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

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. 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 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. It’s All About The Anatomy!

5. Airway
Bones
Cardiac
Diaphragm
Effusion
Foreign body
Gastric
Hilum

6. Healthy Young
Female After A
Heroin Overdose

7. Non-Cardiogenic Pulmonary Edema
Healthy Young
Female After A
Heroin Overdose

8. Healthy Young
Male Kicked In
The Left Ribs

9. Healthy Young
Male Kicked In
The Left Ribs
Large Left Traumatic Pneumothorax

10. Healthy Young
Male Kicked In
The Left Ribs
Catheter
Drainage
Large Left Traumatic Pneumothorax

11. 55 Year Old With
One Month Of
Shortness Of
Breath

12. 55 Year Old With
One Month Of
Shortness Of
Breath
Large Left Spontaneous Pneumothorax

13. 55 Year Old With
One Month Of
Shortness Of
Breath
Catheter
Drainage
Large Left Spontaneous Pneumothorax

14. 65 Year Old With
Three Weeks Of
Progressive
Dyspnea

15. 65 Year Old With
Three Weeks Of
Progressive
Dyspnea
Left Upper Lobe Lung Mass

16. 65 Year Old With
One Month Of
Shortness Of
Breath
Left Upper Lobe Lung Mass

17. 30 Year Old With One Month Of Shortness Of Breath

18. 30 Year Old With One Month Of Shortness Of Breath

19. 30 Year Old With One Month Of Shortness Of Breath
But What Is This Density?
Is It An Effusion?

20. 30 Year Old With
One Month Of
Shortness Of
Breath
Large Pleural-Based Mass

21. 35 Year Old Male
In A High Speed
Car Crash

22. 35 Year Old Male
In A High Speed
Car Crash
Deep Sulcus
Sign
Tension Pneumothorax With Shift

23. 35 Year Old Male
In A High Speed
Car Crash
Tension Pneumothorax With Shift

24. 35 Year Old Male
In A High Speed
Car Crash
Tension Pneumothorax With Shift

25. 43 Year Old Male
With HPTN
Presents With
Progressive
Dyspnea & Cough

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. 43 Year Old Male With HPTN Presents With Progressive Dyspnea & Cough
Multi-Chamber Enlargement On ED Bedside ECHO

28. Healthy 27 Year Old Male With Severe Right Pleuritic Chest Pain And Cough

29. Healthy 27 Year Old Male With Severe Right Pleuritic Chest Pain And Cough
Chest X-Ray Read As “Negative” By The Radiologist.

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. Right Lower Lobe Pneumonia
Healthy 27 Year Old Male With Severe Right Pleuritic Chest Pain And Cough

32. 63 Year Old Male
Sharp Right Sided
Chest Pain

33. 63 Year Old Male
Sharp Right Sided
Chest Pain
Right Upper Lobe Pleural Based Mass

34. Right Upper Lobe Pleural Based Mass
63 Year Old Male
With Sharp Right
Sided Chest Pain

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. 68 Year Old
Female On Active
Chemotherapy
For Breast Case
Presents With
Severe Dyspnea
CXR Four Days
Ago Is Normal

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. 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. See You Next Week!