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Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 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, Flail Chest, Metastatic Melanoma

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Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 cases

  1. 1. Chest X-Rays Of The Month 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 Adult Chest X-Ray Mastery Project May 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 Carolinas Medical Center departments, and now… Brazil, Chile and Tanzania.  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. 65 Year Old With Dyspnea
  7. 7. 65 Year Old With Dyspnea Hazy Left Hemithorax – Pleural Effusion Mediastinal Shift With Tracheal Deviation
  8. 8. ED Bedside Ultrasound Confirms The Effusion
  9. 9. ED Bedside Ultrasound Confirms The Effusion Left Pleural Effusion
  10. 10. Healthy 20 Year Old Struck By A Car On Arrival
  11. 11. Healthy 20 Year Old Struck By A Car Severe Pulmonary Contusion On Arrival
  12. 12. Healthy 20 Year Old Struck By A Car Severe Pulmonary Contusion 16 Hours Later
  13. 13. Cases Studies From Our Emergency Medicine Partners In Tanzania CXR Last Week CXR Today
  14. 14. Cases Studies From Our Emergency Medicine Partners In Tanzania 25 Year-Old Presents With “Wheezing.” CXR One Week Ago Reveals Aortic Dilatation And The Patient Refused Hospital Admission Then. Imaging Now Reveals “Impending Aortic Rupture!” CXR Last Week CXR Today
  15. 15. 56 Year Old With Traumatic Paraplegia Now Presents In Respiratory Failure
  16. 16. 56 Year Old With Traumatic Paraplegia Now Presents In Respiratory Failure Right Lower Lobe Collapse
  17. 17. 75 Year Old Has A Pre-Operative Chest X-Ray
  18. 18. 75 Year Old Has A Pre-Operative Chest X-Ray Thoracic Endovascular Aortic Repair [TEVAR]
  19. 19. 60 Year Old With Advanced Cirrhosis And Encephalopathy
  20. 20. 60 Year Old With Advanced Cirrhosis And Encephalopathy Right Pleural Effusion
  21. 21. 60 Year Old With Advanced Cirrhosis And Encephalopathy Right Pleural Effusion
  22. 22. 72 Year Old With Metastatic Breast Cancer
  23. 23. 72 Year Old With Metastatic Breast Cancer Malignant Right Pleural Effusion
  24. 24. 72 Year Old With Metastatic Breast Cancer Malignant Right Pleural Effusion
  25. 25. 43 Year Old With Metastatic Breast Cancer
  26. 26. 43 Year Old With Metastatic Breast Cancer Bilateral Malignant Pleural Effusions
  27. 27. 35 Year Old With A Long History Of Alcohol Abuse Presents With Dyspnea
  28. 28. 35 Year Old With A Long History Of Alcohol Abuse Presents With Dyspnea Dilated Cardiomyopathy
  29. 29. 25 Year Old With A History Of Intravenous Drug Abuse Presents With Fever And Dyspnea
  30. 30. 25 Year Old With A History Of Intravenous Drug Abuse Presents With Fever And Dyspnea Endocarditis & Septic Pulmonary Emboli
  31. 31. 55 Year Old With A Large Tracheal Laceration On ECMO
  32. 32. 55 Year Old With A Large Tracheal Laceration On ECMO Massive Subcutaneous Emphysema
  33. 33. LifeVest Defibrillator®
  34. 34. LifeVest Defibrillator®
  35. 35. Intubated Trauma Patient Head Injury + Right Humeral Neck Fracture CXR Findings Can Be Subtle!
  36. 36. Intubated Trauma Patient Head Injury + Right Humeral Neck Fracture Aspirated Tooth CXR Findings Can Be Subtle!
  37. 37. Aspirated Tooth Intubated Trauma Patient Head Injury + Right Humeral Neck Fracture
  38. 38. RLL Collapse CXR Findings Can Be Subtle!
  39. 39. Aspirated Tooth Right Mainstem Bronchus RLL Collapse CXR Findings Can Be Subtle!
  40. 40. CXR Finding Can Be Subtle! Routine Preoperative CXR
  41. 41. CXR Finding Can Be Subtle! Routine Preoperative CXR Pulmonary Nodule
  42. 42. Pulmonary Nodule Routine Preoperative CXR
  43. 43. Pulmonary Nodule Routine Preoperative CXR
  44. 44. High Speed MVC And Left-Sided Chest Pain
  45. 45. High Speed MVC And Left-Sided Chest Pain Multiple Rib Fractures With A Clinical Flail Segment
  46. 46. Flail Chest  Inspiration increases [-] thoracic pressure.  Leads to paradoxical motion of the flail segment.
  47. 47. 70 Year-Old With Uncontrolled HPTN As Well As ESRD Presents With Dyspnea Initial Oxygen Saturations 65%
  48. 48. 70 Year-Old With Uncontrolled HPTN As Well As ESRD Presents With Dyspnea Initial Oxygen Saturations 65% Acute Pulmonary Edema
  49. 49. 75 Year Old With Metastatic Melanoma – CXR One Year Ago
  50. 50. 75 Year Old With Metastatic Melanoma – CXR Today
  51. 51. 75 Year Old With Metastatic Melanoma – CXR Today Multiple New Metastases
  52. 52. 75 Year Old With Metastatic Melanoma – CXR Today Multiple New Metastases
  53. 53. Summary Of Diagnoses This Month • 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
  54. 54. See You Next Month!

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