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Musculoskeletal Imaging
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Prepare trainees to be on call for the emergency department with this specialized training series.
Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Introduction
Introduction
1 topic, 1 min. of video
Right Upper Quadrant Pain
Right Upper Quadrant Pain
20 topics, 55 min. of video
Normal Anatomy and Basic Ultrasounds: Abdomen and Pelvis
8 m.Cholelithiasis
2 m.Case: Acute Cholecystitis on Ultrasound
2 m.Acute Cholecystitis on Ultrasound
3 m.Case: Acute Cholecystitis on CT
2 m.Acute Cholecystitis on CT
1 m.Case: Cholecystitis With Calcified Stones
3 m.Gallstones on CT
2 m.Case: Tensile Gallbladder Fundus Sign
2 m.Tensile Gallbladder Fundus Sign
2 m.Case: Gangrenous Cholecystitis
2 m.Gangrenous Cholecystitis
2 m.Case: Emphysematous Cholecystitis With Portal Venous Gas Air
2 m.Emphysematous Cholecystitis With Portal Venous Gas Air
4 m.Case: Emphysematous Cholecystitis With Perforation
5 m.Emphysematous Cholecystitis Summary
3 m.Case: Mirizzi Syndrome With Dilated Intrahepatic Bile Ducts
4 m.Mirizzi Syndrome
6 m.Case: Choledocholithiasis
5 m.Choledocholithiasis
4 m.Midline Pain
Midline Pain
10 topics, 24 min. of video
Case: Acute Gallstone Pancreatitis
2 m.Causes of Pancreatitis
4 m.Cases: Pancreatitis Without/With Necrosis
3 m.Revised Atlanta Classification
6 m.Case: Pancreatitis With SMV and Splenic Vein Thrombosis
3 m.Pancreatitis Complication: SMV and Splenic Vein Thrombosis
3 m.Case: Pancreatitis With Pseudoaneurysm of Splenic Artery
2 m.Pancreatitis Complication: Splenic Artery Pseudoaneurysm
2 m.Case: Duodenal Ulcer With Perforation
2 m.Types of Perforated Ulcers
2 m.Lower Quadrant Pain
Lower Quadrant Pain
4 topics, 11 min. of video
Left Lower Quadrant Pain
Left Lower Quadrant Pain
11 topics, 16 min. of video
Case: Classic Diverticulitis
2 m.Diverticulitis
2 m.Case: Diverticulitis With Free Air
2 m.Case: Diverticulitis, Perforated with Abscess
2 m.Diverticulitis: Perforated With Abscess Post Drainage
2 m.Case: Diverticulitis With Colovesical Fistula
2 m.Diverticulitis With Colovesical Fistula
1 m.Case: Diverticulitis With IMV Thrombosis
2 m.Diverticulitis With IMV Thrombosis
2 m.Case: Epiploic Appendagitis
2 m.Epiploic Appendagitis and Omental Infarction
3 m.Bowel Obstruction
Bowel Obstruction
26 topics, 1 hr. of video
Case: Umbilical Hernia
3 m.Obstructing Umbilical Hernias
3 m.Groin Hernias: Introduction
3 m.Case: Indirect Inguinal Hernia
2 m.Inguinal Hernias
2 m.Case: Femoral Hernia
2 m.Case: Obturator Hernia
2 m.Groin Hernias: Summary
3 m.Case: Simple Bowel Obstruction
2 m.Case: High Grade Bowel Obstruction
2 m.Case: Gallstone Ileus
3 m.Gallstone Ileus and Cholecytocolic Fistula
3 m.Case: Closed Loop Small Bowel Obstruction
3 m.Closed Loop Small Bowel Obstruction
5 m.Case: Large Bowel Colonic Obstruction
2 m.Large Bowel Colonic Obstruction
2 m.Case: Perforated Colon From Colon Cancer
3 m.Perforated Colon
4 m.Case: SMA Embolism With Bowel Ischemia
3 m.SMA Embolism
4 m.Case: Mesenteric Vein Thrombosis
3 m.Mesenteric Vein Thrombosis
2 m.Case: Cecal Volvulus
2 m.Cecal Volvulus
4 m.Case: Sigmoid Volvulus
3 m.Sigmoid Volvulus
3 m.Retroperitoneum
Retroperitoneum
15 topics, 46 min. of video
Retroperitoneum
3 m.Case: Ruptured Abdominal Aortic Aneurysm
2 m.Abdominal Aortic Aneurysm Rupture
4 m.Case: Bleeding Angiomyolipoma
3 m.Angiomyolipoma
2 m.Case: Psoas Hematoma
3 m.Retroperitoneal Bleeding
2 m.Case: Renal Stones
3 m.Enhancement Patterns of Kidneys
7 m.Case: Forniceal Rupture
4 m.Forniceal Rupture
2 m.Case: Pyelonephritis
3 m.Pyelonephritis
3 m.Case: Renal Infarcts
3 m.Renal Infarcts
9 m.0:00
Okay, so let's talk about the
0:02
tensile gallbladder fundus sign.
