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Chest X-Rays Of The Week
Michael Gibbs, MD, FACEP, FAAEM
Professor And Chair
Department of Emergency Medicine
Carolinas Me...
Disclosures
 This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Prog...
Process
 Many are providing cases and these slides are shared with all contributors.
 Contributors from many CMC departm...
It’s All About The Anatomy!
Airway
Bones
Cardiac
Diaphragm
Effusion
Foreign body
Gastric
Hilum
60 Year Old With Advanced Cirrhosis And Encephalopathy
60 Year Old With Advanced Cirrhosis And Encephalopathy
Right Pleural Effusion
72 Year Old With Metastatic Breast Cancer
72 Year Old With Metastatic Breast Cancer
Malignant Right Pleural Effusion
43 Year Old With Metastatic Breast Cancer
43 Year Old With Metastatic Breast Cancer
Bilateral Malignant Pleural Effusions
35 Year Old With
A Long History Of
Alcohol Abuse
Presents With
Dyspnea
35 Year Old With
A Long History Of
Alcohol Abuse
Presents With
Dyspnea
Dilated Cardiomyopathy
25 Year Old With
A History Of
Intravenous Drug
Abuse Presents
With Fever And
Dyspnea
25 Year Old With
A History Of
Intravenous Drug
Abuse Presents
With Fever And
Dyspnea
Endocarditis & Septic Pulmonary Emboli
55 Year Old
With A Large
Tracheal
Laceration On
ECMO
55 Year Old
With A Large
Tracheal
Laceration On
ECMO
Massive Subcutaneous Emphysema
LifeVest Defibrillator®
LifeVest Defibrillator®
Intubated
Trauma Patient
Head Injury +
Right Humeral
Neck Fracture
CXR Findings Can Be Subtle!
Intubated
Trauma Patient
Head Injury +
Right Humeral
Neck Fracture
Aspirated Tooth
CXR Findings Can Be Subtle!
Aspirated Tooth
Intubated
Trauma Patient
Head Injury +
Right Humeral
Neck Fracture
CXR Findings Can Be Subtle!
Aspirated Tooth
Right Mainstem
Bronchus
RLL Collapse
CXR Findings Can Be Subtle!
CXR Finding Can Be Subtle!
Routine
Preoperative CXR
CXR Finding Can Be Subtle!
Routine
Preoperative CXR
Pulmonary
Nodule
Pulmonary Nodule
Routine
Preoperative CXR
High Speed MVC
And Left-Sided
Chest Pain
Multiple Rib Fractures With A Clinical Flail Segment
Flail Chest
 Inspiration increases [-] thoracic pressure.
 Leads to paradoxical motion of the flail segment.
70 Year-Old With
Uncontrolled
HPTN As Well As
ESRD Presents
With Dyspnea
Initial Oxygen
Saturations 65%
Acute Pulmonary Ed...
75 Year Old With Metastatic Melanoma – CXR One Year Ago
75 Year Old With Metastatic Melanoma – CXR Today
75 Year Old With Metastatic Melanoma – CXR Today
Multiple New Metastases
Summary Of Diagnoses This Week
• Pleural effusion
• Dilated cardiomyopathy
• Septic pulmonary emboli
• Tracheal laceration...
See You Next Week!
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 cases
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Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 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: Pleural Effusion, Dilated Cardiomyopathy, Septic Pulmonary emboli, Tracheal Laceration, LifeVest Defibrillator, Aspirated Tooth, Pulmonary Nodule, Rib Fractures, Fail Chest, Metastatic Melanoma.

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Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 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 22nd 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 many 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. 60 Year Old With Advanced Cirrhosis And Encephalopathy
  7. 7. 60 Year Old With Advanced Cirrhosis And Encephalopathy Right Pleural Effusion
  8. 8. 72 Year Old With Metastatic Breast Cancer
  9. 9. 72 Year Old With Metastatic Breast Cancer Malignant Right Pleural Effusion
  10. 10. 43 Year Old With Metastatic Breast Cancer
  11. 11. 43 Year Old With Metastatic Breast Cancer Bilateral Malignant Pleural Effusions
  12. 12. 35 Year Old With A Long History Of Alcohol Abuse Presents With Dyspnea
  13. 13. 35 Year Old With A Long History Of Alcohol Abuse Presents With Dyspnea Dilated Cardiomyopathy
  14. 14. 25 Year Old With A History Of Intravenous Drug Abuse Presents With Fever And Dyspnea
  15. 15. 25 Year Old With A History Of Intravenous Drug Abuse Presents With Fever And Dyspnea Endocarditis & Septic Pulmonary Emboli
  16. 16. 55 Year Old With A Large Tracheal Laceration On ECMO
  17. 17. 55 Year Old With A Large Tracheal Laceration On ECMO Massive Subcutaneous Emphysema
  18. 18. LifeVest Defibrillator®
  19. 19. LifeVest Defibrillator®
  20. 20. Intubated Trauma Patient Head Injury + Right Humeral Neck Fracture CXR Findings Can Be Subtle!
  21. 21. Intubated Trauma Patient Head Injury + Right Humeral Neck Fracture Aspirated Tooth CXR Findings Can Be Subtle!
  22. 22. Aspirated Tooth Intubated Trauma Patient Head Injury + Right Humeral Neck Fracture
  23. 23. CXR Findings Can Be Subtle!
  24. 24. Aspirated Tooth Right Mainstem Bronchus RLL Collapse CXR Findings Can Be Subtle!
  25. 25. CXR Finding Can Be Subtle! Routine Preoperative CXR
  26. 26. CXR Finding Can Be Subtle! Routine Preoperative CXR Pulmonary Nodule
  27. 27. Pulmonary Nodule Routine Preoperative CXR
  28. 28. High Speed MVC And Left-Sided Chest Pain Multiple Rib Fractures With A Clinical Flail Segment
  29. 29. Flail Chest  Inspiration increases [-] thoracic pressure.  Leads to paradoxical motion of the flail segment.
  30. 30. 70 Year-Old With Uncontrolled HPTN As Well As ESRD Presents With Dyspnea Initial Oxygen Saturations 65% Acute Pulmonary Edema
  31. 31. 75 Year Old With Metastatic Melanoma – CXR One Year Ago
  32. 32. 75 Year Old With Metastatic Melanoma – CXR Today
  33. 33. 75 Year Old With Metastatic Melanoma – CXR Today Multiple New Metastases
  34. 34. Summary Of Diagnoses This Week • Pleural effusion • Dilated cardiomyopathy • Septic pulmonary emboli • Tracheal laceration - ECMO + massive subcutaneous emphysema • LifeVest Defibrillator® • Aspirated tooth • Pulmonary nodule • Rib fractures with a clinical flail segment • Metastatic melanoma
  35. 35. See You Next Week!

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