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04/20/2007 10:29:23 AM · #26 |
Um, Mike? Didja ask your doctor what it was?
I know, crazy idea.
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04/20/2007 11:42:42 AM · #27 |
Originally posted by levyj413:
Um, Mike? Didja ask your doctor what it was?
I know, crazy idea. |
And how would that be as much fun as this thread? |
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04/20/2007 12:02:13 PM · #28 |
Asim! You have to agree with me that this is not a conventionnal view.
If I'd have seen this in the ER, I would've returned the patient to the departement for a better view.
All in all, this was an "interesting" thread.
TGIF everyone...Have a good weekend!
Originally posted by asimchoudhri:
what is labeled as "? accessory rib" on this is the articulating facet of a lower cervical vertebrae
what is labeled as "scapula" is the scapula
what is labeled as "arm bone" is not an actual structure, but likely our mind trying to join together several lines of different objects and imagine it is a structure (it's called "confluence of shadows" in radiology). the tip of what's labeled "arm bone" is actually right next to the bottom of the head of the humerus (bone of the upper arm). your arms are angled upward, so the rounded part that we see at the bottom is the part that articulates with the shoulder joint.
what is labeled as "?" is probably the clavicle.
what is labeled as "sternum" is actually what puzzles me, since the top part of the sternum (the manubrium) is at the level of the clavicles, and the sternum goes inferior to that. my guess is that this is the other clavicle, and that your arms were not raised equally. if you have a better version of this, or any other views, i can confirm this for you. (this is my day job) |
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04/20/2007 01:12:54 PM · #29 |
Originally posted by levyj413:
Um, Mike? Didja ask your doctor what it was?
I know, crazy idea. |
Yeah...how much fun would this thread have been? The doc didn't mention anything with this particular view, so I figure there isn't anything to worry about. Just thought that part of it was kinda interesting, portraying what would seem to be something other than what it is, and not being too sure myself. But, I am pretty sure that part is my clavicle.
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04/20/2007 02:26:16 PM · #30 |
| Why is the date 1-20-2006? Someone having fun with photoshop hmm? |
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04/20/2007 02:47:08 PM · #31 |
Originally posted by lifternessjt:
Asim! You have to agree with me that this is not a conventionnal view.
If I'd have seen this in the ER, I would've returned the patient to the departement for a better view.
All in all, this was an "interesting" thread.
[...] |
i agree completely, which is why i waffled a little in my comments. #1, a swimmer's lateral is usually done with people lying flat on their back, often in a neck brace, so the curvature is a little different than i'm used to seeing. #2, it's centered lower and more anterior than i would expect, so i think there is slightly increased parallax obscuring view of some of the structures intended to be evaluated. #3, it does not appear to be a "true" lateral, but rather is very slightly obliqued (not a big deal by itself). #4, i don't think the arms are symmetric, which is exacerbated by #3. unless there were other views that adequately evaluated the cervicothoracic junction (either a lateral of the t-spine or of the c-spine), i wouldn't consider this by itself to be diagnostic quality.
mike, since this was taken with digital technique, if you are still curious you can ask for a copy of the entire set of images on a CD. Ideally, ask for the images in the native DICOM format, and not as .jpgs, as DICOM has a higher dynamic range.
edit: to clarify, when i say this by itself is not "diagnostic quality" i mean that there's not a whole lot of information you could get from this individual image on its own. as a part of a set of some other views, this may be very helpful to trouble-shoot areas that the other views don't see as well, but for the most part this type of view is a "helper" view, and it's hard to draw too many conclusions without the other views that this is intended to "help" with. thus, the exam overall may have been diagnostic quality, but this image alone will not give many answers.
Message edited by author 2007-04-20 15:20:18. |
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04/20/2007 03:12:21 PM · #32 |
Looks like a boner. Get it a boner, he he ok carry on.
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04/20/2007 03:17:53 PM · #33 |
A) I'm still confused as to who this was and the age of the person. Doesn't it look like a child's x-ray? The PA certainly does.
B) What do you make of the air column being so far posterior? Is that also a result of some twisting of the torso or the direction the xray was taken in?
EDIT to say the PA has disappeared from the thread...
