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Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #10 cases

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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: Non-Cardiogenic Pulmonary Edema, Traumatic Pneumothorax, Pulmonary Malignancies, Tension Pneumothorax, Deep Sulcus Sign, Cardiomegaly, RLL Pneumonia, Pneumonitis

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Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #10 cases

  1. 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 Interim Vice President of Research Atrium Health Chest X-Ray Mastery Project April 15th 2019
  2. 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. 3. Process  Many are providing cases and these slides are shared with all contributors.  Contributors from CMC departments, and soon… Tanzania and Brazil.  Cases submitted this week will be distributed next week.  When reviewing the presentation, the 1st image will show a chest X-ray without identifiers and the 2nd image will reveal the diagnosis.
  4. 4. It’s All About The Anatomy!
  5. 5. Airway Bones Cardiac Diaphragm Effusion Foreign body Gastric Hilum
  6. 6. Healthy Young Female After A Heroin Overdose
  7. 7. Non-Cardiogenic Pulmonary Edema Healthy Young Female After A Heroin Overdose
  8. 8. Healthy Young Male Kicked In The Left Ribs
  9. 9. Healthy Young Male Kicked In The Left Ribs Large Left Traumatic Pneumothorax
  10. 10. Healthy Young Male Kicked In The Left Ribs Catheter Drainage Large Left Traumatic Pneumothorax
  11. 11. 55 Year Old With One Month Of Shortness Of Breath
  12. 12. 55 Year Old With One Month Of Shortness Of Breath Large Left Spontaneous Pneumothorax
  13. 13. 55 Year Old With One Month Of Shortness Of Breath Catheter Drainage Large Left Spontaneous Pneumothorax
  14. 14. 65 Year Old With Three Weeks Of Progressive Dyspnea
  15. 15. 65 Year Old With Three Weeks Of Progressive Dyspnea Left Upper Lobe Lung Mass
  16. 16. 65 Year Old With One Month Of Shortness Of Breath Left Upper Lobe Lung Mass
  17. 17. 30 Year Old With One Month Of Shortness Of Breath
  18. 18. 30 Year Old With One Month Of Shortness Of Breath
  19. 19. 30 Year Old With One Month Of Shortness Of Breath But What Is This Density? Is It An Effusion?
  20. 20. 30 Year Old With One Month Of Shortness Of Breath Large Pleural-Based Mass
  21. 21. 35 Year Old Male In A High Speed Car Crash
  22. 22. 35 Year Old Male In A High Speed Car Crash Deep Sulcus Sign Tension Pneumothorax With Shift
  23. 23. 35 Year Old Male In A High Speed Car Crash Tension Pneumothorax With Shift
  24. 24. 35 Year Old Male In A High Speed Car Crash Tension Pneumothorax With Shift
  25. 25. 43 Year Old Male With HPTN Presents With Progressive Dyspnea & Cough
  26. 26. 43 Year Old Male With HPTN Presents With Progressive Dyspnea & Cough Cardiomegaly & Interstitial Edema New Diagnosis Of Heart Failure ECHO: Ejection Fraction 10%
  27. 27. 43 Year Old Male With HPTN Presents With Progressive Dyspnea & Cough Multi-Chamber Enlargement On ED Bedside ECHO
  28. 28. Healthy 27 Year Old Male With Severe Right Pleuritic Chest Pain And Cough
  29. 29. Healthy 27 Year Old Male With Severe Right Pleuritic Chest Pain And Cough Chest X-Ray Read As “Negative” By The Radiologist.
  30. 30. Healthy 27 Year Old Male With Severe Right Pleuritic Chest Pain And Cough Chest X-Ray Read As “Negative” By The Radiologist. But It Is Not Normal To See Lung Markings Abutting The Diaphragm.
  31. 31. Right Lower Lobe Pneumonia Healthy 27 Year Old Male With Severe Right Pleuritic Chest Pain And Cough
  32. 32. 63 Year Old Male Sharp Right Sided Chest Pain
  33. 33. 63 Year Old Male Sharp Right Sided Chest Pain Right Upper Lobe Pleural Based Mass
  34. 34. Right Upper Lobe Pleural Based Mass 63 Year Old Male With Sharp Right Sided Chest Pain
  35. 35. Right Upper Lobe Pleural Based Mass Rib Destruction The Likely Cause Of Pain 63 Year Old Male With Sharp Right Sided Chest Pain
  36. 36. 68 Year Old Female On Active Chemotherapy For Breast Case Presents With Severe Dyspnea CXR Four Days Ago Is Normal
  37. 37. 68 Year Old Female On Active Chemotherapy For Breast Case Presents With Severe Dyspnea CXR Four Days Ago Is Normal Chemotherapy-Induced Pneumonitis
  38. 38. Summary Of Diagnoses This Week • Non-cardiogenic pulmonary edema • Traumatic and spontaneous pneumothorax • Pulmonary malignancies • Tension pneumothorax and deep sulcus sign • Cardiomegaly and new onset severe cardiomyopathy • Subtle RLL pneumonia on CXR, seen well on chest CT • Chemotherapy-induced pneumonitis
  39. 39. See You Next Week!

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