Dr. Michael Gibbs is a Professor of Emergency Medicine and interested in educating others. Radiology is a passion of his. Follow along with the EMGuideWire.com team as they post Dr. Gibbs's weekly educational, self-guided radiology slides on: Traumatic Aortic Disruption, Foreign Bodies, Sternal Fracture, Rib Fractures, Chest Trauma, Pneumothorax, Hemothorax, and Thoracic Aortic Aneurysms.

1. Chest X-Rays Of The Week
Michael Gibbs, MD, FACEP, FAAEM
Professor And Chair
Department of Emergency Medicine
Carolinas Medical Center & Levine Children’s Hospital
Vice President of Research
Atrium Health
CMC X-Ray Mastery Series
February 11th 2019

2. Disclosures
 This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
 The goal is to promote widespread mastery of CXR interpretation.
 There is no personal health information [PHI] within and ages have been
changed to protect patient confidentiality.

3. Process
 Many are contributing: Emergency Medicine, Fellows from the Center For
Advanced Practice, Trauma & Acute Care Surgery, SHVI, and Medical
Critical Care. Slides are shared with all contributors.
 Cases submitted this week be distributed next week.
 The 1st image will show a chest X-ray without identifiers and the 2nd image
will reveal the diagnoses.

4. It’s All About The Anatomy!

5. Airway
Bones
Cardiac
Diaphragm
Effusion
Foreign body
Gastric
Hilum

6. Fall Off Of A Roof

7. Flail Chest
 The result of severe blunt chest trauma.
 Multiple ribs fractured in ≥2 places.
Fall Off Of A Roof

8. Flail Chest
 Inspiration increases [-] thoracic pressure.
 Leads to paradoxical motion of the flail segment.

9. Flail Chest
 Frequently requires mechanical ventilation.
 Rib plating stabilizes the fail segment.

10. Pedestrian
Struck By An
SUV

11. Pedestrian
Struck By An
SUV
Traumatic Aortic Disruption [TAD]
 Typically a high mechanism of injury.
 MVC, pedestrian struck, fall from a height.
Wide
Mediastinum

12. Our Patient
Aortic
Laceration

13. TAD Chest X-Ray Findings
1. Wide mediastinum
2. Abnormal aortic contour
3. Lost of aortopulmonary window
4. Tracheal deviation
5. Depressed left mainstem
6. Apical cap
7. Deviated nasogastric tube
8. Widened paratracheal stripe

16. Loss Of The
Aortopulmonary
Window

17. Tracheal
Deviation
Loss Of The
Aortopulmonary
Window

18. Apical
CapTracheal
Deviation
Loss Of The
Aortopulmonary
Window

19. Apical
CapTracheal
Deviation
Loss Of The
Aortopulmonary
Window

24. MVC – Struck Chest On The Steering Wheel

25. MVC – Struck Chest On The Steering Wheel
Sternal Fracture
 Direct impact to the anterior chest.
 Overlying tenderness & swelling.
 Best seen on the lateral view.

27. Sometimes The Foreign Body Is No So Easy To See!
Get A 2nd Views If You Suspect It And Your PA or AP Views Are “Negative.”
Swallowed
Coin

29. Nail Gun
Injury
Sometimes The Foreign Body Is No So Easy To See!
Get A 2nd Views If You Suspect It And Your PA or AP Views Are “Negative.”

30. Car Crash

31. Car Crash
Left Pneumothorax, Rib Fractures, SQ Emphysema.
*
*
*

32. Multiple Left
Sided Rib
Fractures

33. Stab Wound
To Left Chest

34. Left Hemothorax
Stab Wound
To Left Chest
Notice:
Early Tracheal Deviation

35. After Chest Tube Placed
Stab Wound
Left Chest

36. After Chest Tube Placed
Stab Wound
Left Chest
Notice:
Midline Trachea

37. 72 Year-Old
Who Moved To
Charlotte From
Honduras
This Month

38. 72 Year-Old
Who Moved To
Charlotte From
Honduras
This Month
Traumatic Aortic Aneurysm [TAA]
 Thoracic aorta >3.5 cm considered dilated.
 Thoracic aorta >4.5 cm considered aneurysmal.

39. TAA: Anatomy Defined By CT Angiography

40. Thoracic Aortic Aneurysm
Endovascular Repair

41. TAA: Endograft

42. Thoracic Aortic Aneurysm

43. Thoracic Aortic Aneurysm

44. Thoracic Aortic Aneurysm

45. Summary Of Diagnoses This Week
• Flail chest
• Traumatic aortic disruption
• Foreign bodies that can be difficult to see
• Sternal fracture
• Chest trauma with assorted findings (e.g.: rib fracture,
pneumothorax, hemothorax, subcutaneous emphysema)
• Thoracic aortic aneurysm

46. See You Next Week!