Dr. David Lyness Profile picture
GP AiT: ex-ICM Dr & Anaes💉 https://t.co/vKmL9zpHHJ💻 Principal Consultant at KDPC. MSc & LL.B. Specialist in Reg Law/Risk⚖️ 🏳️‍🌈MFCI FRSB FRSA FRSPH

May 27, 2021, 22 tweets

Radiology in ICU - 1 - A Tweetorial of some interesting (and some very rare!) cases relevant to ICU on @Radiopaedia #FOAMed #FOAMcc #FOAMrad

Can we just take a minute to appreciate the tremendous resource of @Radiopaedia - the best radiological resource of our age - #FOAMed. Shared and open learning. #FOAMcc. Follow the links to see the cases in beautiful detail with Radiological commentary. radiopaedia.org

Empyema necessitans (EN)=rare complication of empyema with extension of the fluid collection and infection to the subcut soft tissue. Most common cause = Mycobacterial infx. Others = actinomyces, streptococcus, and staph infection. radiopaedia.org/play/35878/ent… (Dr J Yeung rID: 13415)

Pott disease (TB spondylodiscitis) and paravertebral abscess - involvement of the vertebral body more than the disc, skip lesions, gibbus deformity and paravertebral abscess. radiopaedia.org/play/35878/ent…

A pontine haemorrhage leading to locked-in syndrome radiopaedia.org/articles/locke…

Pneumothorax in the SUPINE patient. Full article and cases: radiopaedia.org/articles/pneum… More really good examples at this link including 'double diaphragm'.

There's fascinating work being done on low-field MRI - that could be done in the ICU... radiopaedia.org/articles/low-f…

Known CF, +ve for Pseudomonas aeruginosa =most common infective agent in CF. NOTE p.aeruginosa is uncommon for CAP, but common for nosocomial infections - so beware in ICU on ventilators... Bronchial wall thickening, ground glass in UZ and multiple lobes radiopaedia.org/articles/pulmo…

Hyponatraemia in up to 30% pts in ICU. Leads to impaired sensorium, so remember the causes of dementia... and think of the PONS (cerebellopontine demyelination) via the osmotic shifts. radiopaedia.org/articles/hypon…

Interestingly clinical diagnosis of ARDS using internationally accepted guidelines and chest radiographs has been demonstrated to correlate poorly with histopathological diagnosis at autopsy... radiopaedia.org/articles/acute…

This case of ARDS in ICU is secondary to a Tiger Snake Bite (Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 53759) radiopaedia.org/cases/ards-sec…

Differential of ARDS is Acute Pulmonary Oedema (here is alveolar and interstitial oedema) (Case courtesy of Assoc Prof Frank Gaillard, rID: 3011) radiopaedia.org/cases/apo-arro…

Or indeed another ARDS differential is pulmonary haemorrhage (here is right upper airzone opacities) radiopaedia.org/cases/pulmonar… (Case courtesy of Assoc Prof Frank Gaillard, rID: 7145) See how different it looks on CT coronal section.

A really good series here showcases normal and abnormal CVC placements. Excellent images in the link 👉 radiopaedia.org/articles/centr…

Abnormal CVC placement leads to consideration of 'infusothorax' - Fluro study needed and evaluation of tip of portocath... lateral views suggest an extraplural course or SVC perf... Case courtesy of Dr Jayanth Keshavamurthy, rID: 41567 - radiopaedia.org/cases/infusoth…

The CVC can sometimes curl! Case courtesy of Dr Matthew Lukies, rID: 43299 radiopaedia.org/cases/suboptim…

Acute pancreatitis is very serious and can be life threatening. It's a common enough ICU condition: radiopaedia.org/articles/acute…

Gross pathology of acute pancreatitis: Case courtesy of Dr Henry Knipe, rID: 27638. There is haemorrhagic, black-brown necrosis of the pancreatic parenchyma and peripancreatic fat. radiopaedia.org/cases/acute-ne…

Diffuse pancreatic parenchymal enlargement is seen with surrounding retroperitoneal fat stranding and fluid: radiopaedia.org/cases/acute-pa… = Dr Mohammad Taghi Niknejad, rID: 20829

Aspergilloma - In invasive fungal infections the nodule is composed of necrosed tissue, later this necrotic nodule is reabsorbed peripherally and retracted and air gets trapped inside the nodule and give rise to air crescent around it. radiopaedia.org/play/28945/ent…

Temporary mucous plugging in intubated patients can be extremely serious - look at this series... Before --> Left lung collapse --> Resolution. (Dr Dixon, rID:9787) radiopaedia.org/play/32537/ent…

Acute occlusive thrombus of the SMV extending along its whole length, partially extending to the portal and splenic veins with periportal collaterals. Associated mesenteric oedema. radiopaedia.org/play/32537/ent… Case courtesy of Dr Mostafa El-Feky rID: 54918

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