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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More from @Gas_Craic

26 May
Mucormycosis in ICU - A Tweetorial (Relevant due to #COVID19 in India) #FOAMed #FOAMcc
It's an invasive mould. Mucormycosis is a unifying term for infections belonging to 'Mucorales' - (so, Rhizopus, Mucor, Absidia etc). The fungi are filamentous. It's also all around us. pubs.rsna.org/doi/full/10.11…
Pulmonary infection is clinically indistinguishable from more common moulds such as invasive pulmonary aspergillosis (IPA) - PLUS, it's not a reportable disease, which makes it (obviously) underreported.
Read 30 tweets
25 May
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First to note - is that there is no apparent association between GBS and #COVID19 #FOAMed #FOAMcc ucl.ac.uk/news/2020/dec/…
GBS is an ACUTE polyneuropathy (peripheral nervous system). Symmetrical in distribution. The onset is often over about 4 weeks and recovery often begins 2 weeks after progression has completed.
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25 May
Amazing work from Regional Anaesthesia Land this year once again - #RAUK21. Lots to dissect! Let's look at the highlights of this year! @elboghdadlym @shaskinsMD @rosie_hogg @davejohnston24 @amit_pawa
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22 May
👇👇 Live Thread for the great topics of #C19marathon, 22/05/2021 - #COVID #ICU @ESICM 👉👉 Watch the conference live here: esicm.org/events/lives-c… Image
Today, we'll be using the hashtag: #livesc19 for all content.
#livesc19 We'll kick off by looking at what went well and what we can do better together, accompanied by a global update on #COVID19. A focus on the science used to fight the pandemic and the successes/difficulties we had throughout the world. @DrMCecconi @msh_manu @strachanjamie
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Antimicrobials in COVID-19 Patients in ICU is one of our sessions at the #C19marathon this Saturday - let's have a look at some of the current literature ahead of the session.
Due to the high amounts of multi-drug resistant organisms, superimposed infections are problematic in C19 patients - via immune dysregulation and mechanical ventilation. karger.com/Article/FullTe… Image
There are many studies that have referenced multiple organisms with varying mortalities and abx-use profiles: karger.com/Article/FullTe… ImageImage
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11 Oct 20
#COVID19 ICU-related recap. October 2020 with a focus on a 2nd Surge. @ESICM @ICS_updates
@JohnsHopkinsIH dashboard of current worldwide cases.
@FT graph showcasing the cumulative confirmed cases in various countries/areas. Raw numbers log, then per million linear. The steepness of the increase in NI is obviously a worrying trend.
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