Dr. Michael Gibbs is a Professor of Emergency Medicine and interested in educating others. Radiology is a passion of his. Follow along with the EMGuideWire.com team as they post Dr. Gibbs's weekly educational, self-guided radiology slides on: Spontaneous Pneumothorax, Pneumoperitoneum, Esophageal Perforation, Hemothorax, Traumatic Aortic Disruption, PCP pneumonia, HIV, Large Pneumatocele, Pericardial Effusion, Cardiomegaly, Pulmonary Hypertension, Flail Chest
Dr. Michael Gibbs's CMC X Ray Mastery Project - Week #9 Cases
1. Chest X-Rays Of The Week
Michael Gibbs, MD, FACEP, FAAEM
Professor And Chair
Department of Emergency Medicine
Carolinas Medical Center & Levine Children’s Hospital
Vice President of Research
Atrium Health
Chest X-Ray Mastery Project
April 8th 2019
2. Disclosures
This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
The goal is to promote widespread mastery of CXR interpretation.
There is no personal health information [PHI] within, and ages have been
changed to protect patient confidentiality.
3. Process
Many are contributing: Emergency Medicine, Fellows from the Center For
Advanced Practice, Surgery, Internal Medicine, SHVI, and Medical Critical
Care. Slides are shared with all contributors.
Cases submitted this week will be distributed next week.
When reviewing the presentation, the 1st image will show a chest X-ray
without identifiers and the 2nd image will reveal the diagnosis.
8. Sahn SA. NEJM 2000; 342:868-874.
Classification Of Pneumothorax According To Cause
Spontaneous
1°: No clinical lung disease
2°: A complication of clinically apparent lung disease
Traumatic
• Penetrating trauma
• Blunt trauma
Iatrogenic
• Transthoracic needle aspiration
• Central line placement
• Thoracentesis
• Lung biopsy
32. 25 Year Old With
Recently
Diagnosed HIV and
PCP Pneumonia
33. 25 Year Old With
Recently
Diagnosed HIV and
PCP Pneumonia
Diffuse Infiltrates Consistent With PCP Pneumonia
34. 25 Year Old With
Recently
Diagnosed HIV and
PCP Pneumonia
Diffuse Infiltrates Consistent With PCP Pneumonia
But What
Is This?
35. 25 Year Old With
Recently
Diagnosed HIV and
PCP Pneumonia
Diffuse Infiltrates Consistent With PCP Pneumonia
Large
Pneumatocele
36. 25 Year Old With
Recently
Diagnosed HIV and
PCP Pneumonia
Large Pneumatocele
Next Day:
Pneumatocele
Rupture And
Pneumothorax
37. 25 Year Old With
Recently
Diagnosed HIV and
PCP Pneumonia
Large Pneumatocele
Percutaneous
Chest Tube
38. 2003; 126:859-861.
• Thin walled parenchymal cysts
• More common in children than in adults
Causes:
• Blunt chest trauma
• COPD and other bullous/cystic lung diseases
• Severe pneumonia [aspiration, anaerobic, TB, Pneumocystis…]
• Mechanical ventilator barotrauma
Complications:
• Infection
• Rupture and pneumothorax
• Rapid expansion and tension pneumatocele