CXR-Interpretation胸部医学影像解读(可编辑修改).ppt

Interpretation of Chest RadiographsUNC Emergency MedicineUNC Emergency MedicineMedical Student Lecture SeriesMedical Student Lecture SeriesObjectivesThe BasicsApproach to interpretationApproach to interpretationAnatomyAnatomyInterstital diseaseInterstital diseaseAlveolar diseaseAlveolar diseasePattern RecognitionPractice!InterpretationUse a systematic approachUse a systematic approach Use or develop one you likeUse or develop one you likeUse the same approach every time Use the same approach every time Describe what you seeDescribe what you seeForm a differential based on patient presentation Form a differential based on patient presentation and appearance of x-rayand appearance of x-rayIf you find an abnormality,dont stop thereIf you find an abnormality,dont stop there Finish your systematic readingFinish your systematic reading The second lesion is often missedThe second lesion is often missedSystematic ApproachABCDEAirway(trachea)Midline v.deviated or rotated,FB in trachea,ET Midline v.deviated or rotated,FB in trachea,ET tube positiontube positionBones(clavices,ribs,humeri,etc)Cardiomediastinal silhoutteDiaphragms(and the costophrenic angles)Everything Else(lung fields,soft tissues,tubes,lines,wires,devices,etc)Normal Chest RadiographTracheaRight main stem bronchusLeft mainstem bronchusPulmonary arteryPulmonary arteryAortic knobLeft ventricleRight atriumAnatomyLeft hemidiaphragmRight costophrenicangleStomachUpper lobesMiddle lobeLingulaLower LobesAnatomyLower lobesUpper lobesRight middle lobeLingula Common ViewsPAAPLeft LateralRight anterior obliqueAP supineRight lateral decubitusPortable CXRPA/Lateral CXRThese are from the Same Patient Explain the difference.PAAPAlways get a PA film to avoid cardiac magnificationExceptions:trauma,active cardiac chest pain,unstable,unable to cooperate with procedure Silhouette SignTwo substances of the Two substances of the same density,in direct same density,in direct contact,cannot be contact,cannot be differentiated from each differentiated from each other on x-rayother on x-rayCommon locationsCommon locations Lower lobes-diaphragmsLower lobes-diaphragms Right heart border RMLRight heart border RML Left heart border LingulaLeft heart border Lingula Left diaphragm Heart (on Left diaphragm Heart (on lateral view)lateral view)Air Bronchogram SignVisualization of air in the Visualization of air in the intrapulmonary bronchiintrapulmonary bronchiAbnormal Abnormal Denotes a pulmonary Denotes a pulmonary lesion/consolidation lesion/consolidation(excludes a pleural or(excludes a pleural or mediastinal lesion)mediastinal lesion)Seen in pneumonia,Seen in pneumonia,pulmonary edema or pulmonary edema or pulmonary infarct pulmonary infarct An air bronchogram within the heart shadow suggests LLL consolidationSilhouette signInterstitial Lung DiseaseThe vessels(lung The vessels(lung markings)appear markings)appear more prominentmore prominentAlveoli are still aeratedAlveoli are still aeratedDDx:Pulmonary DDx:Pulmonary edema,inflammation,edema,inflammation,tumor,fibrosistumor,fibrosisAlveolar DiseaseVessels are less visible Vessels are less visible in the area of diseasein the area of diseaseLung is not aeratedLung is not aeratedMay have air May have air bronchograms or bronchograms or silhouette signsilhouette signDDx:Bacterial DDx:Bacterial pneumonia,pulmonary pneumonia,pulmonary edemaedemaLets PracticeWhat type of filmDescribe what you seeConsolidation,infiltrate,nodular,diffuse,Consolidation,infiltrate,nodular,diffuse,streaky,opacificationstreaky,opacificationLook for Silhouette sign and air bronchogramsLook for Silhouette sign and air bronchogramsIs it an interstitial or alveolar pattern?Is it an interstitial or alveolar pattern?Other findingsOther findingsGive differential or diagnosis75 yo F with hx of MI now presenting with SOB,hypoxiaPulmonary edemaOpacification of right hemithorax,obscured left hemidiaphramDDx:Massive pleural effusion,right pneumonectomyMultiple R sided rib fractures flail chest Opacification of left hemithorax,air-fluid level in left upper lobe,left clavicular fractureDiagnosis:Left empyema after traumaAir-fluid(cavitary)lesionSame patientLateral view Air-fluid level48 yo M with hx of PUD presenting with abdominal painpneumoperitoneum67 yo smoker with one week of cough,sob,feversLeft lower lobe pneumonia“Spine Sign”http:/ air in neck and shoulder and pneumomediastinum(left heart border)Lack of lung markings on right,collapsed lungDx:Complete rightpneumothoraxCollapsed lungIs it a tension pneumothorax?NO!Tension PneumothoraxMediastinum is shifted to Mediastinum is shifted to oppositeopposite site of site of pneumothoraxpneumothoraxLook at trachea and bronchiLook at trachea and bronchiLook at heartLook at heartYour patient is unstable or in distressYour patient is unstable or in distressAbsent breath soundsAbsent breath soundsRespiratory difficulty,hypoxiaRespiratory difficulty,hypoxiaHypotensionHypotensionTrachea shiftedTrachea shiftedDeep sulcus signThank You!Any Questions?