0:04
Now, commonly in our ER, the surgeons will
0:07
come back and talk to us, and you know,
0:09
they don't really want to listen to us.
0:10
They think everything is fine.
0:11
They're like, oh, the patient doesn't have any pain
0:12
despite the pound of morphine they've been given.
0:15
And they're reticent to want to
0:16
take the patient to surgery.
0:17
And I have to say, sometimes you have to break
0:18
bad news to surgeons and let them know that you
0:21
have a problem, right?
0:22
And honestly, part of your job as a radiology resident
0:26
is to establish some dominance in the reading room.
0:28
So knowing some of the signs, knowing their
0:30
sensitivities and specificities, and being able
0:33
to explain that to your surgical colleagues can
0:35
really bring you a long way towards validation
0:37
with that population of referring physicians.
0:40
So the tensile gallbladder sign, I think it's helped
0:41
me a number of times when I think that the gallbladder
0:44
findings are kind of, um, a little bit on the edge
0:47
or, uh, a little bit less dramatic, and that's
0:50
that this anterior fundus of the gallbladder
0:52
is going to push that abdominal wall away.
0:55
It is 75% sensitive and 95% specific for acute
0:59
cholecystitis in the absence of any other sign.
1:02
So if you see that gallbladder pushing
1:05
the abdominal wall, you can call
1:07
cholecystitis.
1:08
It's a really useful sign, especially
1:09
in making that early diagnosis.
1:11
Some of our patients are coming
1:12
to the ER either later or earlier.
1:14
It seems to be on either edge of that spectrum,
1:16
but those early presenters who are getting their
1:18
CT scans early, this can be a really helpful sign
1:21
in order to establish this diagnosis and be able
1:24
to just stop there and move the patient to the
1:26
next level, which is a surgical intervention.
Tensile Gallbladder Fundus Sign
HIDEInteractive Transcript
0:00
Okay, so let's talk about the
0:02
tensile gallbladder fundus sign.
0:04
Now, commonly in our ER, the surgeons will
0:07
come back and talk to us, and you know,
0:09
they don't really want to listen to us.
0:10
They think everything is fine.
0:11
They're like, oh, the patient doesn't have any pain
0:12
despite the pound of morphine they've been given.
0:15
And they're reticent to want to
0:16
take the patient to surgery.
0:17
And I have to say, sometimes you have to break
0:18
bad news to surgeons and let them know that you
0:21
have a problem, right?
0:22
And honestly, part of your job as a radiology resident
0:26
is to establish some dominance in the reading room.
0:28
So knowing some of the signs, knowing their
0:30
sensitivities and specificities, and being able
0:33
to explain that to your surgical colleagues can
0:35
really bring you a long way towards validation
0:37
with that population of referring physicians.
0:40
So the tensile gallbladder sign, I think it's helped
0:41
me a number of times when I think that the gallbladder
0:44
findings are kind of, um, a little bit on the edge
0:47
or, uh, a little bit less dramatic, and that's
0:50
that this anterior fundus of the gallbladder
0:52
is going to push that abdominal wall away.
0:55
It is 75% sensitive and 95% specific for acute
0:59
cholecystitis in the absence of any other sign.
1:02
So if you see that gallbladder pushing
1:05
the abdominal wall, you can call
1:07
cholecystitis.
1:08
It's a really useful sign, especially
1:09
in making that early diagnosis.
1:11
Some of our patients are coming
1:12
to the ER either later or earlier.
1:14
It seems to be on either edge of that spectrum,
1:16
but those early presenters who are getting their
1:18
CT scans early, this can be a really helpful sign
1:21
in order to establish this diagnosis and be able
1:24
to just stop there and move the patient to the
1:26
next level, which is a surgical intervention.
Report
Faculty
Laura L Avery, MD
Assistant Professor of Emergency Radiology Harvard Medical School
Massachusetts General Hosptial
Tags
Infectious
Gastrointestinal (GI)
Gallbladder
Emergency
CT
Body
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