#RADIOLOGY (NEET-PG)
Q- An 8-year old child was injected contrast in the hand for CECT chest. Immediately he developed swelling in the arm which gradually increased. After 4 hours, there was numbness and pain, and he was not allowing the doctor to flex the hand. Pulse is present. What should be done?
A. High dose prednisolone
B. Arterial thrombectomy
C. Immediate fasciotomy
D. Angiography
Answer is C. i.e. Immediate fasciotomy
▪️Immediate development of swelling in the arm after contrast injection with numbness and pain is highly suggestive of compartment syndrome due to extravasation of contrast medium. The best treatment is immediate fasciotomy so that contrast medium and fluid can be drained and the patient can be relieved.
▪️Extravasation of Contrast and Compartment Syndrome
▪️Extravasation of contrast is a possible complication of imaging studies performed with contrast.
▪️Most cases of subcutaneous extravasation occur due to small volumes of extravasation of contrast causing swelling and localized erythema that is rapidly resolved.
▪️If larger volumes are extravasated, extensive tissue and skin necrosis may occur. Compartment syndrome is a very rare complication.
▪️Acute compartment syndrome occurs when the tissue pressure within a closed muscle compartment exceeds the perfusion pressure and results in nerve and muscle ischemia.
▪️It typically occurs subsequent to a traumatic event, most commonly a fracture.
Clinical Features:
▪️Classic features: Pain (bursting sensation), altered sensibility, and paresis (or more usually, weakness in muscle contraction).
▪️Ischemic muscle is highly sensitive to stretch.
▪️If the limb is unduly painful, swollen, or tense, the muscles (which may be tender) should be tested by stretching.
Diagnosis:
Confirmation of the diagnosis can be made by measuring the intra-compartmental pressure.
Treatment:
Emergency fasciotomy.
Q- A person is hemiplegic and bed ridden for one year. Changes in bone mineral density are first seen in:
A. Distal radius
B. Proximal femur
C. Proximal humerus
D. Lumbar spine
Answer is C. Proximal humerus
The person is hemiplegic and bed-ridden for one year, changes in bone mineral density are first seen in the proximal humerus.
Osteoporosis in Hemiplegia:
▪️BMDs of proximal humerus, distal radius, femoral neck, and calcaneus bilaterally, and third lumbar vertebra, measured with dual-energy X-ray absorptiometry (DXA), were compared between affected and unaffected sides at admission and discharge.
▪️BMDs of the affected side is lower and most marked in the humerus.
Q- A person has an injury in the forefinger with glass and it is suspected that he has a retained piece of glass in his finger. What is the first investigation you will do?
A. MRI
B. CT scan
C. Plain radiograph
D. Ultrasonography
Answer is C: Plain radiograph
Plain films can be clinically beneficial in locating glass foreign bodies in deep wounds with or without exploration.
Glass Foreign Body :
▪️Patients with glass embedded in a wound are more likely to report the sensation of foreign bodies.
▪️In patients with the sensation of a foreign body, superficial wounds that have been adequately explored do not require radiography.
▪️Plain films can be clinically beneficial in locating glass foreign bodies in deep wounds with or without exploration
▪️In patients without sensation, the history can guide the decision for further investigation.
▪️All glass is radiopaque; however, there is limited ability for radiography to detect glass fragments smaller than 2 mm.
▪️Glass is inert and can be left in place if it is difficult to locate or remove.
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