By Prof.Shana

1. Chest X-Ray Collection By AMIR B.CHANNA FFARCS,DA (Eng) King Khalid Univ. Hospital Riyadh KSA

3. Have a System…

4. Step #1: Always, always, always… Confirm the patient’s name & check date on film

5. Step #2: Know a good CXR when you see one… assess the film’s quality HOW ?

7. Step #3: Read the film… DO NOT JUMP TO DIAGNOSIS

11. Know your anatomy…

21. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10

23. A B C Heart size - Cardiothoracic Ratio (CTR) A+B/C

32. Slice width Conventional CT

33. Spiral CT

34. Air Bone Water

35. Normal Anatomy

37. Bone Anatomy Sternum Rib

39. Lateral view

40. Cardiac Anatomy: Right Sided Chambers

41. Cardiac Anatomy: Left Sided Chambers

42. isnpexp SVC Aortic Arch Right Descending Pulmonary Artery Left Descending Pulmonary Atery

45. Trachea Carina R + L Main Bronchi

53. Parietal Pleura Visceral pleura

54. normaldiag Diaphragms Normal: Sharp costophrenic sulcus

55. normaldiag

56. Which is right and left diaphragm?

59. isnpexp Clavicles Spinous Process Vertebral Body Visible 6 7 Counting anterior ribs 10 11 Counting posterior ribs

61. 4 th Anterior 8 th Posterior Expiration Image

62. Inspiration: Same Patient Expiration

64. Bone and Soft Tissues

65. productive1stribs Productive 1 st rib changes: Can simulate nodule

66. Lordotic View Better assess apices without bone overlap

67. Rib Fracture

69. Presenting CXR

71. MRI Computed Tomography Pancoast Tumour

72. Cardiovascular

73. Increased Cardiac Size: Can be Cardiac or Pericardial Pericardial Effusion Dilated Cardiomyopathy What imaging would you use to differentiate between the two ?

74. Left Ventricular Enlargement Enlargement of Left Ventricle Left Ventricle IVC

75. Airspace Disease and Silhouette Sign

78. Bronchopneumonia Pattern: Airspace Nodules

79. Acinar Nodules Computed Tomography

81. airbronch

83. CT Consolidation: Air Bronchograms

85. Where is the Pneumonia?

94. What Types of CXRs Are Available?

98. Enough Basics… Lets read some films! **Don’t feel bad if you miss some things… these are not easy films**

99. Case #201

100. 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…

101. CXR 201

102. Case #202

103. 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…

104. CXR 202

105. CXR 202 (lat)

106. Case #203

107. 35 yo with chronic cough, new onset oligoarthritis & painful nodules on his BLE’s… A Portable film was obtained in the ER…

108. CXR 203

109. Case #204

110. 44 yo alcoholic presents with new onset SOB… PA & lat from the ED…

111. CXR 204

112. CXR 204 (lat)

113. CXR 204 (decub)

114. These are the two CXRs of the same patient taken few seconds apart, what is evident from it

116. Identify the problem with this patient having this CXR, what are its anesthetic implications

117. Identify the problem with this patient having this CXR, what are its anesthetic implications

118. Identify the problems with this patient having this CXR, what are its anesthetic implications

119. Identify the problems with this patient having this CXR, what other investigations would you do for this patient who is scheduled for chest surgery

121. Identify the problems with this patient having this CXR, what are its anesthetic implications

122. Identify the problem with this patient having this CXR, what are its anesthetic implications & how will you manage this patient

123. Identify the problem with this patient having this VQ scan, what are its anesthetic implications & how will you manage this patient

124. Identify the problem with this patient having this CXR, what are its anesthetic implications & how will you manage this patient

125. Identify the problems with this child having this CXR, what are its anesthetic implications

126. Identify the problem with this patient having this CXR, what do the arrows point toward & what are its anesthetic implications

127. Identify the problems with this patient having this CXR, what are its anesthetic implications

185. Case #205

186. Same 44 yo alcoholic presents 1 week later with fevers & chills… PA/lat CXR performed in the ED…

187. CXR 205

188. CXR 205 (lat)

189. Case #206

190. 50 yo male with sinusitis, fever & progressive cough/DOE for 8 weeks… An AP film was obtained in the ED…

191. CXR 206

192. Case #207

193. 25 yo female presents with acute L sided chest pain… AP & lateral films were obtained in the ED…

194. CXR 207

195. CXR 207 (lat)

196. Case #208

197. 40 yo with HIV (refused HAART), presents with new SSCP… A portable film was obtained in the ED…

198. CXR 208

199. Case #209

200. 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…

201. CXR 209

202. Case #210

203. 60 yo with 1 week of progressive DOE followed by SOB at rest… AP film was obtained in the ED…

204. CXR 210

206. Case #211

207. 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…

208. CXR 211

209. CXR 211 (lat)

210. Case #212

211. 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…

212. CXR 212

213. Case #213

214. 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…

215. CXR 213

216. Case #214

217. 40 yo previously healthy immigrant presents with new onset massive (>400cc) hemoptysis… A portable CXR was obtained in the ED…

218. CXR 214

219. Case #215

220. 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…

221. CXR 215A

222. CXR 215B

223. CXR 215C

224. End CXR 201 Happy CXR reading!