复习课件CXR Interpretation胸部医学影像解读.ppt

48 yo M with hx of PUD presenting with abdominal pain 优选文档 * * * * * * * * Interpretation of Chest Radiographs UNC Emergency Medicine Medical Student Lecture Series 优选文档 * Objectives The Basics Approach to interpretation Anatomy Interstital disease Alveolar disease Pattern Recognition Practice! 优选文档 * 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 优选文档 * 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) 优选文档 * Normal Chest Radiograph 优选文档 * Trachea Right main stem bronchus Left main stem bronchus Pulmonary artery Pulmonary artery Aortic knob Left ventricle Right atrium Anatomy 优选文档 * Left hemidiaphragm Right costophrenic angle Stomach Upper lobes Middle lobe Lingula Lower Lobes Anatomy 优选文档 * Lower lobes Upper lobes Right middle lobe Lingula 优选文档 * Common Views PA AP Left Lateral Right anterior oblique AP supine Right lateral decubitus Portable CXR PA/Lateral CXR 优选文档 * These are from the Same Patient Explain the difference….. 优选文档 * PA AP Always get a PA film to avoid cardiac magnification Exceptions: trauma, active cardiac chest pain, unstable, unable to cooperate with procedure 优选文档 * Silhouette Sign 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) 优选文档 * Air Bronchogram Sign Visualization of air in the intrapulmonary bronchi Abnormal Denotes a pulmonary lesion/consolidat