Chest Film Part 1

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Chest Film Part 1

  1. 1. Radiology Review- Part 1 The chest film and cardiovascular diagnoses MDFPR July 29, 2009 M. LaCombe
  2. 2. Why is this patient short of breath?
  3. 3. What is the valvular disease here?
  4. 4. Can this young woman play college soccer, doctor?
  5. 5. What is the likely organism?
  6. 6. Is this really a normal chest xray as the radiologist reported it to be?
  7. 7. Does any of this matter?
  8. 8. No, not at all. Unless: <ul><li>You want to be a great doctor rather than merely ordinary </li></ul><ul><li>You wish to avoid burn-out </li></ul><ul><li>You are interested in helping people rather than collecting a paycheck </li></ul><ul><li>You wish to save lives </li></ul>
  9. 9. Major Segue: In defense of intellectual curiosity - <ul><li>One can bother to know, or one can ask: </li></ul><ul><li>… a radiologist when you find one </li></ul><ul><li>… an astronomer when you have a chance </li></ul><ul><li>… a naturalist when you see one </li></ul><ul><li>… a botanist if you think of it </li></ul><ul><li>… a mycologist if there is one around </li></ul>
  10. 10. This is either a ‘blurry star”
  11. 11. Or the Andromeda Galaxy
  12. 12. … and this, a caterpillar, or the larval form of the Monarch butterfly
  13. 13. This is either a toadstool, or the velvet-footed pax, Paxillus atrotomentosus
  14. 14. … and this, a pretty wildflower, or a species of aquilegia
  15. 15. And finally, this is either “maybe a big heart” or the typical chest xray of a patient with an ASD
  16. 16. Back to our lecture, and a systematic approach to the chest film:
  17. 17. This is just one system to use only until you become facile with chest xrays
  18. 18. Let’s start with a review of anatomy
  19. 35. Another patient, with mitral stenosis, showing this double density finding a bit better:
  20. 47. (What is truncus arteriosus, you ask?) Truncus arteriosis is a complex defect where there is a single (normally there are two separate arteries) vessel arising from the heart that forms the aorta and pulmonary artery. Another congenital heart defect that occurs with truncus arteriosus is a ventricular septal defect (ventricular septum, or dividing wall between the two lower chambers of the heart known as the right and left ventricles).
  21. 48. ...and tetralogy of Fallot? Tetralogy of Fallot has four key features. A ventricular septal defect (a hole between the ventricles) and many levels of obstruction from the right ventricle to the lungs (pulmonary stenosis) are the most important. Also, the aorta (major artery from the heart to the body) lies directly over the ventricular septal defect, and the right ventricle develops thickened muscle.
  22. 49. ...so how do you fix it?
  23. 50. Blalock and Taussig
  24. 51. But who is this?
  25. 97. In closing, which constellation is this?

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