Respiratory system 1                         In The name of GodCreate PDF files without this message by purchasing novaPDF...
Physical Examination                                                of the Chest                                          ...
Diagram of Thoracic AreaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Chest Topography:                                            Anterior ChestCreate PDF files without this message by purcha...
Chest Topography:                                             Lateral ChestCreate PDF files without this message by purcha...
Chest Topography:                                            Posterior ChestCreate PDF files without this message by purch...
Respiratory tract anatomy              fig 13-1                                                                           ...
Lung Anatomy                • Right Lung                       – Superior lobe                       – Middle lobe        ...
Fissures:Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Location of LobesCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Lung AnteriorCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Lung PosteriorCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Lung Left SideCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Lung Right SideCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Physical Exam Techniques                •    Observation                •    Palpation                •    Percussion     ...
Observation:                                            Breathing Patterns                •    Apnea                •    T...
Observation:                                              Thoracic ContourCreate PDF files without this message by purchas...
Observation: Thoracic Contour                                (cont.)                •    Pectus Excavatum                •...
Barrel ChestCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
ScoliosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Kyphosis                                                                                                   Slide 18-22Crea...
Observation: ClubbingCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Palpation: Tracheal AlignmentCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Tracheal Alignment                                           Abnormalities                • Pneumothorax – shifts to unaff...
Palpation : Chest ExcursionCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Palpation: Vocal Fremitus                • BILATERAL comparison                  of vocal vibrations                • Incr...
Percussion                • Assess density of                  underlying tissueCreate PDF files without this message by p...
Percussion Notes                • Resonance – normal                • Dullness – increased density                       –...
Lets all listen inCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Auscultation: Listening to breath                         sounds with a stethoscopeCreate PDF files without this message b...
Normal Breath Sounds and Their                                       LocationsCreate PDF files without this message by pur...
Abnormal Breath Sounds:                                                Diminished or Absent                • Increased dis...
Abnormal Breath Sounds:                    Bronchial or Bronchovesicular                      in abnormal part of the lung...
Abnormal Breath Sounds:                                                 Adventitious Sounds                • Wheeze – cont...
Abnormal Breath Sounds:                                                 Adventitious Sounds                • Crackles – di...
Condition                       Chest                           Fremitus                   Percussion Breath              ...
Techniques - Projection             •P-A (relation of x-ray beam to patient)Create PDF files without this message by purch...
Techniques - Projection (continued)                •LateralCreate PDF files without this message by purchasing novaPDF pri...
Techniques - Projection (continued)              •Lateral DecubitusCreate PDF files without this message by purchasing nov...
Techniques - Projection (continued)              •ObliqueCreate PDF files without this message by purchasing novaPDF print...
The Normal Chest X-ray                •       PA View:                       1.      Aortic arch                       2. ...
Lung Anatomy                • Trachea                • Carina                • Right and Left Pulmonary                  B...
AnatomyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
RotationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Rotation   (continued)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
PenetrationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Inspiration/ExpirationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Technical Details                                     •Type                                     •Rotation                 ...
Summary of Density                •    Air                •    Water                •    Bone                •    Tissue  ...
Densities        The big two densities are:         (1) WHITE - Bone         (2) BLACK - Air       The others are:        ...
Pitfalls to Chest X-ray                                                                    Interpretation                •...
Systematic Approach                • Soft Tissues                       –    Breast shadows                       –    Sup...
Systematic Approach                • Diaphragm and                  Pleural Surfaces                       – Diaphragm    ...
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MediastinumCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
HilumCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Hilum                       Made of:                       1. Pulmonary Art.+Veins                       2. The Bronchi   ...
RibsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Lung Anatomy on Chest X-ray                • The right upper lobe                  (RUL) occupies the upper               ...
Lung Anatomy on Chest X-ray                • The right middle lobe                  is typically the                  smal...
Lung Anatomy on Chest X-ray            • The right lower lobe is the              largest of all three lobes,             ...
Lung Anatomy on Chest X-ray           • These lobes can be separated             from one another by two             fissu...
Lung Anatomy on Chest X-ray                • The lobar architecture                  of the left lung is                  ...
Lung Anatomy on Chest X-ray                • These two lobes are                  separated by a major                  fi...
The Silhouette Sign                • An intra-thoracic radio-                  opacity, if in anatomic                  co...
PathologyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
RUL pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
RML pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
RLL pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
LUL pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
LLL pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Consolidation on CTCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Hilar m lCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
The Enlarged Hila                Causes:                1. Adenopathies (neoplasia, infection)                2. Primary T...
