Makindo Medical Notes

💡 Imaging Recognition for Medical Students In the MLA and finals, students are expected to recognise classic imaging appearances of common acute and chronic conditions. The aim is not detailed reporting, but identifying key abnormalities that influence diagnosis and management.

🫁 Chest Imaging

• Pneumonia (CXR): Localised consolidation ± air bronchograms.
• Pneumothorax (CXR): Visible pleural edge with absent lung markings beyond.
• Pleural effusion (CXR): Blunting of costophrenic angle, meniscus sign.
• Congestive heart failure (CXR): Cardiomegaly, upper lobe diversion, Kerley B lines, alveolar oedema ("bat’s wing").
• Pulmonary embolism (CTPA): Intraluminal filling defect in pulmonary arteries.

🧠 Neuroimaging

• Intracranial haemorrhage (CT head): Hyperdense (white) acute bleed — epidural (lens-shaped), subdural (crescent), subarachnoid (sulci/ventricles), intracerebral.
• Ischaemic stroke (CT head): Early loss of grey–white differentiation, dense MCA sign; infarct becomes hypodense later.
• Raised ICP (CT head): Midline shift, effacement of ventricles/cisterns.
• Brain tumour (MRI/CT): Space-occupying lesion with surrounding oedema.

🦴 Musculoskeletal Imaging

• Fractures (X-ray): Break in cortical continuity; recognise displaced vs undisplaced, intra-articular involvement.
• Osteoarthritis (X-ray): Loss of joint space, subchondral sclerosis, osteophytes, cysts ("LOSS").
• Rheumatoid arthritis (X-ray hand): Periarticular osteopenia, symmetrical joint space narrowing, erosions, ulnar deviation.
• Osteoporotic vertebral wedge fracture (X-ray/CT): Anterior wedge collapse, loss of vertebral height.
• Metastatic bone disease (X-ray): Lytic or sclerotic lesions, pathological fracture risk.

🫀 Cardiovascular Imaging

• Aortic dissection (CT angiography): Intimal flap with true/false lumen.
• AAA (USS/CT): Dilated abdominal aorta >3 cm;>5.5 cm usually surgical threshold.
• Pericardial effusion (Echo): Anechoic rim around heart; tamponade = diastolic collapse of RA/RV.
• Valvular disease (Echo): E.g., mitral stenosis with doming leaflets, aortic stenosis with calcification and restricted opening.

🧪 Abdominal Imaging

• Gallstones (USS): Echogenic foci with acoustic shadowing in gallbladder.
• Cholecystitis (USS): Thickened gallbladder wall, pericholecystic fluid, positive sonographic Murphy’s sign.
• Renal colic (CT KUB): Radio-opaque stone in ureter ± hydronephrosis.
• Bowel obstruction (Abdo X-ray): Dilated loops, air-fluid levels; “stacked coin” or “string of pearls”.
• Perforation (Abdo erect CXR): Free air under diaphragm.
• Appendicitis (USS/CT): Dilated, non-compressible tubular structure ± peri-appendiceal fat stranding.
• Liver cirrhosis (USS/CT): Shrunken, nodular liver ± splenomegaly, ascites.

🧬 Endocrine / Metabolic

• Thyroid goitre/nodule (USS): Enlarged thyroid with solid/cystic nodules; vascularity on Doppler.
• Adrenal mass (CT/MRI): Incidentaloma, pheochromocytoma, adrenal adenoma.
• Hyperparathyroidism (X-ray hand): Subperiosteal bone resorption, "pepper-pot skull".

⚠️ Red Flag Imaging Signs (must recognise in exams)

• Cauda equina (MRI): Compressed thecal sac, loss of CSF space.
• Tension pneumothorax (CXR): Absent lung markings, mediastinal shift.
• SAH (CT head): Blood in basal cisterns and sulci.
• AAA rupture (CT): Retroperitoneal haematoma around aorta.
• Pathological fracture (X-ray): Fracture through lytic lesion.

📚 Key Teaching Pearls

• Think: pattern recognition, not radiology reporting.
• Always correlate with clinical question — imaging is an adjunct, not a diagnosis in isolation.
• Recognise acute emergencies (pneumothorax, perforation, SAH, obstruction) quickly.