CXR Interpretation胸部医学影像解读

Multiple R sided rib fractures – flail chest
Air-fluid (cavitary) lesion
Opacification of left hemithorax, air-fluid level in left upper lobe, left clavicular fracture Diagnosis: Left empyema after trauma
Let’s Practice
► What
type of 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…
Air Bronchogram Sign
► ► ►
►
Visualization of air in the intrapulmonary bronchi Abnormal Denotes a pulmonary lesion/consolidation (excludes a pleural or mediastinal lesion) Seen in pneumonia, pulmonary edema or pulmonary infarct
►
►
Two substances 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)
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
Normal Chest Radiograph
Anatomy
Trachea
Aortic knob Right main stem bronchus Left main stem bronchus Pulmonary artery
Pulmonary artery
Right atrium
Left ventricle
Finish your systematic reading The second lesion is often missed
Systematic Approach
► ABCDE ► Airwห้องสมุดไป่ตู้y
(trachea)
Midline v. deviated or rotated, FB in trachea, ET tube position
Dx: Subcutaneous air in neck and shoulder and pneumomediastinum (left heart border)
Lack of lung markings on right, collapsed lung
Dx: Complete right pneumothorax
PA/Lateral CXR
PA Right anterior oblique
Left Lateral AP Right lateral decubitus
AP supine
Portable CXR
These are from the Same Patient
Explain the difference…..
Left lower lobe pneumonia
“Spine Sign”
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Collapsed lung
Is it a tension pneumothorax?
NO!
► Tension
Pneumothorax
Mediastinum is shifted to opposite site of pneumothorax
►Look
at trachea and bronchi ►Look at heart
Any Questions?
Silhouette sign
An air bronchogram within the heart shadow suggests LLL consolidation
Interstitial Lung Disease
► The
vessels (lung markings) appear more prominent ► Alveoli are still aerated ► DDx: Pulmonary edema, inflammation, tumor, fibrosis
Your patient is unstable or in distress
►Absent
breath sounds ►Respiratory difficulty, hypoxia ►Hypotension ►Trachea shifted
Deep sulcus sign
Thank You!
Anatomy
Upper lobes
Middle lobe
Lingula
Right costophrenic angle
Stomach Left hemidiaphragm
Lower Lobes
Upper lobes
Right middle lobe
Lower lobes
Lingula
Common Views
► Bones
(clavices, ribs, humeri, etc) ► Cardiomediastinal silhoutte ► Diaphragms (and the costophrenic angles) ► Everything Else (lung fields, soft tissues, tubes, lines, wires, devices, etc)
► Pattern
Recognition ► Practice!
Interpretation
► Use ► Use
a systematic approach
Use or develop one you like
the same approach every time ► Describe what you see ► Form a differential based on patient presentation and appearance of x-ray ► If you find an abnormality, don’t stop there
PA
Exceptions: trauma, active cardiac chest pain, unstable, unable to cooperate with procedure
AP
Always get a PA film to avoid cardiac magnification
Silhouette Sign
► Give
differential or diagnosis
75 yo F with hx of MI now presenting with SOB, hypoxia
Pulmonary edema
Opacification of right hemithorax, obscured left hemidiaphram DDx: Massive pleural effusion, right pneumonectomy
Interpretation of Chest Radiographs
UNC Emergency Medicine Medical Student Lecture Series
Objectives
► The
Basics

Approach to interpretation Anatomy Interstital disease Alveolar disease
Same patient Lateral view
Air-fluid level
48 yo M with hx of PUD presenting with abdominal pain
pneumoperitoneum
67 yo smoker with one week of cough, sob, fevers