Core Curriculum Illustration Project (CCIP)

I. Objectives

To define the content structure and study plan for the instruction of radiology residents rotating through emergency radiology rotations, and for fellows in emergency radiology, during their emergency radiology fellowship year.

II. Curriculum and Recommendations for Study

II.A. Central Nervous System

Central Nervous System – James M. Provenzale, MD

1. Skull fractures

2. Extra-axial hemorrhages

a. subdural hematoma
b. epidural hematoma

3. Parenchymal injuries
a. cortical contusion
b. diffuse axonal injury
c. deep gray matter injury
d. brainstem injury

4. Subarachnoid hemorrhage

5. Vascular injuries

6. Penetrating injuries

7. Herniation syndromes

8. Cerebral infarction
a. arterial infarction
b. venous infarction
c. diffusion imaging appearance
d. perfusion imaging appearance

9. Non-traumatic hemorrhage
a. subarachnoid hemorrhage
b. parenchymal hemorrhage

10. Central nervous system infections
a. meningitis
b. encephalitis
c. abscess/cerebritis
d. subdural empyema
e. spinal epidural abscess
f. osteomyelitis/discitis

11. Dural sinus thrombosis

12. Reversible posterior leukoencephalopathy syndrome

13. Pituitary apoplexy

14. Spinal trauma
a. spinal cord contusion
b. spinal epidural hematoma
c. nerve root avulsion

CREDITS:
AUTHOR: JAMES M. PROVENZALE, MD
CASE ILLUSTRATION EDITORS: MICHELE H. JOHNSON, MD;
ALEXANDER B. BAXTER, MD
SUGGESTED READINGS:
Cerebral Infarction

Sorensen AG, Bounanno FS, Gonzalez RG, et al. Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynanically weighted echo planar MR imaging. Radiology 1996; 199:391-401

Truwit CL, Barkovich AJ, Gean-Marton A, Hibri , Norman D. Loss of the insular ribbon: another early CT sign of acute middle cerebral artery infarction. Radiology 1990; 176: 801-806

Tomsick TA, Brott TG, Chambers AA, et al. Hyperdense middle cerebral artery sign on CT: efficacy in detecting middle cerebral artery thrombosis. AJNR 1990; 11: 473-477

Elster AD, Moody DM. Early cerebral infarction: Gadopentate dimeglumine enhancement. Radiology 1990; 177: 627-632

Provenzale JM, Sorensen AG. Diffusion-weighted MR imaging in acute stroke: Theoretical considerations and clinical applications. AJR 1999; 173:1459-1468

Carotid and Vertebral Artery Dissection

Levy C, Laissy JP, Raveau V, et al. Carotid and vertebral artery dissections: Three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography. Radiology 1994; 190:97-103

Leclerc X, Godefroy O, Salhi A, Lucas C, Leys D, Pruvo JP. Helical CT for the diagnosis of extracranial carotid artery dissection. Stroke 1996; 27:461-466

Provenzale JM. Dissection of the internal carotid and vertebral arteries: Imaging findings. AJR 1995; 165:1099-1104

Intracranial Hemorrhage

Weisberg LA. Subcortical lobar intracerebral hemorrhage: clinical-computed tomographic correlations. J Neurol Neurosurg Psychiatry 1985; 48:1078

Kase CS, Caplan LR (eds). Intracerebral hemorrhage. Butterworth-Heinemann, Boston, 1994

Meyer JT, Gorey MT. Differential diagnosis of nontraumatic intracranial hemorrhage. Neuroimaging Clin North Am 1998;8:263-293

Dural Sinus Thrombosis

Zimmerman RD, Ernst RJ. Neuroimaging of cerebral venous thrombosis. Neuroimaging Clin North Am 1992;2:463-485

Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S. The empty delta sign: Frequency and significance in 76 cases of dural sinus thrombosis. Radiology 1987;162:779-785

Casey SO, Alberico RA, Patel M, et al. Cerebral CT venography. Radiology 1996;198:163-170

Provenzale JM, Joseph GJ, Barboriak DP. Dural sinus thrombosis: findings on CT and MR imaging and diagnostic pitfalls. AJR 1998;170:777-783

Reversible Posterior Leukoencephalopathy Syndrome (Hypertensive Encephalopathy)

Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500

Schwartz RB, Mulkern RV, Gudbjartsson H, Jolesz F. Diffusion-weighted MR imaging in hypertensive encephalopathy: Clues to pathogenesis. AJNR 1998; 19:859-862

Brain and Spine Trauma

Gentry LR, Godersky JC, Thompson B. MR imaging of head trauma: Review of the distribution and radiopathologic features of traumatic lesions. AJNR 1988; 9:101-110

Gentry LR. Godersky JC. Thompson B. MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. AJR. 150:663-72, 1988

Gentry LR, Godersky JC, Thompson B. Traumatic brainstem injury: MR imaging. Radiology 1989; 171: 177-187

CNS Infections

Post MJD, Quencer RM, Montalvo BM, et al. Spinal infection: evaluation with MR imaging and intraoperative US. Radiology 1988;169:765-771

