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

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. 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 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. It’s All About The Anatomy!

5. Airway
Bones
Cardiac
Diaphragm
Effusion
Foreign body
Gastric
Hilum

6. 71 Year-Old From
Ghana With Chest
Pain.

7. 71 Year-Old From
Ghana With Chest
Pain.
Thoracic Artery Aneurysm With Type A Dissection

8. 71 Year-Old From
Ghana With Chest
Pain.
Thoracic Artery Aneurysm With Type A Dissection

9. 51 Year-Old With
Burning Chest Pain
For 1 Hour After
Getting In To An
Argument.
HR 57, BP 196/100

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. Aortic Dissection

12. 67 Year-Old In A
Single Vehicle MVC
Against A Tree

13. 67 Year-Old In A
Single Vehicle MVC
Against A Tree
Wide
Mediastinum
Loss Of The
Aortopulmonary
Window

14. 67 Year-Old In A
Single Vehicle MVC
Against A Tree

15. 67 Year-Old In A
Single Vehicle MVC
Against A Tree
Traumatic
Pseudoaneurysm

16. 67 Year-Old In A
Single Vehicle MVC
Against A Tree

17. 67 Year-Old In A
Single Vehicle MVC
Against A Tree
Successfully Deployed
Endovascular Stent
Graft

18. 33 Year-Old Male On
A Moped Struck By A
Car

19. 33 Year-Old Male On
A Moped Struck By A
Car
Wide
Mediastinum
Traumatic Aortic Disruption

20. 33 Year-Old Male On
A Moped Struck By A
Car
Traumatic Aortic Disruption

21. 2 Month-Old With
Respiratory
Distress.

22. 2 Month-Old With
Respiratory
Distress.
Diaphragmatic Hernia
Bowel In
The Chest

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. 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. RML pneumonia:
 Blurred right heart border
 Lateral diaphragm clear
 Often seen best on the lateral

26. RML Infiltrate

27. RML Infiltrate

30. 51 Year-Old With
Cough & Fever.

31. 51 Year-Old With
Cough & Fever.
Pneumonias Can Be Subtle On The PA View Alone.

32. 51 Year-Old With
Cough & Fever.

33. 51 Year-Old With
Cough & Fever.
Retrocardiac LLL Pneumonia On The Lateral View

34. What Do You See?

35. What Do You See?
Pulmonary Arterial Hypertension
Enlarged Right
Pulmonary Artery
Enlarged Left
Pulmonary Artery

36. Valvular Heart Disease
Which cardiac chamber is enlarged in patients with significant chronic
mitral stenosis?
• Right atrium
• Right ventricle
• Left atrium
• Left ventricle

37. Valvular Heart Disease
Which cardiac chamber is enlarged in patients with significant chronic
mitral stenosis?
• Right atrium
• Right ventricle
• Left atrium
• Left ventricle

39. Mitral Stenosis

41. Mitral Stenosis

43. What Are You Worried About?
No Pulse
Left Arm!

44. Gunshot Wound
To The Neck…

45. Gunshot Wound
To The Neck…
Injury To The Trachea & Esophagus

46. Pneumomediastinum

47. Pneumomediastinum
Pneumomediastinum
Pneumomediastinum

48. 33 Year-Old With
Chest Pain
Situs Inversus
Heart & Stomach Both On The Wrong Side

49. Dextrocardia
Heart On The Wrong Side, Stomach On The Correct Side

51. Pulmonary Bullae

52. 28 Year-Old With
COPD And
Pulmonary Fibrosis.

53. 28 Year-Old With
COPD And
Pulmonary Fibrosis.
Recurrent Left Apical Pneumothorax

54. 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

55. See You Next Week!