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Chest X-Ray   Collection By AMIR B.CHANNA FFARCS,DA (Eng) King Khalid  Univ. Hospital  Riyadh KSA
Most important things when reading a CXR… ,[object Object],[object Object],[object Object],[object Object]
Have a System…
Step #1: Always, always, always… Confirm the patient’s name & check date on film
Step #2: Know a good CXR when you see one… assess the film’s quality  HOW ?
Assessing Quality: R.I.P. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Step #3: Read the film… DO NOT JUMP TO DIAGNOSIS
My System: the Short Version: ( Use this for routine films) ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Long Version: Use this system for more complicated films on the wards & at Morning Report ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
More Details on the Lungs: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Know your anatomy…
 
 
 
 
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10
 
A B C Heart size - Cardiothoracic Ratio (CTR) A+B/C
 
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
 
Slice   width Conventional CT
Spiral CT
Air Bone Water
Normal Anatomy
Bone-CT Reconstruction ,[object Object],Clavicle Rib Intercostal Space Vertebral Column
Bone Anatomy Sternum Rib
Heart Size ,[object Object]
Lateral view
Cardiac Anatomy: Right Sided Chambers
Cardiac Anatomy: Left Sided Chambers
isnpexp SVC Aortic Arch Right Descending Pulmonary Artery Left Descending Pulmonary Atery
inspexp ,[object Object],Retrosternal Airspace Scapula IVC Pulmonary Vessels Hilum
Airway Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trachea Carina R + L Main Bronchi
Lung Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
Pleura and Fissures ,[object Object],[object Object],[object Object],[object Object],[object Object]
Parietal Pleura Visceral pleura
normaldiag Diaphragms Normal: Sharp costophrenic sulcus
normaldiag
Which is right and left diaphragm?
 
Approach to Chest Radiograph: Technical Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
isnpexp Clavicles Spinous Process Vertebral Body Visible 6 7 Counting anterior ribs 10 11 Counting posterior ribs
Inspiration/Expiration  Images ,[object Object],[object Object],[object Object],[object Object]
4 th  Anterior 8 th  Posterior Expiration Image
Inspiration: Same Patient Expiration
Abnormal Cases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bone and Soft Tissues
productive1stribs Productive 1 st  rib changes: Can simulate nodule
Lordotic View Better assess apices without bone overlap
Rib Fracture
 
Presenting CXR
 
MRI Computed Tomography Pancoast Tumour
Cardiovascular
Increased Cardiac Size: Can be Cardiac or Pericardial Pericardial Effusion Dilated Cardiomyopathy What imaging would you use to differentiate between the two ?
Left Ventricular Enlargement Enlargement of Left Ventricle Left  Ventricle IVC
Airspace Disease and Silhouette Sign
Airspace Disease ,[object Object],[object Object],[object Object],[object Object],[object Object]
Air Space Disease: Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object]
Bronchopneumonia Pattern: Airspace Nodules
Acinar Nodules Computed Tomography
Air Bronchogram ,[object Object],[object Object]
airbronch
 
CT Consolidation: Air Bronchograms
Silhouette Sign ,[object Object],[object Object],[object Object],[object Object]
Where is the Pneumonia?
 
 
 
 
 
 
 
 
What Types of CXRs Are Available?
Different CXR Views: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Routine CXR Views: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When to get special views… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Enough Basics… Lets read some films! **Don’t feel bad if you miss some things… these are not easy films**
Case #201
Patient is brought to the ED after a restrained MVA…he complains of CP and abd pain… A Portable film was obtained in the ER…
CXR 201
Case #202
Patient presents to the WSVA emergency room with severe abd pain, nausea & vomiting… the lab calls and says their machine is broken… A Portable film was obtained in the ER… you have only this CXR with which to make your Dx…
CXR 202
CXR 202 (lat)
Case #203
35 yo with chronic cough, new onset oligoarthritis & painful nodules on his BLE’s… A Portable film was obtained in the ER…
CXR 203
Case #204
44 yo alcoholic presents with new onset SOB… PA & lat from the ED…
CXR 204
CXR 204 (lat)
CXR 204 (decub)
These are the two CXRs of the same patient taken few seconds apart, what is evident from it
 
Identify the problem with this patient having this CXR, what are its anesthetic implications
Identify the problem with this patient having this CXR, what are its anesthetic implications
Identify the problems with this patient having this CXR, what are its anesthetic implications
Identify the problems with this patient  having this CXR, what other investigations would you do for this patient who is scheduled for chest surgery
 
Identify the problems with this patient  having this CXR, what are its anesthetic implications
Identify the problem with this patient having this CXR, what are its anesthetic implications & how will you manage this patient
Identify the problem with this patient having this VQ scan, what are its anesthetic implications  & how will you manage this patient
Identify the problem with this patient having this CXR, what are its anesthetic implications & how will you manage this patient
Identify the problems with this child  having this CXR, what are its anesthetic implications
Identify the problem with this patient having this CXR,  what do the arrows point toward  & what are its anesthetic implications
Identify the problems with this patient  having this CXR, what are its anesthetic implications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Case #205
Same 44 yo alcoholic presents 1 week later with fevers & chills… PA/lat CXR performed in the ED…
CXR 205
CXR 205 (lat)
Case #206
50 yo male with sinusitis, fever & progressive cough/DOE for 8 weeks… An AP film was obtained in the ED…
CXR 206
Case #207
25 yo female presents with acute L sided chest pain… AP & lateral films were obtained in the ED…
CXR 207
CXR 207 (lat)
Case #208
40 yo with HIV (refused HAART), presents with new SSCP… A portable film was obtained in the ED…
CXR 208
Case #209
40 yo with HIV on HAART x 10 years (cd4 count 250) presents with new onset fever & night sweats… Portable film obtained in the ED…
CXR 209
Case #210
60 yo with 1 week of progressive DOE followed by SOB at rest… AP film was obtained in the ED…
CXR 210
[object Object]
Case #211
70 yo presents with 6 weeks of progressive DOE, chronic n-p cough and now SOB at rest… PA & lateral films were obtained in the ED…
CXR 211
CXR 211 (lat)
Case #212
55 yo with severe epigastric pain x 2 days followed by 4 hours of new onset SSCP and worsing abd pain… Portable film obtained in the ED…
CXR 212
Case #213
45 yo smoker gets this pre-op CXR before an elective Nissen fundapplication… He’s been having a lingering non-productive cough x 6 weeks This PA film was obtained…
CXR 213
Case #214
40 yo previously healthy immigrant presents with new onset massive (>400cc) hemoptysis… A portable CXR was obtained in the ED…
CXR 214
Case #215
40 yo previously healthy female presents with 1 day fever, cough & SOB She is admitted to the floor for dehydration but then develops hypoxemia requiring increasing O2… Serial CXR’s over the next 12 hours were obtained…
CXR 215A
CXR 215B
CXR 215C
End CXR 201 Happy CXR reading!

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Pulmonary Imaging

Notas del editor

  1. Self explanatory and goes with next slide
  2. Summary of things that will be shown
  3. CF