Chang KH, Han MH, Roh JK, et al. Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT. AJNR 11:69-76, 1990

II.B. Face & Neck

Face & Neck – James Rhea, MD, MBA, FACR*; Diego Nuñez, MD, MPH*

1. Facial fractures

a. Orbital fractures

Blow-out fracture

Blow-in fracture

Orbital apex fracture

b. Zygoma fractures

Isolated arch fracture

Zygomatic complex fracture

c. Nasal fractures

d. Naso-orbital-ethmoid fractures

Posteriorly displaced

Telescoped

e. Frontal fractures

f. Maxillary fractures

Dentoalveolar fractures

Maxillary sagittal fractures

LeFort fractures

g. Mandible fractures

2. Soft tissue injuries of the orbit

a. Post bulbar emphysema and hemorrhage

b. Extraocular muscle entrapment

c. Ocular injuries

Rupture

Laceration

Lens dislocation

Vitreous hemorrhage

Subchoroidal hemorrhage

3. Trauma to the aerodigestive tract

a. Laryngeal trauma

b. upper esophageal injuries

4. Infection of the paranasal sinuses

a. Acute rhinosinusitis

b. Aggressive fungal sinusitis

c. Chronic and allergic sinusitis

d. Complications

1. cellulitis

2. orbital subperiostial abscess

3. osteomyelitis

4. epidural abscess

5. subdural empyema

6. cavernous sinus thrombosis

5. Acute Infection of the suprahyoid neck

a. retropharyngeal and prevertebral abscess and inflammation (edema)

b. tonsillitis and tonsilar/peritonsilar abscess

c. Odontogenic infections

1. masticator abscess

2. submandibular abscess

3. sublingual abscess

d. Ranula

e. Parotitis

f. submandibular sialoadenitis

g. Ludwig’s angina and cervical necrotizing fascitis.

6. Acute infections of the infrahyoid neck

a. epiglotitis

b. croup

c. lymphadenitis and suppurative adenopathy

d. jugular thrombophebitis

7. Ear Infections

a. External otitis

b. Cholesteatoma

c. otomastoiditis

d. otitis media

e. apical petrositis

8. Orbital infection

a. orbital cellulitis

b. orbital pseudotumor

c. optic neuritis

CREDITS:
AUTHORS: JAMES T. RHEA, MD, MBA, FACR*; DIEGO NUNEZ, MD, MPH*
CASE ILLUSTRATION EDITOR: CHRISTOPHER A. POTTER, MD
*Fellow of the American Society of Emergency Radiology (FASER)

SUGGESTED READINGS:
LeFort, R: E’tude experimentale sur les fractures de la machoire superieure. Rev Chir 23:208-227, 360-379, 479-507, 1901

Rhea JT, Rao PM, Novelline RA, Helical CT and three-dimensional CT of facial and orbital injury, Radiologic Clinics of North America 37:489-513, 1999

Novelline RA, Head and neck CD-ROM, RSNA, Chicago, 1996

Novelline RA, Rao PM, Rhea J, Sacknoff R, Lawrason N, CT diagnosis of orbital and ocular trauma, Radiographics CD-ROM, Neuroradiology teaching atlas, 1996

Lawrason JN, Diagnostic imaging of facial trauma, In: Imaging in trauma and critical care, Mirvis SE, Young JWR, editors, Williams and Wilkins, Baltimore MD, 243-290, 1992

Harris JH, Face, including intraorbital soft tissues; and Castillo M, Acute conditions of the intraorbital soft tissues, In: The Radiology of Emergency Medicine, Harris JH, Harris WH, Novelline RA, editors, Williams and Wilkins, Baltimore MD, 36-119 and 121-126, 1993

Gean AD, Maxillofacial trauma, In: Imaging of head trauma, Gean AD editor, Raven Press, NY NY, 427-495, 1994

Som PM, Curtin HD, Head and neck imaging, Mosby, St. Louis, 1996

II.C. Spine

Spine – Diego B. Nuñez, MD, MPH*

Initial assessment issues = “Clearance” in the Emergency Department
– The evaluation of low-risk patients
– The evaluation of high-risk patients (multitrauma)
– The evaluation in patients with neurologic deficits

Concept and Assessment of Instability
Concept: Mechanism of injury, radiographic patterns, normal variants, frequently associated injuries.

