The patient above was seen for upper extremity symptoms of pain, numbness and tingling. Since you know the symptoms, what do you notice unusual about the images? Are these images taken from PA or AP? What would you suspect the medical diagnosis might be?
I think that it is an AP view since the posterior portions of the vertebrae are most obvious, such as the spinous processes. As far as the diagnosis, it appears that there may be cervical ribs present on C7 that could cause thoracic outlet syndrome. I have to admit though that the curve of the vertebrae seen in the radiograph threw me off at first. But, it looks like there are extensions to the C7 transverse processes seen right above the first rib. I might be completely wrong though!
ReplyDeleteI think that it's a posterior to anterior view (PA) because features such as the direction of the ribs and the mastoid processes are prominent (Sally, I bet you just said it wrong - we know which one you meant!) I agree with Sally, I think what I see are cervical ribs present on C7, and along with the pain, numbness and tingling, could possibly indicate TOS. Questions about history of autonomic changes could be asked to determine involvement of Stellate ganglion.
ReplyDeleteI agree with the ladies that there are cervical ribs on C7. However, I believe this is an AP view because, to me, it seems as though the vertebral bodies are more clear than the spinous processes. Also, the heart is projecting to the left and there's an R indicating the right side of the patient. TOS is common with cervical ribs and could be tested with the Adson's, Roos, or Cyriax release tests.
ReplyDeleteI'm on board with Jennifer with this one. I believe it is an AP view because of a clear view of the vertebral bodies and poorly defined spinous processes, direction of the heart with the big R on the image, the scauplae are poorly defined, and the styloid processes appear to be in front of the mastoids (that one I could be wrong on, just an opinion). I also agree that there are cervical ribs at play here, but are they starting at C6? Is that even possible to have cervical ribs that high? Also, it seems like there some lateral curvature in the c-spine, maybe a little scoliosis? If the symptoms are on the patient's RUE, that would make sense with the facets closing down on the ipsilateral side.
DeleteThis is an AP view. If it was a PA view the heart would be more clearly defined on the image as it is closer to the film. I have to agree with Michael. After looking closely at the image it appears that the cervical ribs begin on C6. There is also mild scoliosis beginning just inferior to the cervical thoracic junction. When performing an examination on this patient I would expect to find decreased passive accessory joint mobility of the lower cervical spine.
DeleteThe above image appears to show an AP view of the posterior ribs above the diaphragm. The posterior ribs can be seen (more prominently than anterior) attached to the thoracic vertebrae. The image is similar to Figure 9-27 in the McKinnis text, which shows an AP projection where the heart projects to the left. The image appears to show cervical ribs on C7, which would explain the patient's presentation of numbness, tingling, and pain due brachial plexus involvement. Thoracic outlet syndrome also may involve compression of the subclavian artery (entrapment between the cervical rib and scalene muscle). A diagnosis of a cervical rib and thoracic outlet syndrome are likely.
ReplyDeleteI feel like this is a PA view. The posterior ribs are more prominent to me and the lack of definition from the sternum leads me to believe this. I concur that there is a cervical rib present and think that the diagnosis of TOS is quite probable. I agree with Denning on the possibility of having a mild scoliosis, however I think it is more of a contributor to the pain, N/T than the main instigator.
ReplyDeleteTo be completely honest, every time I look at this picture I convince myself that it is a different view! I am going to make a final decision to say that this is a PA view. I feel this way due to the lack of density of the manubrium and the direction of the ribs in the photo. I also agree with previous classmates that there appears to be a cervical rib at C6 and C7 which would justify the signs and symptoms of TOS that the patient is experiencing.
ReplyDeleteI beleive this view is a PA because of the lack of definition of the sternum and maneubrium. The clavicals have curvature as if the image was taken in a PA view. I can also clearly see the ribs coming off the TPs indicating those structures are more anterior. I agree with the cervical rib comment from the people above, but I agree with Denning that there appears to be one at C6 and C7. I have also never heard of a cervical rib at C6, but to me they look like they originate at C6. Cervical ribs would explaine the numbness and tingling symptoms the pt. is experiencing. I would expect the medical diagnosis to be TOS secondary to the cervial ribs and the syptoms of the pt.
ReplyDeleteThis appears to be a PA view, although the position of the heart and the R on the left of the image makes me question that. There appears to be cervical ribs at C7, a left thoracic scoliosis with a rib hump on the left, assuming this is a PA view, and bilateral clavicles appear to be depressed. There is an assymetrical appearance of the mastoid processes, which may be due to a left rotation. I believe the medical diagnosis is a combination of TOS and cervical radiculopathy resulting from the cervical ribs, depressed clavicles, and possible foraminal narrowing due to the sidebending and rotation of the spine.
