Chest X-Ray Review胸部影像学复习.pptVIP

Chest X-Ray Review Why order a CXR? SYMPTOMS: Bad or persistent cough Chest pain Chest injury Coughing up blood Fever Shortness of breath S/P fall Why order a CXR? Pleural effusion Pneumothorax Hemothorax Pulmonary embolus Trauma Monitoring chest drainage TB Lung cancer Chest pain (MI?) Hypertension Screening Pneumonia COPD Asthma Normal Chest X-Ray Compare symmetry Review organs (bones, lungs, heart) in sequence Left to Right then… Top to Bottom Random free search Recognition of abnormal first requires knowledge of normal. Over diagnosis of normal variation may be more serious than omission may lead to needless harmful therapy. Chest X-RayFindings Is heart enlarged or normal? Signs of heart failure and fluid overload? Does patient have pneumonia or collapsed lung? Is there evidence of emphysema? Are there findings of an aortic aneurysm? Is there fluid in the sac that surrounds the lung? Is there free air under the diaphragm? Is there a tumor in the lung that could represent cancer? The Normal Chest X-Ray Systematically evaluate chest wall, mediastinum, lungs, pleural space, heart, large arteries, ribs diaphragm. Also evaluate neck, axilla, thyroid gland abdomen What does air under diaphragm signify? What is best position for this diagnosis? Poor Quality CXR Supine position Decreases lung volume, increased heart size Basilar infiltrates interstitial spaces accentuated Increases venous return to the heart Semi-upright position Enlarges normal structures Changes air-fluid levels Failure to hold breath Lung structures diaphragm blurred Expiration film Basilar infiltrates interstitial spaces accentuated Increased heart size Missed Diagnoses What is wrong with this lung tissue??? Nothing!! But the clavicle is fractured! 10% of all x-ray interpretations have errors Especially if there are multiple problems, don’t focus on the most obvious abnormality! Systematic CXR Interpretation IDENTIFICATION Correct patient Correct date time Correct examination