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: RUL pneumonia, tension hemothorax, blunt bronchial injury, pneumomediastinum, Free air under the diaphragm, Lung Cancer and pleural effusion, Tension pneumothorax, cardiomegaly

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
March 4th 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. Prior CXR
Now
54 Year-Old With COPD & Diabetes Fever, Hypoxia, Altered Mental Status

7. Prior CXR
Now
54 Year-Old With COPD & Diabetes Fever, Hypoxia, Altered Mental Status
RUL Pneumonia

8. 42 Year-Old In A
High Speed Motor
Vehicle Crash.

9. 42 Year-Old In A
High Speed Motor
Vehicle Crash.
Traumatic Right Tension Hemothorax

10. 31 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.

11. 31 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
Right Chest
Tube
Multiple Rib Fractures And A Persistent Right
Pneumothorax Despite A Well Place Chest Tube

12. 42 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
1st Right
Chest Tube
2nd Right
Chest Tube
So, Why Does The Pneumothorax Persist After TWO Chest Tubes?

13. 42 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
1st Right
Chest Tube
2nd Right
Chest Tube
So, Why Does The Pneumothorax Persist After TWO Chest Tubes?
Our Patient Has A Large
Bronchial Laceration
That Leaks Air Into The
Pleural Space Faster
Than The Chest Tubes
Can Remove It.

14. 42 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
Our Patient Has A Large
Bronchial Laceration
That Leaks Air Into The
Pleural Space Faster
Than The Chest Tubes
Can Remove It.
The Next Step Is To Isolate & Occlude The Right Lung
Balloon Catheter
Occlusion Of The
Right Lung

15. Healthy 13 Year-Old With Throat And Upper Chest Pain

16. Healthy 13 Year-Old With Throat And Upper Chest Pain
Pneumomediastinum & Pneumopericardium

17. Healthy 13 Year-Old With Throat And Upper Chest Pain
Pneumomediastinum & Pneumopericardium

18. Healthy 13 Year-Old With Throat And Upper Chest Pain
Pneumomediastinum & Pneumopericardium

19. 39 Year-Old With A Past History of Large Bowel Obstruction Presents With Severe Abdominal Pain

20. 39 Year-Old With A Past History of Large Bowel Obstruction Presents With Severe Abdominal Pain
Free Air Under The Diaphragm: Colonic Perforation

21. 48 Year-Old With Gallstone Pancreatitis Develops Acute Severe Peritonitis.

22. 48 Year-Old With Gallstone Pancreatitis Develops Acute Severe Peritonitis.
Free Air Under The Diaphragm: Duodenal Perforation

23. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath

24. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath
Prior CXR: Right Hilar Mass + RUL Density
RUL
Density

25. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath

26. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath
Current CXR: New Malignant Right Pleural Effusion
New (Malignant)
Pleural Effusion

28. Left Tension Pneumothorax After Central Line Placement

29. Left Tension Pneumothorax – After Chest Tube

31. RLL Pneumonia – The Lateral Views Helps Differentiate From RML Involvement

32. 28 Year Old With Progressive Dyspnea.

33. 28 Year Old With Progressive Dyspnea.
LLL Pleural Effusion – The Lateral Helps Define The Size Of The Effusion

35. Cardiomegaly
AICD

37. AICD
LVAD
Cannula
Cardiomegaly

39. Cardiomegaly
Swan Ganz
Catheter
Subclavian
Central Line

40. Summary Of Diagnoses This Week
• Right upper lobe pneumonia
• Traumatic tension hemothorax
• Blunt bronchial injury
• Pneumomediastinum
• Free air under the diaphragm
• Lung cancer + malignant pleural effusion
• Tension pneumothorax after central line placement
• Right lower lobe pneumonia
• Pleural effusion
• Cardiomegaly

41. See You Next Week!