1. Cranio-cervical / C1-C2
a. Occipital condyle fracture
b. Atlanto-occipital dislocation / subluxation
c. Jefferson burst fracture
d. Atlanto-axial rotary fixation
e. C1 – posterior arch
f. Dens fracture
g. Hangman’s fracture

2. C3-T1
a. Anterior subluxation / whiplash syndromes
b. Hyperextension sprain / spinal cord injury without radiographic abnormalities (Case 1) (Case 2)
c. Wedge compression, spinous process fractures
d. Burst compression
e. Flexion tear drop fracture
f. Bilateral facet dislocation
g. Unilateral facet dislocation
h. Articular mass and transverse process fractures (Case 1) (Case 2)
i. Traumatic isolation of articular pillar / pedicolumnar separation
j. Corner Avulsion Fracture (extension teardrop)
k. Laminar fractures
l. Facet dislocation with fracture
m. Acute ligamentous injuries

3. Thoraco-lumbar spine trauma
a. Compression fracture
b. Burst Fracture
c. Chance fracture
d. Complex fracture-dislocation
e. Pathological fracture

4. Traumatic injuries to intervertebral disks

5. Ostoemyelitis / discitis

6. Epidural abscess

7. Disk herniation

8. Other

CREDITS:
AUTHOR: DIEGO B. NUNEZ, MD, MPH*
CASE ILLUSTRATION EDITOR: NAGA R. CHINAPUVVULA, MD
*Fellow of the American Society of Emergency Radiology (FASER)

SUGGESTED READINGS:
Young JWR: Cervical spine trauma. (In) Imaging in Trauma and Critical Care, Mirvis SE & Young JWR (eds); Williams & Wilkins; Baltimore, MD; 1992, pp 291-379.

Berquist TH: Spinal trauma. (In) Trauma Radiology, McCort JJ & Mindelzun RE (eds); Churchill Livingstone; New York; 1990, pp 31-63(74).

Spine, including soft tissues of the pharynx and neck. (In) The Radiology of Emergency Medicine. Harris JH, Harris WH, (eds); Williams & Wilkins, Baltimore; 1999, pp 137-298.

Harris JH: Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR 1994;162:881-886,887-892

Rogers LF: Fractures of the sacrum. (In) Radiology of Skeletal Trauma (2nd Ed), Rogers LF (ed); Churchill Livingstone, New York; 1992, pp 1019-1023

II.D. Chest

Chest – Steven L. Primack, MD

1. Chest trauma
      a. Rib fractures
      c. Hemothorax
      d. Pneumothorax and pneumomediastinum
      e. Mediastinal hemorrhage
      f. Pulmonary contusion, laceration, hematoma (Case 1) (Case 2) (Case 3)
      g. Tracheobronchial injury
      h. Esophageal tear

      i. Diaphragm injury 

3. Acute pulmonary infections (Case 1) (Case 2) (Case 3) (Case 4) (Case 5)

5. Airway foreign bodies 

6. Obstructive airway disease 

7. ARDS: near-drowning, fat embolism syndrome 

8. Esophageal rupture 

CREDITS:

AUTHOR: STEVEN L. PRIMACK
CASE ILLUSTRATION EDITOR: PATRICK D. MCLAUGHLIN, MBBCH, BAO

SUGGESTED READINGS:

Penetrating and Nonpenetrating Chest Trauma. (In) Diagnosis of Diseases of the Chest, Fourth Edition. Fraser RS, Müller NL, Colman N, Paré PD; W.B. Saunders, Philadelphia; 1999, pp 2611-2657.

Chest. (In) The Radiology of Emergency Medicine, Fourth Edition. Harris, JH, Harris, WH; Lippincott, Williams & Wilkens, Philadelphia; 2000, pp 437-581

Chest Trauma. (In) Imaging of Diseases of the Chest, Second Edition. Armstrong P, Wilson AG, Dee P, Hanell DM; Mosby, St. Louis; 1995, pp 869-893.

Thrombosis and Thromboembolism. (In) Diagnosis of Diseases of the Chest, Fourth Edition. Fraser RS, Müller NL, Colman N, Paré PD; W.B. Saunders, Philadelphia; 1999, pp 1773-1843.

Shanmuganathan K, Mirvis S. Imaging diagnosis of nonaortic thoracic injury. The Radiologic Clinics of North America 1999; 37:533-551.

Imaging of Thoracic Trauma. Primack SL, guest editor. Journal of Thoracic Imaging, April 2000. (symposium issue)

Kuhlman JE, Pozniak MA, Collins J, Knisely BL. Radiographic and CT findings of blunt chest trauma: Aortic injuries and looking beyond them. RadioGrapics 1998; 18:1085-1106.

Van Hise ML, Primack SL, Israel RS, Müller NL. CT in blunt chest trauma: indications and limitations. RadioGraphics 1998; 18:1071-1084.

Shackleton KL, Stewart ET, Taylor AJ. Traumatic diaphragmatic injuries: spectrum of radiographic findings. RadioGraphics 1998; 18:49-59.

Karabulut N, Goldman LR. The role of helical CT in the diagnostic work-up for pulmonary embolism. Emergency Radiology 1999; 6:10-16.

Goodman LR. Lipchik RJ, Kuzo RS. Acute pulmonary embolism: the role of computed tomographic imaging. J Thorac Imaging 1997; 12:83-86.

Greaves SM, Hart EM, Aberle DR. CT of pulmonary thromboembolism. Semin Ultrasound CT MR 1997; 18:323-337.

