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1、1,Interpretation of Chest Radiographs,UNC Emergency Medicine Medical Student Lecture Series,2,Objectives,The Basics Approach to interpretation Anatomy Interstital disease Alveolar disease Pattern Recognition Practice!,3,Interpretation,Use a systematic approach Use or develop one you like Use the sam
2、e approach every time Describe what you see Form a differential based on patient presentation and appearance of x-ray If you find an abnormality, dont stop there Finish your systematic reading The second lesion is often missed,4,Systematic Approach,ABCDE Airway (trachea) Midline v. deviated or rotat
3、ed, FB in trachea, ET tube position Bones (clavices, ribs, humeri, etc) Cardiomediastinal silhoutte Diaphragms (and the costophrenic angles) Everything Else (lung fields, soft tissues, tubes, lines, wires, devices, etc),5,Normal Chest Radiograph,6,Trachea,Right main stem bronchus,Left main stem bron
4、chus,Pulmonary artery,Pulmonary artery,Aortic knob,Left ventricle,Right atrium,Anatomy,7,Left hemidiaphragm,Right costophrenic angle,Stomach,Upper lobes,Middle lobe,Lingula,Lower Lobes,Anatomy,8,Lower lobes,Upper lobes,Right middle lobe,Lingula,9,Common Views,PA,AP,Left Lateral,Right anterior obliqu
5、e,AP supine,Right lateral decubitus,Portable CXR,PA/Lateral CXR,10,These are from the Same Patient,Explain the difference.,11,PA,AP,Always get a PA film to avoid cardiac magnification Exceptions: trauma, active cardiac chest pain, unstable, unable to cooperate with procedure,12,Silhouette Sign,Two s
6、ubstances of the same density, in direct contact, cannot be differentiated from each other on x-ray Common locations Lower lobes-diaphragms Right heart border RML Left heart border Lingula Left diaphragm Heart (on lateral view),13,Air Bronchogram Sign,Visualization of air in the intrapulmonary bronc
7、hi Abnormal Denotes a pulmonary lesion/consolidation (excludes a pleural or mediastinal lesion) Seen in pneumonia, pulmonary edema or pulmonary infarct,An air bronchogram within the heart shadow suggests LLL consolidation,Silhouette sign,14,Interstitial Lung Disease,The vessels (lung markings) appea
8、r more prominent Alveoli are still aerated DDx: Pulmonary edema, inflammation, tumor, fibrosis,15,Alveolar Disease,Vessels are less visible in the area of disease Lung is not aerated May have air bronchograms or silhouette sign DDx: Bacterial pneumonia, pulmonary edema,16,Lets Practice,What type of
9、film Describe what you see Consolidation, infiltrate, nodular, diffuse, streaky, opacification Look for Silhouette sign and air bronchograms Is it an interstitial or alveolar pattern? Other findings Give differential or diagnosis,17,75 yo F with hx of MI now presenting with SOB, hypoxia,18,Pulmonary
10、 edema,19,20,Opacification of right hemithorax, obscured left hemidiaphram DDx: Massive pleural effusion, right pneumonectomy,21,22,Multiple R sided rib fractures flail chest,23,24,Opacification of left hemithorax, air-fluid level in left upper lobe, left clavicular fracture Diagnosis: Left empyema
11、after trauma,Air-fluid (cavitary) lesion,25,Same patient Lateral view,Air-fluid level,26,48 yo M with hx of PUD presenting with abdominal pain,27,pneumoperitoneum,28,67 yo smoker with one week of cough, sob, fevers,29,Left lower lobe pneumonia,30,“Spine Sign”,31,32,Dx: Subcutaneous air in neck and s
12、houlder and pneumomediastinum (left heart border),33,34,Lack of lung markings on right, collapsed lung Dx: Complete right pneumothorax,Collapsed lung,Is it a tension pneumothorax?,35,NO!,Tension Pneumothorax Mediastinum is shifted to opposite site of pneumothorax Look at trachea and bronchi Look at heart Your patient is unstable or in distress Absent breath sounds Respiratory difficulty, hypoxia Hypotension Trachea shifted,36,Deep sulcus sign,37,Thank You!,Any Questions?,