Message edited by author 2007-04-20 15:18:41.
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04/20/2007 03:25:13 PM · #34 |
Originally posted by DrAchoo:
A) I'm still confused as to who this was and the age of the person. Doesn't it look like a child's x-ray? The PA certainly does. |
i never saw a pa study in this thread... that would help a lot...
Originally posted by DrAchoo:
B) What do you make of the air column being so far posterior? Is that also a result of some twisting of the torso or the direction the xray was taken in? |
i think the airway is probably ok, given the projection. slight obliquity may be making things look a little skewed, but the prevertebral soft tissue in the lower cervical spine looks fairly normal, and that's the only reliable landmark that i see in this image.
Originally posted by DrAchoo:
EDIT to say the PA has disappeared from the thread... |
aha... |
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04/20/2007 03:46:30 PM · #35 |
Originally posted by DrAchoo:
A) I'm still confused as to who this was and the age of the person. Doesn't it look like a child's x-ray? The PA certainly does.
B) What do you make of the air column being so far posterior? Is that also a result of some twisting of the torso or the direction the xray was taken in?
EDIT to say the PA has disappeared from the thread... |
A. I'm 33. It's me.
B. I was laying on my left side, kinda curled in a fetal position for this one. Don't know why.
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04/20/2007 03:53:48 PM · #36 |
Originally posted by cryingdragon:
[...] I was laying on my left side, kinda curled in a fetal position for this one. Don't know why. |
that makes sense. i think those two things are your clavicles, and they are a little asymmetric because of your positioning. i don't see any definite evidence of an extra rib on THIS view. as i said, if you have other views they may answer the question more about an extra rib. otherwise it seems pretty normal, within the limits of this .jpg capture. |
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04/20/2007 04:01:14 PM · #37 |
Originally posted by cryingdragon:
I was laying on my left side, kinda curled in a fetal position for this one. Don't know why. |
I believe it's a mother complex. Were you sucking your thumb?
Keep in mind, I'm no psychiatrist (but I did impersonate one during a brief stay at a mental institution). |
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04/22/2007 03:49:03 AM · #38 |
| So what do people know about accessory ribs? I've got large amounts of pain in places that led a chiropractor to believe that I might have something going on with the rib thing.... |
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04/22/2007 07:36:53 AM · #39 |
Originally posted by klstover:
So what do people know about accessory ribs? I've got large amounts of pain in places that led a chiropractor to believe that I might have something going on with the rib thing.... |
there are two main types of accessory ribs. you can have an extra one that is too high up (a cervical rib), or an extra one that is too far low down (a lumbar rib). usually both are fairly small, and a lumbar rib is rarely (although not never) associated with symptoms. a cervical rib can cause pinching of nerves and blood vessels in your neck. at the same time, if your symptoms are in your neck, those symptoms may not even require an extra rib. that can also be caused by slight hypertrophy of some of the muscles in the neck and arm, causing nerves or vessels to get pinched between two muscles, or between a muscle and a normal rib.
a detailed history and physical exam can help sort this out. this may include evaluating symptoms and how they change with head position and with lifting your arms. if there is strong suspicion for one of these problems, (and i mean strong suspicion by a physician who deals with these problems on a regular basis... most primary care docs don't see this often enough to know based just on physical exam) there are imaging tests that can help confirm this. if nerve compression is suspected, and MR to evaluate a bundle of nerves called the brachial plexus can be performed. if venous compression is suspected, injecting contrast dye into the veins (venogram) can be done. if arterial compression is suspected, an arteriogram can be performed (although i'd make sure they were sure before going this route). those imaging tests alone may not give the full answer, since there is a wide variation in what normal anatomy is. that's why a detailed physical exam by a physician that is familiar with these diagnosis is needed to give a pre-test-probability before the imaging is performed.
alternatively, a simple chest x-ray can be done to see if you have an extra rib... however, as i mentioned even if you have an extra rib, that may not be causing the problem, and even if you don't there still could be other things causing the problem. so, unless there is strong suspicion that an extra rib is causing a specific problem, i'd probably skip the chest x-ray as well. |
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04/22/2007 05:49:11 PM · #40 |
| Wow, thanks for the info! |
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