II.E. Cardiovascular

Cardiovascular – Stuart E. Mirvis, MD, FACR*

1. Myocardium and Pericardium
       a. Myocardial infarction
       b. Myocardial laceration
       c. Myocardial contusion
       d. Pericardial effusion – tamponade
       e. Pneumopericardium – tamponade 

2. Aorta
    a. Aortic trauma
    b. Aortic dissection (Case 1) (Case 2) (Case 3)
3. Pulmonary Edema – Various etiologies

4. Thrombo-embolic disease
     b. Pulmonary embolism

CREDITS:

AUTHOR: STUART E. MIRVIS, MD, FACR*
CASE ILLUSTRATION EDITOR: JAMLIK-OMARI JOHNSON, MD

*Fellow of the American Society of Emergency Radiology (FASER)

 

SUGGESTED READINGS:

James CA. Magnetic resonance angiography in trauma. Clin Neurosci 1997;4:137-145

Harris JA, Bis KG, Glover JL, Bendick PJ, Shetty A, Brown OW. Penetrating atherosclerotic ulcers of the aorta. J Vasc Surg 1994:90-98.

Coady MA, Rizzo JA, Hammond GL, et al. Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it? J Vasc Surg 1998;27:1006-1015.

Gavant ML. Helical CT grading of trauamtic aortic injuries. Impact on clinical guidelines for medical and surgical management. Radiol Clin N Am 1999;37:553-574.

Akbar K, Smith DC, Bansal RC, Catalano RD. Angiography in blunt thoracic aortic injury. J Trauma 1997;42:665-669.

Fabian TC, Richardson JD, Croce MA et al. Prospective study of blunt aortic injury: Multicenter trial of the American Association for the Surgery of Trauma. J Trauma 1997;42:374-380.

Sommer T, Fehske W, Holzknecht N, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology 1996;199:347-352.

Wicky S, Capasso P, Meuli R et al. Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury. Eur Radiol 1998;8:828-833.

Patel NH, Stephens KE Jr., Mirvis SE, et al. Imaging of acute thoracic aortic injury due to blunt trauma: a review. Radiology 1998:209;335-348.

Torossov M, Singh A, Fein SA. Clinical presentation, diagnosis, and hospital outcome of patients with documented aortic dissection: the Albany Medical Center experience, 1986 – 1996. Am Heart J 1999;137:154-161.

Sebastia C, Pallisa E, Quiroga S, et al. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics 1999;19:45-60.

Creasy JD, Chiles C, Routh WD, Dyer RB. Overview of traumatic injury of the thoracic aorta, Radiographics 1997;17:27-45.

Sarasin FP, Louis-Simonet M, gaspoz JM, Junod AF. Detecting acute dissection in the emergency department: time constraints and choice of the optimal diagnostic test. Ann Emerg Med 1996;28:278-288.

Duvernoy O, Coulden R, Yitterberg C. Aortic motion: a potential pitfall in CT imaging of dissection in the ascending aorta. J Comput Assist Tomogr 1995;19:569-572.

Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993;328:1-9.

Fisher RG, Sanchez-Torres M, Thomas JW, Whigham CJ. Subtle and atypical injuries of the thoracic aorta and brachiocephalic vessels in blunt thoracic trauma. Radiographics 1997;17:835-839.

Fultz PJ, Melville D, Ekanei A, et al. Nontraumatic rupture of the thoracic aorta: chest radiographic features of an often unrecognized condition. AJR 1998;171:351-357.

Tennant WG, Hartnell GG, Baird RN, Horrocks M. Inflammatory aortic aneurysm: characteristic appearance on magnetic resonance imaging. Eur J Surg 1992;6:399-402.

Von Kodolitsch Y, Simic O, Nienaber CA. Aneurysms of the ascending aorta: diagnostic features and prognosis in patients with Marfan’s syndrom versus hypertension. Clin Cardiol 1998;21:817-824..

Halliday KE, al-Kutoubi A. Draped aorta: CT sign of contained leak of aortic aneurysms. Radiology 1996;199:41-43.

Vogelzang RL, Sohaey R. Infected aortic aneurysm: CT appearances. J Comput Assist Tomogr 1988;12:109-112.

Van de Wal HJ, Draaisma JM, Vincent JG, Goris RJ. Rupture of the supradiaphragmatic inferior vena cava by decelerating trauma: case report. J Trauma 1990;30:111-113.

Walsh A, Snyder HS. Azygous vein laceration following a vertical deceleration injury. J Emerg Med 1992;10:35-37.

Killeen KL, Poletti PA, Shanmuganathan K, Mirvis SE. CT diagnosis of cardiac and pericardial injuries. Emerg Radiol 1999;6:339-344.

Oliver TB, Murchison JT, Reid JH. Spiral CT in acute non-cardiac chest pain. Clin Radiol 1999;54:38-45.

Flamm SD, VanDyke CW, White RD. MR imaging of the thoracic aorta. Magn Reson Imaging Clin N Am 1996;4:217-235.

Ho VB, Prince MR. Thoracic MR aortography: imaging techniques and strategies. Radiographics 1998;18:287-309.

