ABCS In Cervical Spine Injuries

A cervical spine injury is unlikely in an alert patient (i.e. not under the influence of alcohol or drugs) without neck pain, bony tenderness, focal neurological defect or a painful distracting injury. 

Obtain lateral, AP and an open mouth peg view if a cervical spine injury 

is suspected. 
In the lateral view ABCS have to be examined as described below:

A Alignment and adequacy
Visualize from base of skull to the C7/T1 junction. In-line arm traction, during the cross table lateral or a swimmer’s views can be helpful in visualising C7/T1. Look for the normal smooth curve of the anterior vertebral, posterior vertebral and spino-laminar lines. In a child pseudo-subluxation of C2 on C3 can cause confusion. In these cases, examine the spinolaminar line from C1 to C3. If the bases of these spinous processes lie 2 mm from this line an injury should be suspected. Correlate with soft tissue findings.The distance between the anterior arch of C1 and the odontoid peg should be 3mm in an adult and 5mm in a child.

Lateral cervical radiography showing (A) anterior vertebral line, (P) posterior vertebral line and (SL) spinolaminar line. 

B Bone:
Assess for normal bony outline and density. An increase in density may indicate a compression fracture.

C Cartilage
The intervertebral spaces should be uniform. Widening of these or the interspinous distance may indicate an unstable dislocation. An increase in interspinous distance of 50% suggests ligamentous disruption. Muscular spasm can make interpretation difficult.

S Soft tissues

Retro-pharyngeal soft tissue swelling may be the only sign of a significant injury. Normal measurements are less than 7mm C2–C4 (half a vertebral body at this level) and less than 22m below C5 (a vertebral body width). Air within the soft tissues suggests rupture of esophagus or trachea/bronchus. Bulging of the pre-vertebral fat stripe is an early sign.

MRI for Imaging Breast Implants

MRI is the technique of choice for assessing the integrity of breast implants, with a sensitivity and specificity of over 90%. When imaging breast implants, NO contrast agent is required unless malignancy is suspected. Imaging should be performed in the prone position using a dedicated breast coil. The main goal is to determine whether the implant has ruptured and, if so, to establish the location of the leaked filler (usually silicon).

When implants fail, the rupture may be either intra-capsular or extra-capsular. Intra-capsular rupture occurs when silicon has escaped from the plastic shell of the implant, but is contained within the fibrous implant capsule; signs of intracapsular rupture include the ‘wavy line’, ‘linguini’, ‘key-hole’ and ‘salad oil’ sign. False-positive interpretations can be made when normal implant folds are mistaken for signs of rupture.
Intra-capsular implant rupture.'linguini' sign and ‘salad oil’ sign.

Extra-capsular implant rupture.

Hampton's hump sign

Picture of a camel displaying its hump which is a rounded mass or protuberance on its back.

Hampton's hump sign, also called Hampton hump, is a radiological sign which consists of a shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface. It is named after Aubrey Otis Hampton who first described it in 1940.

Hampton's hump along with Westermark's sign aids in the diagnosis of pulmonary embolism.

Hampton's Sign.

Yellow star in the region of wedged-shape opacity that represent Hampton's Sign.