Multiple MassesCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Hilar Lymphadenopathy - BLCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Pleural EffusionCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Pulmonary FibrosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Heart failureCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
PneumothoraxCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
RUL collapseCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
EmphysemaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Cervical RibCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Cavitating lesionCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Hiatus herniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Chest Tube, NG Tube,                                                              Pulm. artery cathCreate PDF files withou...
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Physical examinatio+cxr

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Physical examinatio+cxr

  1. 1. Respiratory system 1 In The name of GodCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  2. 2. Physical Examination of the Chest ‫ﻣﻌﺎﯾﻨﮫ ﻓﯿﺰﯾﮑﯽ ﺳﯿﺴﺘﻢ ﺗﻨﻔﺲ‬Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  3. 3. Diagram of Thoracic AreaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  4. 4. Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  5. 5. Chest Topography: Anterior ChestCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  6. 6. Chest Topography: Lateral ChestCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  7. 7. Chest Topography: Posterior ChestCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  8. 8. Respiratory tract anatomy fig 13-1 8Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  9. 9. Lung Anatomy • Right Lung – Superior lobe – Middle lobe – Inferior lobe • Left Lung – Superior lobe – Inferior lobeCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  10. 10. Fissures:Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  11. 11. Location of LobesCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  12. 12. Lung AnteriorCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  13. 13. Lung PosteriorCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  14. 14. Lung Left SideCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  15. 15. Lung Right SideCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  16. 16. Physical Exam Techniques • Observation • Palpation • Percussion • AuscultationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  17. 17. Observation: Breathing Patterns • Apnea • Tachypnea/Bradypnea • Biot’s • Cheynes-Stokes • KussmaulCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  18. 18. Observation: Thoracic ContourCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  19. 19. Observation: Thoracic Contour (cont.) • Pectus Excavatum • Pectus Carinatum • Kyphosis • Scoliosis • Kyphoscoliosis • Symmetry of chest movementCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  20. 20. Barrel ChestCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  21. 21. ScoliosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  22. 22. Kyphosis Slide 18-22Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  23. 23. Observation: ClubbingCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  24. 24. Palpation: Tracheal AlignmentCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  25. 25. Tracheal Alignment Abnormalities • Pneumothorax – shifts to unaffected side • Pleural Effusion – shifts to unaffected side • Fibrosis or Atelectasis – shifts towards affected side • Pulmonary consolidation – no shiftCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  26. 26. Palpation : Chest ExcursionCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  27. 27. Palpation: Vocal Fremitus • BILATERAL comparison of vocal vibrations • Increased with alveolar consolidation • Decreased with increased distance between lung and chest wall – Pneumothorax, Pleural effusionCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  28. 28. Percussion • Assess density of underlying tissueCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  29. 29. Percussion Notes • Resonance – normal • Dullness – increased density – Atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis • Hyperresonance – decreased density – Hyperinflation (COPD), PneumothoraxCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  30. 30. Lets all listen inCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  31. 31. Auscultation: Listening to breath sounds with a stethoscopeCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  32. 32. Normal Breath Sounds and Their LocationsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  33. 33. Abnormal Breath Sounds: Diminished or Absent • Increased distance between aerated lung and chest wall: – Pneumothorax, Pleural effusion, Atelectasis, Obesity around thorax • Decreased or absent airflow – Airflow obstruction (eg asthma), Hyperinflation (COPD), Malpositioned ET TubeCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  34. 34. Abnormal Breath Sounds: Bronchial or Bronchovesicular in abnormal part of the lung • Lung has become more solid and less aerated in these areas • Consolidation, eg, pneumonia, or AtelectasisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  35. 35. Abnormal Breath Sounds: Adventitious Sounds • Wheeze – continuous musical sounds heard mostly during expiration – May be also heard on inspiration • Caused by a sudden change in airway caliber – Edema, spasm, secretions, foreign bodyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  36. 36. Abnormal Breath Sounds: Adventitious Sounds • Crackles – discontinuous sound heard mostly on inspiration • Caused by small airways and alveoli popping open or from secretions in very large airwaysCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  37. 37. Condition Chest Fremitus Percussion Breath Excursion Sounds Atelectasis Pneumothorax Pleural Effusion COPD Pulmonary Consolidation Fibrosis Pulmonary EdemaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  38. 38. Techniques - Projection •P-A (relation of x-ray beam to patient)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  39. 39. Techniques - Projection (continued) •LateralCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  40. 40. Techniques - Projection (continued) •Lateral DecubitusCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  41. 41. Techniques - Projection (continued) •ObliqueCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  42. 