ReplyDeleteI have gone back and forth on what view this was taken from but I have finally decided it is PA for several reasons. First if all the clear definition of the spinous processes as well as the ribs make me think PA view. Second the sternum/manubrium aren't very clear and position of the clavicles appear like they are anterior to the ribs indicating that this was taken from the PA direction. I too agree with my classmates, there appears to be a cervical rib present at C7 that is affecting the brachial plexus causing s/s of pain, numbness and tingling. There also appears to be a slightly abnormal curvature causing some narrowing of the left intervertebral foramen causing impingement of the intervertebral at this level. Further nerve testing is needed to determine which nerve roots are affected (dermatomes/myotomes). As well as special testing to determine if the cervical rib is causing TOS (Adson's, Roos etc.)
ReplyDeleteThe image above to me appears to be taken from the PA viewpoint. The diagnosis I would lean toward would be an elevated rib the L side (the unusual thing in the radiograph) at the level of C7 which would be to cause for nubness and tingling sensations reported by the patient. When a rib becomes elevated (due to mm spasms, muscle shortening, poor posture over time) the area the brachial plexus exits from the neck can become compromised resulting in TOS. TOS can be tested and ruled in by performing Roo's or Addison's, along with upper limb tension testing to determine which nerves are most compromised.
ReplyDeleteIn diagnosing the view point, what made up my mind was the definition of the curvature of the ribs. It appears that the posterior attachments are prominant and you can visually see the upper two ribs wrapping around toward the front of the body. The next give away for me was that the spinous processes were more visible than the manubrium and sternum. Since the spinous processes can superimpose over the manubrium with a PA view, I feel this was another clue to point me in the correct direction. I also noticed that the clavicles were behind the ribs indicating they were further from the initial side of the radiograph.
After going back and forth several times, I will say that I think this is an AP view. The reason I chose AP is because of the label for the patient's right side and the position of the heart. Also, to me it looks like the spinous processes are not clearly defined. I believe that this patient has bilateral cervical ribs at C7 and possibly C6, and it also appears that the right ribs are elevated. The combination of cervical ribs and elevated ribs could lead to thoracic outlet syndrome and cause the patietn's symptoms of N/T and pain.
ReplyDeleteI believe this is an AP view, based on the fact that 1) the book rarely, if ever, mentions PA views of cervical spine in a routine examination, and 2) the position of the heart on the right side of the image (a PA view would have the heart on the left side of the image), and 3) the mastoid processes are prominent.
ReplyDeleteThis radiograph appears to show a bilateral C7 cervical rib. It also appears this patient has a right thoracic scoliosis; combined with the cervical rib could easily compress the brachial plexus or subclavian artery, causing TOS signs/symptoms.
I agree with Cole (and many others) that this is an AP view. I think Cole gave great reasons for why it makes sense that this is an AP view. To me the prominence of the mastoid processes and the position of the heart are the biggest factors that lead me to choose AP.
DeleteI also agree with all those who notice the presence of bilateral cervical ribs. These could certainly contribute to the patients n/t and pain. I wonder if the curvature of the spine is a separate issue or is it somehow compensatory due to the cervical ribs and symptoms? It also looks to me like the spinous processess of some vertebrae (Roughly C6-T1) are not aligned with the midline of the vertebral bodies. This could indicate rotated vertebra to the left and may be confirmed by the asymmetric appearance of the ribs (to me the left ribs look slightly elevated).Certainly lots to consider on this image.
I tend to agree with both Cole and Trevor that this is an AP view for the reasons they listed. The position of the heart and clear view of the posterior rib attachments. I also tend to agree that the radiograph shows cervical ribs bilaterally using the intervetebral discs to count inferiorly. I do also notice a curvature of the cervical spine which several people have suggested as a scoliosis but it does seem possible it could just be due to muscular pain of the neck causing an abnormal resting position of comfort, or that the patient has assumed this position to help alleviate the N/T they are experiencing.
DeleteWith all that said, my guess is that the medical diagnosis is TOS secondary to bilateral cervical ribs at the C7 level.
I believe this image to be an AP view. If it was a PA view you could more clearly see the sternum and the anterior ribs attaching to it. The position of the heart on the left side (right when looking at the image) is another clue. I agree with my classmates about the cervical rib; however, I am unsure exactly where it originates. It almost appears that it begins at C6, but knowing that most begin at C7 makes me question that. I would also agree that scoliosis is present. You can definitely see the curvature in the spine and the decreased rib space on the left ribs. I would say that the medical diagnosis for this patient is a cervical rib (leading to TOS) and scoliosis, both leading to the radicular symptoms this patient is experiencing.
ReplyDeleteFirst off, I noticed the presence of bilateral cervical ribs, which I believe are at C7. Based on views from the book, I would say this is an AP view. Since the posterior ribs are seen so clearly, that means they are closest to the image receptor. I would suspect the medical diagnosis to be thoracic outlet syndrome.
ReplyDeleteIt should be noted that there is a mild right curvature at the CTJ/upper thoracic vertebrae which may contribute to compression the nerves on the left side.
I believe this is an AP view, pretty much based on all the reasons Cole mentioned. I also agree that based on both the radiographs and the symptoms, this patient has thoracic outlet syndrome caused by a cervical rib. As far as the scoliosis, is it possible that the patient was simply not laying perfectly straight on the table when the image was taken? The upper c-spine and skull are definitely tilted the opposite direction of the CTJ.