II.F. Abdomen

Abdomen – O. Clark West, MD, FACR*

1. Abdominal Trauma
        a. Hemoperitoneum and intraperitoneal fluid
        c. Retroperitoneal hemorrhage
        d. Gas collections: intraperitoneal and retroperitoneal
        e. Active arterial extravasation on CT
        f. Splenic injuries
        g. Liver injuries
        h. Gallbladder and biliary injuries
        i. Bowel injuries
        j. mesenteric injuries
        k. Pancreatic injuries
        l. Renal injuries
       m. Adrenal injuries
       n. Bladder injuries: intraperitoneal and extraperitoneal
2. Non-traumatic Abdominal Emergencies
      a. The peritoneal cavity
           Ascities
           Peritonitis
           Abdominal abscess
       b. Liver and biliary tract
          Jaundice: obstructive and non-obstructive
          Cholecystitis
       c. Pancreatitis
       d. Urinary tract
           Urinary stones
           Infection
           Pyelonephritis
           Renal abscess
       e. Adrenal hemorrhage
       f. Gastrointestinal tract
          Gastrointestinal hemorrhage
          Bowel obstruction
          Bowel infarction
          Bowel infection
          Appendicitis
          Diverticulitis
          Infectious enteritis and colitis
      g. Epiploic appendagitis
      h. Inflammatory bowel disease
          Crohn disease

          Ulcerative colitis 

CREDITS:

AUTHOR: O. CLARK WEST, MD, FACR*
CASE ILLUSTRATION EDITOR(S): 
                 SCOTT D. STEENBURG, MD (ABDOMEN TRAUMA) 


*Fellow of the American Society of Emergency Radiology (FASER)

SUGGESTED READINGS:

 Baker SR, Cho KC, The Abdominal Plain Film with Correlative Imaging. Stamford, CT: Appleton & Lange,  1999.

 Jeffrey RB, Jrl, Ralls PW. CT and Sonography of the Acute Abdomen. 2nd ed. Philadelphia: Lippincott-  Raven, 1996.

 McKenney KL. Ultrasound of Blunt Abdominal Trauma, The Radiology Clinics of North America 1999; 37-  879-894.

 Novelline RA, Rhea JT, Bell T. Helical CT of Abdominal Trauma. The Radiology Clinics of North America  1999; 37; 591-612.

 Rao PM, Rhea JT, Novelline RA. Helical CT of Appendicitis and Diverticulitis. The Radiology Clinics of  North America 1999; 895-910

 Smith RC, Levine J, Rosenfeld AT, Helical CT of Urinary Tract Stones: Epidemiology, Origin,  Pathophysiology, Diagnosis and Management. The Radiology Clinics of North America 1999; 37: 911-  952.

 West OC, Jarolimek AM. Abdomen: Traumatic Emergencies In: The Radiology of Emergency Medicine.  4th ed. Philadelphia: Lippincott Williams & Wilkins, 2000:689-724.

 West OC, Tamm EP, Kawashima A, Jarolimek AM. Abdomen: Non-traumatic Emergencies In: The  Radiology of Emergency Medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2000:583-657

II.H. Male Genitourinary

Male Genitourinary – Stanford M. Goldman, MD, FACR*

1. Urethral and penile trauma 

2. Urethral foreign bodies 

3. Urethral stones 

4. Scrotal and testicular trauma 

5. Acute non-traumatic scrotal conditions
     a. Testicular torsion
     b. Epididymitis
     c. Orchitis
     d. Acute fluid collections (Hydrocele, hematocele, pyocele)
     e. Epididymoorchitis
     f. Infarction
     g. Abcess

     h. Fornierís Gangre

CREDITS:
AUTHOR: STANFORD M. GOLDMAN, MD, FACR*
CASE ILLUSTRATION EDITOR: TATIANA C. ROCHA, MD

*Fellow of the American Society of Emergency Radiology (FASER)

SUGGESTED READINGS:

Dunnick NR, Sandler CM, Amis ES Jr: Newhouse Textbook of Uroradiology 3rd Edition. Baltimore Williams and Wilkins 2000. Chapters on Urethra & Penis; Scrotum & Contents (to be published).

Mitty HA, Fritzche P, Dunnick NR, Sandler CM, Goldman SM: Genitourinary Tract disease Syllabus (4th ) series), Vol 30. American College of Radiology, Reston, Virginia, 1992. Pp 2-23.

Goldman SM, Sandler CM, Corriere JN Jr, McGuire EJ: Blunt Urethral Trauma: A New Unified Anatomical-Mechanical Classification. J Urol 157: 85-89, 1997.

