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Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #2 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: Pneumonia, Pulmonary Hypertension, Left Artial Enlargement for Mitral Stenosis, Situs Inverses, Dextrocardia, Pulmonary Bullae, Recurrent Pneumothorax, Shot Gun Blast with pulseless arm, Aortic dissection, Traumatic Aortic Disruption

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Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #2 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 Vice President of Research Atrium Health CMC X-Ray Mastery Series February 18th 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 contributing: Emergency Medicine, Fellows from the Center For Advanced Practice, Trauma & Acute Care Surgery, SHVI, and Medical Critical Care. Slides are shared with all contributors.  Cases submitted this week be distributed next week.  The 1st image will show a chest X-ray without identifiers and the 2nd image will reveal the diagnoses.
  4. 4. It’s All About The Anatomy!
  5. 5. Airway Bones Cardiac Diaphragm Effusion Foreign body Gastric Hilum
  6. 6. 71 Year-Old From Ghana With Chest Pain.
  7. 7. 71 Year-Old From Ghana With Chest Pain. Thoracic Artery Aneurysm With Type A Dissection
  8. 8. 71 Year-Old From Ghana With Chest Pain. Thoracic Artery Aneurysm With Type A Dissection
  9. 9. 51 Year-Old With Burning Chest Pain For 1 Hour After Getting In To An Argument. HR 57, BP 196/100
  10. 10. 51 Year-Old With Burning Chest Pain For 1 Hour After Getting In To An Argument. HR 57, BP 196/100 During His ED Stay The Pain Migrates To His Abdomen…
  11. 11. Aortic Dissection
  12. 12. 67 Year-Old In A Single Vehicle MVC Against A Tree
  13. 13. 67 Year-Old In A Single Vehicle MVC Against A Tree Wide Mediastinum Loss Of The Aortopulmonary Window
  14. 14. 67 Year-Old In A Single Vehicle MVC Against A Tree
  15. 15. 67 Year-Old In A Single Vehicle MVC Against A Tree Traumatic Pseudoaneurysm
  16. 16. 67 Year-Old In A Single Vehicle MVC Against A Tree
  17. 17. 67 Year-Old In A Single Vehicle MVC Against A Tree Successfully Deployed Endovascular Stent Graft
  18. 18. 33 Year-Old Male On A Moped Struck By A Car
  19. 19. 33 Year-Old Male On A Moped Struck By A Car Wide Mediastinum Traumatic Aortic Disruption
  20. 20. 33 Year-Old Male On A Moped Struck By A Car Traumatic Aortic Disruption
  21. 21. 2 Month-Old With Respiratory Distress.
  22. 22. 2 Month-Old With Respiratory Distress. Diaphragmatic Hernia Bowel In The Chest
  23. 23. 57 year old with cough and shortness of breath. The CXR demonstrates: a. Pulmonary edema b. RLL pneumonia c. RML pneumonia d. Pulmonary embolus e. Lung cancer
  24. 24. 57 year old with cough and shortness of breath. The CXR demonstrates: a. Pulmonary edema b. RLL pneumonia c. RML pneumonia d. Pulmonary embolus e. Lung cancer
  25. 25. RML pneumonia:  Blurred right heart border  Lateral diaphragm clear  Often seen best on the lateral
  26. 26. RML Infiltrate
  27. 27. RML Infiltrate
  28. 28. 51 Year-Old With Cough & Fever.
  29. 29. 51 Year-Old With Cough & Fever. Pneumonias Can Be Subtle On The PA View Alone.
  30. 30. 51 Year-Old With Cough & Fever.
  31. 31. 51 Year-Old With Cough & Fever. Retrocardiac LLL Pneumonia On The Lateral View
  32. 32. What Do You See?
  33. 33. What Do You See? Pulmonary Arterial Hypertension Enlarged Right Pulmonary Artery Enlarged Left Pulmonary Artery
  34. 34. Valvular Heart Disease Which cardiac chamber is enlarged in patients with significant chronic mitral stenosis? • Right atrium • Right ventricle • Left atrium • Left ventricle
  35. 35. Valvular Heart Disease Which cardiac chamber is enlarged in patients with significant chronic mitral stenosis? • Right atrium • Right ventricle • Left atrium • Left ventricle
  36. 36. Mitral Stenosis
  37. 37. Mitral Stenosis
  38. 38. What Are You Worried About? No Pulse Left Arm!
  39. 39. Gunshot Wound To The Neck…
  40. 40. Gunshot Wound To The Neck… Injury To The Trachea & Esophagus
  41. 41. Pneumomediastinum
  42. 42. Pneumomediastinum Pneumomediastinum Pneumomediastinum
  43. 43. 33 Year-Old With Chest Pain Situs Inversus Heart & Stomach Both On The Wrong Side
  44. 44. Dextrocardia Heart On The Wrong Side, Stomach On The Correct Side
  45. 45. Pulmonary Bullae
  46. 46. 28 Year-Old With COPD And Pulmonary Fibrosis.
  47. 47. 28 Year-Old With COPD And Pulmonary Fibrosis. Recurrent Left Apical Pneumothorax
  48. 48. Summary Of Diagnoses This Week • Aortic dissection • Traumatic aortic disruption • Right middle lobe pneumonia • Various cases of pneumonia • Pulmonary artery hypertension • Left atrial enlargement from mitral stenosis • Shot gun blast – pulseless left arm • Pneumomediastinum/pneumopericardium • Situs inversus & dextrocardia • Pulmonary bullae • Recurrent left apical pneumothorax
  49. 49. See You Next Week!

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