How read chest xr 13

488 views
387 views

Published on

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
488
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
18
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

How read chest xr 13

  1. 1. HOW READ CHEST XR -13 ANAS SAHLE ,MD
  2. 2. Brief review
  3. 3. POSITION PA AP QUALITY ROTATION PENETRATION INSPIRATION LESIONOPACIT OPACITY Homo Heterogenous Wellill defined Zone Centralperipher Silhouet sign al Y Necrotic PATCHY HILUMMEDIASTINAL NODULE Central deviasionwided MASS COSTO-PHRENIC ANGEL Freeoblitern CAVITARY OTHERINFILTIRATION Bone soft tissuediaphragm
  4. 4. ConsolidationInfection causes Non-infection causes Broncho- WEGNER CardiacPneumonia Lymphoma alveolar COP Sarcoid disease failure carcinoma
  5. 5. Solitary Pulmonary Nodule(SPN) Appearance Margin Calcification cavitation Comparison with a Size previous x-ray to >8mm <8mm Assess growth over time. Location Upperhillar zone Lowerbasesup-pleural Associated abnormalitiesLymph node enlargement Rib destruction/erosion
  6. 6. Cavitary lesion Air + Air-fluid level Air onlytissue Wall thickness Straight Wavy Thick Thin 1. Fungal ball. 2. Rupture hydatid cyct site 3. Necrotic tumor ruptured 4. Blood glot Hydatid Abscess Irregular Regular Peripheral Central inner wall inner wall cyst Emphesemato Cavitating Chronic us pneumatoc neoplasm abscess ele bulla
  7. 7. LINEAR PATTERN LINEAR PATTERNLEFT VENTRICULAR FAILURE Perihilar and peripheral basal septal lines, changes acutely and resolves with diureticsNormal ageing Coarsening of lung markings in lower zones, no change on review of recent filmsLymphangitis Coarse nodular and linear thickening of markings, known malignancy, often associated with pleural effusion, rapid clinical deterioration of patient
  8. 8. LINEAR PATTERN LINEAR PATTERNAtelectasis Short thin lines, often basal, new on review of previous filmsSubsegmental Longer thicker bands, often perihilar or basal,collapse suggest recent infection or infarctionScarring Any length, persist over time unchangedFibrosis Volume loss is key, persists over time
  9. 9. Causes of fibrosis Mid zone lung Lower zone lung Upper zone lungtuberculosis Drug indused fibrosis sarcoidosis (most common)Chronic extrinsic allergic UIPalveolitisRadio-therapy Asbestose-related fibrosisAnkylosing spondylitisProgressive massivefibrosishistoplasmosis
  10. 10. Mediastinum
  11. 11. MEDIASTINAL ANATOMYSuperior: Upper of T4Inferior: Lower of T4( T4-T8)
  12. 12. CXR CXR-4CXR-1 CXR-2 CXR-3
  13. 13. CASE-1• 44-year-old woman is admitted with hemoptysis and progressive shortness of breath.• On physical examination, her vital signs are: – pulse 110bpm; – temperature 99°F; – respirations 22/min; – blood pressure 118/68 mmHg.• She is in mild distress and her lung exam is normal except for occasional crackles.• Laboratory data: – Hb 9.8 g/dL; Hct 30%; – WBCs 9.0/μL; differential normal; – BUN 46 g/dL; creatinine 1.9 mg/dL. – Urinalysis shows RBC casts.• ABGs on room air: pH 7.42; PCO2 38 mm Hg; PO2 72 mm Hg.• Pulmonary function tests are within normal limits except for DLCO, which is 110% of predicted.• Based on this clinical scenario, which of the above chest x-rays is most likely to belong to this patient?• a. CXR-1• b. CXR-2• c. CXR-3• d. CXR-4
  14. 14. CXR CXR-4CXR-1 CXR-2 CXR-3
  15. 15. CASE-2• 62-year-old man is admitted with chest pain.• He has four-vessel disease and undergoes CABG.• On the third postoperative day, the patient develops increasing shortness of breath with diffuse crackles on lung exam.• Laboratory data: – Hb 12 g/dL; Hct 36%; – WBCs 9.8/μL; differential normal; – BUN and creatinine normal.• ABGs on 3% Ventimask: pH 7.50; PCO2 30mm Hg; PO2 87 mm Hg.• Based on this clinical scenario, which of the above chest x-rays is most likely to belong to this patient?• a. CXR-1• b. CXR-2• c. CXR-3• d. CXR-4
  16. 16. CXR CXR-4CXR-1 CXR-2 CXR-3
  17. 17. CASE-3• A 38-year-old female smoker is admitted with progressive shortness of• breath and productive cough with copious amounts of white mucoid sputum.• On physical examination, vital signs are: • pulse 98 bpm; • Temperature normal; • respirations 35/min; • blood pressure 110/80 mm Hg.• The patient is in mild distress and has bilateral crackles in the mid-lung fields with areas of egophony in the right posterior lung zone.• ABGs on room air: pH 7.47; PCO2 34 mm Hg; PO2 57 mm Hg.• Based on this clinical scenario, which of the above chest x-rays is most likely to belong to this patient?• a. CXR-1• b. CXR-2• c. CXR-3• d. CXR-4
  18. 18. CXR CXR-4CXR-1 CXR-2 CXR-3
  19. 19. CASE-4• A 72-year-old man with a history of COPD and chronic sputum production, on home O2, with a long-standing history of reflux esophagitis and difficulty swallowing, is admitted with shortness of breath and fever.• On physical examination, his vital signs are: – pulse 128 bpm; – temperature101°F; – respirations 34/min; – blood pressure: 98/65 mm Hg.• He appears frail and has bilateral crackles and rhonchi on lung exam.• Laboratory data: – Hb 10 g/dL; Hct 30%; – WBCs 15.8/μL; – BUN 56 mg/dL; creatinine 2.8mg/dL; – sodium 128 mEq/L; potassium 3.2 mEq/L.• ABGs on room air: pH7.5; PCO2 34 mm Hg; PO2 48 mm Hg.• Based on this clinical scenario, which of the above chest x-rays is most likely to belong to this patient?• a. CXR-1• b. CXR-2• c. CXR-3• d. CXR-4

×