ReplyDeleteI am going to go with the good ol AP view as Cole brought up some great reasons for this but the main one for me was the position of the heart in the image. I agree with the cervical rib diagnosis leading to TOS according to this image and the symptoms that are present. I do however wonder at what level the cervical ribs are present I want to say C7 but part of me has to agree with Denning in the thought of the possibility for any C6 involvement or I may just be reading the image off a level.
ReplyDeleteI think that this is an AP view and my reasoning is the clarity of the pedicles, vertebral bodies, intervertebral disc space, transverse processes and prominence of the trachea along with some of the comments made by Cole. I too agree with the idea of cervical ribs perhaps compressing the subclavian artery and brachial plexus leading to TOS and the symptoms of N/T that the patient is experiencing and as far as the level of the cervical rib it does appear to be higher than C7 as Denning has pointed out. I also tend to agree with Charlie in that it looks as though there could be cervical radiculopathy as a possibility and as Stephanie pointed out the skull and C-spine are clearly not aligned so it may be part of the problem or an issue with patient positioning.
ReplyDeleteI believe that this is an AP view due to the fact that the superimposition of the overlapping facet joints gives an illusion of two lateral columns for the vertebral bodies. The transverse processes are clear and the clavicles are very disproportionate due to being farther from the film plate. I agree with Ali and Stephanie that the skull and C-spine are not in alignment and I am unsure whether this is due to poor pt positioning or if it is a musculoskeletal restriction, such as scoliosis. Like Cole said, the book doesn't mention PA views of the C-spine in great depth. I agree with most of the comments that this person does have bilateral Cervical Ribs at C7 and that this would contribute to the numbness and tingling in the arms. This pt obviously has S/S indicating TOS which is compressing the artery and/or the brachial plexus. One could perform special tests such as Roos, or Adson's maneuver to rule in TOS and further evaluate the pt.
ReplyDeleteThe image is an AP view of the cervical/thoracic spine. You can tell it is an AP view due to the orientation of the heart. The abnormality noted on the radiograph is the presence of bilateral cervical ribs. Due to the presence of these abnormalities, and the signs and symptoms, this patient likely has a medical diagnosis of thoracic outlet syndrome. Another thing noted on this radiograph is that the skull and cervical spine are not neutrally aligned. This could be due to poor posture or mechanical fault, which might also lead to tightness of scalenes leading to TOS.
ReplyDeleteI initially believed this was a PA view but changed my decision to an AP view based on the lack of visibility of the manubrium/sternum. The reason I believe the sternum is not distinct in this x-ray is because the dense thoracic spine is superimposing it. The book actually states that the sternum is almost impossible to see in the AP view due to this superimposition which I believe is demonstrated in this x-ray. I agree with Sally, Lindsay, and the others who believe that the posterior aspects of the ribs and vertebral segments appear more distinct as well. I also agree with the majority of the class that the presence of bilateral cervical ribs seen on C7 may be causing symptoms relating to TOS. The abnormal position of the skull and upper cspine could have been a secondary adaptation the patient signs and symptoms.
ReplyDeleteThis is Cissy- technologically challenged, yes, but here goes... The clarity of the posterior rib attachments to the vertebrae and the position of the heart suggest to me this is an AP projection as indicated by several of the above entries. If I'm counting the IV discs accurately, B cervical ribs are present at C7. Possible R thoracic curvature, elevated L mastoid process and depressed L clavicle suggest rotation/scoliosis. B scapulae appear lower than normal musculoskeletal image would show-lateral view may reveal curvature in AP plane. The fibrous band that sometimes anchors distal portion of cervical ribs may contribute to compression of neurovascular bundle according to table 7-3 in McKinnis. NV bundle compression would account for N/T and musculoskeletal deformation would account for pain. Possible Dx of TOS, scoliosis, kyphosis?
ReplyDeleteI believe this is an AP view due to the position of the heart and the R on the opposite side. B C7 cervical ribs are apparent on the x-ray. The symptoms of pain and N/T could be TOS which is common with cervical ribs.
ReplyDeleteMy gut feeling is that this is a PA view. As mentioned before, the lack of clarity of the sternum and the way the ribs look to me make feel that it is a PA view. I notice the cervical ribs at C6-7, and with the symptoms present, TOS is what I'm thinking the most likely diagnosis could be. I also notice a slight curvature in the upper thoracic spine. I'm not sure whether it is scoliosis, or maybe the person just wasn't lined up straight at the time of the x-ray.
ReplyDeleteThe image is an AP image. This is determined by the fact that the R is on the left of the image indicating that it is the right side of the body. For that to occur the patient has to be facing you. Another way to tell is that the heart which is usually seen more on the left side of mid-line - is seen on the right side of the image. Again for the heart to be on the right side of the image would indicate the patient is facing you.
ReplyDeleteAs can also clearly be seen this person has several extra cervical ribs. The medical diagnosis that was given from the physician was that of thoracic outlet syndrome due to the extra anatomy.