CXR Interpretation胸部医学影像解读.pptVIP

Dx: Subcutaneous air in neck and shoulder and pneumomediastinum (left heart border) Lack of lung markings on right, collapsed lung Dx: Complete right pneumothorax 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 Your patient is unstable or in distress Absent breath sounds Respiratory difficulty, hypoxia Hypotension Trachea shifted Deep sulcus sign Thank You! Any Questions? Interpretation of Chest Radiographs UNC Emergency Medicine Medical Student Lecture Series Objectives The Basics Approach to interpretation Anatomy Interstital disease Alveolar disease Pattern Recognition Practice! Interpretation Use a systematic approach Use or develop one you like Use 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 Finish your systematic reading The second lesion is often missed Systematic Approach ABCDE Airway (trachea) Midline v. deviated or rotated, 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) Normal Chest Radiograph Trachea Right main stem bronchus Left main stem bronchus Pulmonary artery Pulmonary artery Aortic knob Left ventricle Right atrium Anatomy Left hemidiaphragm Right costophrenic angle Stomach Upper lobes Middle lobe Lingula Lower Lobes Anatomy Lower lobes Upper lobes Right middle lobe Lingula Common Views PA AP Left Lateral Right anterior oblique AP supine Right lateral decubitus Portable CXR PA/Lateral CXR These are from the Same Patient Explain the difference….. PA AP Always get a PA film to avoid cardiac magnification Exceptions: trauma, active cardiac chest pain, unstable, unable to cooperate with procedure Silhouette Sign Two substances of t