Radiographic features & some

common diseases

Classic radiology signs
Do you remember my performance ?
The radiographic features of some
common diseases

• Radiography (Citra Medis) biasanya digunakan

sebagai rujukan untuk mengetahui status
kesehatan dari pasien.
• Radiography (Citra Medis) dikatakan sukses
memiliki informasi iagnostik tergantung pada:
“arti dan makna dgn terminologiy-2 yg sangat
specific”
The radiographic features of some
common diseases
• Berikut ini beberapa contoh terms ‘unfamiliar’
atau “exotic” yang dijumpai dalam radiography
berupa:
– Fakta-fakta subjective kualitas citra (that is often
difficult to define)
– Faktor-faktor yang mempengaruhi kemampuan
observer dalam meng-interpret information
(sensitivity, specificity and diagnostic accuracy of
the imaging modality to detect particular
pathologies)
 The radiographic features of some
common diseases
• Para paktisi pencitraan medis adalah orang pertama yang
melihat - ‘to see the images’; maka, mereka adalah :
– Para pemngambil keputusan terkait ‘acceptability of the produced images’.
– Kriteria citra dapat membantu untuk mengevaluasi ‘diagnostic acceptability of
radiographic images’, tetapi hal ini bukan merupakan kriteria keputusan
yangbersifat absolut.
– pengetahuan pathologis dan variasi gambaran umum kelainan secara radiologis adalah
bersifat essential bagi peningkatan kapabilitas praktisi pencitraan medis dlm
menentukan penerimaan citra radiologis
• Tabel-tabel berikut adl ringkasan beberapa gambaran umum
mendeteksi bentuk-2 kelainan secara radiologi pada
conventional radiography/projection radiography.
 The radiographic features of some common diseases
PATHOLOGY RADIOGRAPHIC FEATURES
Scoliosis Appearance of “S” curves in AP view of the thoracolumbar region

Osteoporosis Osteoporosis can only be detected radiographically when there are more than
30% changes in bone density. The appearances include:
1. Picture-framing effect and cortical thinning in vertebra
2. Wedge fracture or compression fracture will happen in severe cases
3. Coarsened trabecular pattern
4. Absence of osteophytes

Ankylosing spondylitis (Early) bilateral narrowing and fuzziness of the sacroiliac joints (SIJ)
1. (late) obliterated SIJ
2. calcification of vertebral ligament
3. syndesmophytes between vertebrae (the classic ‘bamboo spine’
appearance) and fusion of SIJ.
4. bony sclerosis which appears as squaring of vertebrae.

Spondilolothesis 1. lateral lumbar may demonstrate the pars defect as luscency at the pars
area.
2. bilateral oblique views may visualise the pars interarticularis defect as a
Scottie dog with a collar, and/or an elongated pars may also be seen.
PATHOLOGY RADIOGRAPHIC FEATURES
ARTHRITIS

Osteoarthritis 1. Bone erosions are centrally located.

2. Increased bone density.
3. Osteophyte formation.
4. Subchondral sclerosis.
5. Asymmetric joint space narrowing.
6. Subchondral cysts.
7. Periarticular soft-tissue swelling.
8. Osseous fusion may occur.
9. Gull-wing appearance of interphalangeal joints with central erosions flanked by
raised lips of bone.

Rheumatoid arthritis Early :

1. Periarticular soft-tissue swelling.
2. Juxta-articular osteopenia.
3. Marginal bone erosion.
4. Asymmetric joint space widening.

Late :
1. Osteopenia (diffuse).
2. Joint space narrowing.
3. Obvious erosions.
4. Joint subluxations.
5. Soft tissue atrophy.
6. Rheumatoid nodules.
7. "Swan-neck" deformity with flexion of the joints of the fingers.
8. "Boutonniere" deformities with hyperextension of the joints of the fingers.
PATHOLOGY RADIOGRAPHIC FEATURES
ULCERATIVE COLITIS In Barium study: :
1. Normally smooth colon outline becomes irregular because of ulceration
2. Loss of colon haustration and mucosal oedema referred to as “lead-pipe sign”.
3. Massive colonic dilatation with an abnormal mucosal contour, due to toxic
megacolon.
4. The colon may appear narrow with incomplete filling caused by colonic spasm and
irritability.
5. Thickened haustral folds may result in the appearance of thumbprinting.
CA COLON AND RECTUM “ napkin-ring ” carcinoma or “ apple-core ” lesion in Barium study
HEPATITIS CIRRHOSIS Hepatomegaly in AXR :
1. Dense, grey, ground-glass appearance due to large amounts of ascitic fluid.
2. With supine position, the fluid accumulates in the pelvis and comes up to either
side of bladder and gives a “dog-eared” appearance.
3. Kidneys, psoas muscles, liver and spleen outlines are obscured as volume of fluid
increased.
4. Air-fluid level in lateral decubitus projection.

LIVER CA AXR reveals hepatomegally, which is consistent with chronic hepatitis and cirrhosis.

CHOLELITHIASIS 1. Calculus may appear as single, multiple, pyramidal, faceted or cuboidal

calcification located in right upper quadrant (RUQ).
2. Air may be present within the body of a calculus, creating a stellate lucency term
the “Mercedes-Benz” sign.
PANCREATITIS AXR shows coarse nodules of calcification in the upper abdomen located in the right
paravertebral region and extending across the mid-line into the hypochondrium
 Classic Radiology Signs
• Beberapa karakteristik pathologi pada
radiography yg telah di beri istilah dgn sangat
spesifik
• Berikut ini adl contoh beberapa term “exotic”
yg dpt di jumpai dlm radiografi
SIGNS RADIOGRAPHIC IMAGES
Apple Core lesion (napkin
ring)—signifies annular
carcinomas of the colon—
looks like an apple core or
napkin ring (see below)
due to circumferential
narrowing of the lumen,
noted on contrast studies.
Bamboo Spine —fused
spinal segments with their
syndesmophytes look, on
radiographs, similar to
bamboo stalks—classically
associated with ankylosing
spondylitis.
SIGNS RADIOGRAPHIC IMAGES
Thumb sign —on lateral c-
spine, an enlarged
epiglottis appears as a
“thumb-up” sign.

Thumbprint sign -
Symmetrical thickening of
haustral folds seen in
Ulcerative colitis
resembling a thumbprint.
SIGNS RADIOGRAPHIC IMAGES
Tram-line (railroad track)
sign - parallel line shadows
of lung tissues indicating
bronchiectasis.

Westermark's sign —
abrupt end to a
pulmonary vessel or
marked decrease in
vascularity signifying
pulmonary
embolism.
Bird's Beak (Beak (claw)
sign) — noted on Upper
GI with contrast, a
dilated upper/middle
oesophagus with an
abrupt, exceptional
narrowing of lumen;
typical of achalasia.