42. The Normal Chest X-ray • PA View: 1. Aortic arch 2. Pulmonary trunk 3. Left atrial appendage 4. Left ventricle 5. Right ventricle 6. Superior vena cava 7. Right hemidiaphragm 8. Left hemidiaphragm 9. Horizontal fissureCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  43. 43. Lung Anatomy • Trachea • Carina • Right and Left Pulmonary Bronchi • Secondary Bronchi • Tertiary Bronchi • Bronchioles • Alveolar Duct • AlveoliCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  44. 44. AnatomyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  45. 45. RotationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  46. 46. Rotation (continued)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  47. 47. PenetrationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  48. 48. Inspiration/ExpirationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  49. 49. Technical Details •Type •Rotation •Inspiration/expiration •PenetrationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  50. 50. Summary of Density • Air • Water • Bone • Tissue Tissu eCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  51. 51. Densities The big two densities are: (1) WHITE - Bone (2) BLACK - Air The others are: (3) DARK GREY- Fat (4) GREY- Soft tissue/water And if anything Man-made is on the film, it is: (5) BRIGHT WHITE - Man-madeCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  52. 52. Pitfalls to Chest X-ray Interpretation • Poor inspiration • Over or under penetration • Rotation • Forgetting the path of the x-ray beamCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  53. 53. Systematic Approach • Soft Tissues – Breast shadows – Supraclavicular areas – Axillae – Tissues along side of breastsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  54. 54. Systematic Approach • Diaphragm and Pleural Surfaces – Diaphragm • Dome-shaped • Costophrenic angles – Normal pleural is not visible – Interlobar fissuresCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  55. 55. Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  56. 56. MediastinumCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  57. 57. HilumCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  58. 58. Hilum Made of: 1. Pulmonary Art.+Veins 2. The Bronchi Left Hilus higher (max 1-2,5 cm) Identical: size, shape, densityCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  59. 59. RibsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  60. 60. Lung Anatomy on Chest X-ray • The right upper lobe (RUL) occupies the upper 1/3 of the right lung. • Posteriorly, the RUL is adjacent to the first three to five ribs. • Anteriorly, the RUL extends inferiorly as far as the 4th right anterior ribCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  61. 61. Lung Anatomy on Chest X-ray • The right middle lobe is typically the smallest of the three, and appears triangular in shape, being narrowest near the hilumCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  62. 62. Lung Anatomy on Chest X-ray • The right lower lobe is the largest of all three lobes, separated from the others by the major fissure. • Posteriorly, the RLL extend as far superiorly as the 6th thoracic vertebral body, and extends inferiorly to the diaphragm. • Review of the lateral plain film surprisingly shows the superior extent of the RLL.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  63. 63. Lung Anatomy on Chest X-ray • These lobes can be separated from one another by two fissures. • The minor fissure separates the RUL from the RML, and thus represents the visceral pleural surfaces of both of these lobes. • Oriented obliquely, the major fissure extends posteriorly and superiorly approximately to the level of the fourth vertebral body.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  64. 64. Lung Anatomy on Chest X-ray • The lobar architecture of the left lung is slightly different than the right. • Because there is no defined left minor fissure, there are only two lobes on the left; the left upperCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  65. 65. Lung Anatomy on Chest X-ray • These two lobes are separated by a major fissure, identical to that seen on the right side, although often slightly more inferior in location. • The portion of the left lung that corresponds anatomically to the right middle lobe is incorporated into the left upper lobe.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  66. 66. The Silhouette Sign • An intra-thoracic radio- opacity, if in anatomic contact with a border of heart or aorta, will obscure that border. An intra- thoracic lesion not anatomically contiguous with a border or a normal structure will not obliterate that border.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  67. 67. PathologyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  68. 68. RUL pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  69. 69. RML pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  70. 70. RLL pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  71. 71. LUL pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  72. 72. LLL pneumoniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  73. 73. Consolidation on CTCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  74. 74. Hilar m lCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  75. 75. The Enlarged Hila Causes: 1. Adenopathies (neoplasia, infection) 2. Primary Tumor 3. Vascular 4. SarcoidosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  76. 76. Multiple MassesCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  77. 77. Hilar Lymphadenopathy - BLCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  78. 78. Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  79. 79. Pleural EffusionCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  80. 80. Pulmonary FibrosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  81. 81. Heart failureCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  82. 82. PneumothoraxCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  83. 83. RUL collapseCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  84. 84. EmphysemaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  85. 85. Cervical RibCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  86. 86. Cavitating lesionCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  87. 87. Hiatus herniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  88. 88. Chest Tube, NG Tube, Pulm. artery cathCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)

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