osteopenia in osteoporosis, but they cannot be used to quanti...

Metastases The demonstration of metastatic disease will usually signifi cantly a ff ect surgical management. Modern cross-sectional imaging has greatly improved the detection of metastases, but occult lesions will be overlooked in between 10% and 30% of patien...

Nodes Accurate assessment of nodal involvement remains a chal - lenge for imaging. Most imaging techniques rely purely on size criteria to demonstrate lymph node involvement, with no possibility of identifying micrometastases in normal-sized nodes. A size c...

Perforation The erect chest x-ray (CXR) is the ideal first test for hollow organ perforation and as little as 10–20 /uni00A0 mL of free air can be detected under the diaphragm ( Figures 8.37 and 8.38 ). About 10 minutes should be left between sitting the patie...

Plain radiographs Conventional radiography allows rapid assessment of the major injuries and can be carried out in the trauma room while the patient is clinically assessed and treated. Despite the time constraints, the number of sta ff involved and the restri...

REQUESTING IMAGING Best practice depends on close collaboration between the radiologist and the referrer and must take into account local expertise and access to facilities. When requesting imaging, consider what it is that you want to know from the investigat...

SURGERY Introduction Imaging is an integral part of musculoskeletal diagnosis. Image-guided, minimally invasive techniques also play a major role in treatment. In broad terms, radiographs are the best method of looking for bony lesions or injuries, MRI shows...

Skeletal trauma Musculoskeletal trauma is best imaged by an initial plain radiograph. All skeletal radiographs should be taken from two di ff erent angles, usually at right angles to each other. This is important in trauma because a fracture or dislocation may ...

The acute abdomen The term ‘acute abdomen’ encompasses many diverse entities. The acute abdomen The term ‘acute abdomen’ encompasses many diverse entities. The acute abdomen The term ‘acute abdomen’ encompasses many diverse entities.

Tumour In most published studies, cross-sectional imaging techniques (CT , ultrasound, MRI) are more accurate in staging advanced (T3, T4) than early (T1, T2) diseases, and the staging of early disease remains a challenge. In gut tumours, endoscopic ultra - s...

Ultrasound Ultrasound has an evolving role in the assessment of acutely traumatised patients. The main current roles of ultra sound include the assessment of intraperitoneal fluid and trauma [FAST]), the evaluation of pneumothoraces in supine patients and in...

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Vascular interventional radiology With the development and refinement of CT angiography - techniques, the diagnostic role of formal angiography has become limited. CT angiography is the first-line investigation for aortic trauma and for penetrating and non-pen...

ANAL FISSURE Definition An anal fissure (synonym: fissure- in - ano ) is a longitudinal ulcer in the anoderm of the distal anal canal ( Figure 80.17 ), which extends from the anal verge proximally towards, but not beyond, the dentate line.

ANAL INTRAEPITHELIAL NEOPLASIA AIN is a multifocal virally induced dysplasia of the perianal or intra-anal epidermis associated with HPV . Subtypes 6 and 11 are most often associated with warts and early AIN, whereas subtypes 16 and 18 account for more than 7...

ANATOMY AND PHYSIOLOGY OF THE ANAL CANAL Surgical anatomy The anal canal starts at the level where the rectum passes through the pelvic diaphragm, where the rectal ampulla suddenly narrows, and ends at the anal verge. The muscu lar junction between the rectum ...

ANORECTAL ABSCESSES Aetiology Acute sepsis in the region of the anus is common, more in men than women, although perianal infections with skin-type organisms (and thus unrelated to fistula) are evenly distributed. The cryptoglandular theory of intersphincteri...