Rumack CM, Wilson SR, Charboneau JW: Diagnostic Ultrasound 2nd Edition. Mosby-yearbood, St. Louis, Missouri, pp 812-821. 1998

II.I. Upper Extremity

Upper Extremity – F. A. Mann, MD

1. Scapulothoracic dissociation 

2. Clavicle fractures and dislocations
      a. Dislocations
          Sternoclavicular
          Acromioclavicular 

3. Glenohumeral dislocations 

4. Scapular fractures 

5. Humerus fractures
     a. Proximal (head & neck)
     b. Shaft
     c. Supracondylar
         extra articular, including epicondyles
6. Elbow dislocations 

7. Forearm fractures & dislocations
      1. Fractures
          a. Processes
              1. coronoid process
              2. Radial tubercle
          b. Distal radius
              1. Colles, Smith, Barton types
              2. Die-punch fracture radiolunate fossa
          c. Defensive injuries to ulna, including classic nightstick
     2. Single bone fracture with associated dislocation non fractured bone
         a. Monteggia
         b. Galeazzi
         c. Essex-Lopresti
    3. Dislocations
        a. Elbow
        b. Distal radioulnar joint 

9. Carpal dislocations and malalignments
    a. Perilunate spectrum
    b. Carpal instability patterns 

10. Metacarpal fractures (Case 1) (Case 2)
      a. Carpometacarpal fracture dislocations, including Fightersí equivalent fractures
      b. Extra articular fractures of the base, shaft and neck 

       a. Dislocations
           Simple
           Complex
           Ligament injuries, including those of the extensor mechanism, collateral ligaments
       b. Fractures
           Extra articular
           Intra articular
           Volar plate
           Mallet type
           Amputations

CREDITS:

AUTHOR: FRED A. MANN, MD*
CASE ILLUSTRATION EDITOR: JAMAL BOKHARI, MD

*Fellow of the American Society of Emergency Radiology (FASER)

SUGGESTED READINGS:

Rogers LF. Radiology of Skeletal Trauma (Second Edition).Churchill Livingston, New York; 1992.

Harris JH, Harris WH, The Radiology of Emergency Medicine. Williams & Wilkins, Baltimore, MD, Fourth Edition, 2000.

McCort JJ, Trauma Radiology. Churchill Livingstone, New York, NY.1990.

Novelline RA. Advances in Emergency Radiology, Volumes II, Radiological Clinics of North America. WB Saunders, Philadelphia, PA, 1999.

West OC, Novelline RA, Wilson AJ, Categorical Course Syllabus on Emergency and Trauma Radiology. American Roentgen Ray Society, 2000.

II.J. Pelvis & Hip

Pelvis & Hip – John H. Harris, Jr., MD, DSc*

A. Pelvis
    1. Fractures of isolated bones of the pelvis that do not involve the pelvic ring 
        a. iliac wing (Duvrney) 
        b. sacrum c. coccyx 
        d. avulsion ant. sup. iliac crest apoph. – sartorius m 
            ant. inf. iliac crest apoph. – rectus femoris m 
            ischial tuberosity – hamstring ms
            lesser troch. apoph. (femur) – iliopsoas 

     2. Pelvic ring disruption
         Disruption, ie., fracture or diastasis at two or more sites of the anterior and posterior pelvic arcs. 
         a. Mechanism of injury 
             lateral compression 
             anteroposterior compression 
             discrete: straddle injury 
             diffuse: open-book pelvic ring disruption vertical shear 
          b. Types of pelvic ring disruption 
              Malgaigne (ipsilateral) 
              bucket – handle (contralateral) 
              open – book 
              other fracture patterns without eponym 

3. Insufficiency fractures anterior pelvic arch sacrum 

4. Stress fractures 

5. Acetabular fractures 
    (Involve only one side of pelvic ring. Occur concomitantly with PRD in approximately 12%). 
a. posterior column rim (most common)
b. anterior column 
c. both columns – above, or through, acetabulum but spare the lunate surface 
d. transverse (“T”) “T” with ant. column extension “T” with post. column extension

B. Hip 
    1. Dislocation 
        a. Posterior or posterosuperior pure fracture-dislocation. 
            Fracture involves posterior or posterosuperior acetabular rim 

        b. Anterior (obturator) 
        c. Central 
    2. Fractures (usually associated with dislocation). 
        a. Posterior or posterosuperior acetabular rim (Case 1) (Case 2) 
        b. Anterior (Involve the acetabular “tear-drop”) 
        c. Central

C. Proximal femur 
    1. Slipped capital femoral epiphysis (SCFE) 
    2. Salter-Harris physeal injuries 
    3. Fractures 
        a. Head – usually associated with hip dislocation 
        b. Neck subcapital transcervical basicervical 
        c. Trochanteric intertrochanteric
            2 – part (proximal/distal fragments) 
            3 – part (prox./distal + 1 trochanter) 
            4 – part (prox./distal + each trochanter) 
                 subtrochanteric isolated fracture, greater trochanter

4. Avascular necrosis 
   Stage I – radiograph negative 
   Stage II – inhomogeneity of femoral head 
   Stage III – Progressive inhomogeneity; trabecular disruption; 
                    “crescent” sign; subcondral cortical disruption. 
   Stage IV – fragmentation of head

 

CREDITS:

AUTHOR: JOHN H. HARRIS, JR., MD, DSC*
CASE ILLUSTRATION EDITOR: MANICKAM KUMARAVEL, MD, FRCR

*Fellow of the American Society of Emergency Radiology (FASER)

SUGGESTED READINGS:

Berquist TH, Coventry MB. The Pelvis and Hip. (In) Imaging of Orthopedic Trauma, 2nd ed.

Berquist TH, ed. Raven Press, 1992. Hip: 260-269; Pelvis: 228-240; Acetabulum; 240-246; Proximal femur: 269-272; 285-289.

Pelvis, acetabulum and hips. (In) The Radiology of Emergency Medicine. Harris JH, Harris WH,(eds); Williams & Wilkins, Baltimore; 2000, pp 725-814.

Young JWR: Fractures of the pelvis. (In) Imaging in Trauma and Critical Care, Mirvis SE & Young JWR (eds); Williams & Wilkins; Baltimore, MD; 1992, pp 380-420

Daffner RH: Pelvic trauma. (In) Trauma Radiology, McCort JJ & Mindelzun RE (eds); Churchill Livingstone; New York; 1990, pp 339-380

(In) Radiology of Skeletal Trauma (2nd Ed), Rogers LF (ed); Churchill Livingstone, New York; 1992; Fractures of the acetabulum, pp 1051-1074

Routt ML: Pelvic Fractures. & Mayo KA: Hip Joint: Acetabular Fractures. (In) Orthopaedic Trauma Protocols, Hansen ST & Swiontkowski MF (eds); Raven Press, New York, 1993; pp 225-236 & 243-254.

II.K. Lower Extremity

Lower Extremity – Eric A. Brandser, MD*

1. Femoral shaft fractures

2. Patella fractures 

3. Tibial plateau fractures 

4. Tibial spine avulsion fractures 

5. Cruciate and other ligamentous injuries of the knee 

6. Meniscus tears
    a. Bucket handle tear 
    b. Radial tear 

7. Knee dislocations 

8. Tibial stress fractures 

9. Tibial and fibular shaft fractures 

10. Tibial plafond fracture (pilon fractures) 

11. Ankle mortise injury 

12. Calcaneal fractures 

13. Achilles tendon and ligamentous injuries of the ankle 

14. Talus fractures 

15. Talar and subtalar dislocations 

16. Tarsal fractures 

17. Tarso-metatarsal fracture dislocations (Lisfrancís fracture) 

18. Metatarsal fractures 

19. Toe fractures 

20. Septic arthritis 

21. Muscle injuries 

22. Compartment syndrome 

23. Diabetic muscle infarction 

24. Diabetic foot infections 

CREDITS:

AUTHOR: ERIC A. BRANDSER, MD*
CASE ILLUSTRATION EDITOR: BHARTI KHURANA, MD

*Fellow of the American Society of Emergency Radiology (FASER)

SUGGESTED READINGS:

Radiology of Skeletal Trauma (2nd Ed), Rogers LF (ed); Churchill Livingstone, New York; 1992.

Harris JH, Harris WH, The Radiology of Emergency Medicine. Williams & Wilkins, Baltimore, MD, Fourth Edition, 2000.

McCort JJ, Trauma Radiology. Churchill Livingstone, New York, NY.1990.

Novelline RA. Advances in Emergency Radiology, Volumes II, Radiological Clinics of North America. WB Saunders, Philadelphia, PA, 1999.

West OC, Novelline RA, Wilson AJ, Categorical Course Syllabus on Emergency and Trauma Radiology. American Roentgen Ray Society, 2000

II.L. Pediatric

Pediatric – Carlos J. Sivit, MD*

1. Brain
    A. Trauma 
        1. Cephalohematoma and capput succinadeum 
        2. Unintentional blunt and penetrating 
        3. Intentional (Battered child) 
    B. Infection 
        1. TORCH infections 
        2. Meningitis, cerebritis, cerebral abscess 
        3. Mastoiditis 
    C. Non-traumatic hemorrhage 
        1. Neonatal germinal matrix hemorrhage 
        2. AVM, aneurysm, moya-moya, coagulation disorders 
    D. Cerebral ischemia 
        1. Perinatal brain injury 
        2. Sickle cell disease 
    E. Imaging the child with seizures 

2. Head & Neck 
    a. Trauma 
        1. Facial (orbit, zygoma, maxilla, mandible, frontal, nasal) 
    b. Infection 
        1. Croup 
        2. Epiglottitis 
        3. Retropharyngeal abscess 
        4. Parotitis 
        5. Orbital cellulitis 

3. Spine 
    a. Trauma 
        1. Cervical spine 
        2. Thoracic spine 
        3. Lumbar spine 
     b. Infection 
        1. Osteomyelitis/discitis 
        2. Epidural abscess 
     c. Miscellaneous 
        1. Imaging the child with acute back pain 

4. Chest 
    a. Trauma 
        1. Pulmonary contusion/laceration 
        2. Thoracic air leak 
        3. Mediastinal hemorrhage 
        4. Esophageal and airways injury 
        5. Chest wall injury 
     b. Infection 
        1. Pneumonia 
            a. Neonatal pneumonia 
            b. Bacterial pneumonia 
            c. Viral pneumonia 
            d. Opportunistic infection 
         2. Empyema & pleural disease 
      c. Foreign body aspiration 
      d. Neonatal respiratory distress 
          1. Respiratory distress syndrome 
          2. Meconium aspiration syndrome 
          3. Transient tachypnea of the newborn
       e. Congenital heart disease 
       f. Congestive heart failure and pulmonary edema 

5. Abdomen 
    a. Trauma 
        1. Solid viscus injury 
        2. Hollow viscus injury 
        3. Peritoneal fluid, hemoperitoneum & active hemorrhage 
        4. Hypoperfusion complex
    b. Non-traumatic hemorrhage 
        1. Adrenal hemorrhage 
    c. Infection/Inflammation 
        1. Appendicitis 
        2. Pancreatitis 
        3. Cholecystitis 
        4. Cholangitis 
        5. Pyelonephritis 
    d. Bowel obstruction 
        1. Midgut malrotation 
        2. Bowel atresias 
        3. Intestinal intussusception 
        4. Hirschprungs disease 
        5. Meconium ileus, meconium plug syndrome & meconium peritonitis 
     e. GI bleeding f. Immunocomprimised disorders 
         1. Neutropenic typhlitis 
         2. Pseudomembranous colitis 
     g. Obstructive uropathy
     h. Urolithiasis

6. Pelvis 
    a. Trauma 
        1. Bladder and urethral injury 
    b. Infection/Inflammatory 
        1. PID 
        2. Ovarian cystic disease & torsion 

7. Scrotum 
    a. Trauma 
    b. Infection/Inflammatory 
       1. Neonatal testicular torsion 
       2. Testicular torsion in older children 
       3. Epididymitis/Orchitis 

8. Musculoskeletal
    a. Trauma 
        1. Battered child 
        2. Growth plate injury (Case 1) (Case 2) (Case 3) (Case 4) (Case 5)
        3. Toddlers fracture 
        4. Nursemaids elbow 
        5. Elbow injury & normal developmental variants 
        6. Biomechanical features of growing long bones 
     b. Infection 
         1. Osteomyelitis 
         2. Septic arthritis 
         3. Pyomyositis
      c. Miscellaneous 
         1. Child with limp 

9. Pediatric sedation & monitoring in the emergency setting 

CREDITS:

AUTHOR: CARLOS J. SIVIT, MD*
CASE ILLUSTRATION EDITOR: JOHNATHAN M. LOEWEN, MD

*Fellow of the American Society of Emergency Radiology (FASER)

SUGGESTED READINGS:

Swischuk LE, Imaging of the Newborn, Infant & Youn Child. Williams & Wilkins, 1997.

Kirks D. Practical Pediatric Imaging: Diagnostic Radiology of Infants & Children, Little Brown & Company, 1995.

Siegel MJ, Sivit CJ. Radiologic Clinics of North America: Imaging of the Acute Pediatric Abdomen, W.B. Saunders, July 1997.

Stringer DA, Babyn PS. Pediatric gastrointestinal imaging and intervention. B.C. Decker Inc, 2000.

Harris JH, Harris WH, (eds). The Radiology of Emergency Medicine. Williams & Wilkins, Baltimore, MD, 2000.

Harris JH, Mirvis SE. The Radiology of Acute Cervical Spine Trauma. Williams
and Wilkins, Baltimore, MD, Third Edition, 1995.

McCort JJ, Trauma Radiology. Churchill Livingstone, New York, NY.1990.

Mirvis SE, Young JWR. Imaging in Trauma and Acute Care. Williams and Wilkins, Baltimore, MD, 1992.

Novelline RA. Advances in Emergency Radiology, Volumes I and II, Radiological Clinics of North America. WB Saunders, Philadelphia, PA, 1999.

Stern EJ. Trauma Radiology Companion. Lippincott-Raven, Philadelphia, PA 1997.

Eustace SJ. Magnetic Resonance Imaging of Orthopedic Trauma. Lippincott Williams & Wilkins, Philadelphia, PA, 1999.

III. Recommended Textbooks

  • Harris JH, Harris WH, The Radiology of Emergency Medicine. Williams &
    Wilkins, Baltimore, MD, Fourth Edition, 2000.
  • Harris JH, Mirvis SE. The Radiology of Acute Cervical Spine Trauma. Williams
    and Wilkins, Baltimore, MD, Third Edition, 1995.
  • McCort JJ, Trauma Radiology. Churchill Livingstone, New York, NY.1990.
  • Mirvis SE, Young JWR. Imaging in Trauma and Acute Care. Williams and
    Wilkins, Baltimore, MD, 1992.
  • Novelline RA. Advances in Emergency Radiology, Volumes I and II,
    Radiological Clinics of North America. WB Saunders, Philadelphia, PA, 1999.
  • Stern EJ. Trauma Radiology Companion. Lippincott-Raven, Philadelphia, PA
    1997.
  • West OC, Novelline RA, Wilson AJ, Categorical Course Syllabus on Emergency
    and Trauma Radiology. American Roentgen Ray Society, 2000

IV. Download Core Curriculum

Click Here to Download the Core Curriculum