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Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #3 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: Pericardial effusions, Pneumothorax, Marfan Syndrome, Malignant pleural effusion, Pulmonary Metastatic Disease, Cardiomegaly, Necrotizing Pneumonia, Bronchogenic Carcinoma

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Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #3 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 25th 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. Before Now 33 With A Complex Malignancy Now Presents With Dyspnea
  7. 7. Before Now 33 With A Complex Malignancy Now Presents With Dyspnea The Cardiac Silhouette Now Looks Bigger And More Globular
  8. 8. 33 With A Complex Malignancy Now Presents With Dyspnea ED Bedside Ultrasound: Pericardial Effusion * * * *
  9. 9. 78 Year-Old With HPTN, Atrial Fibrillation Presents With Dyspnea.
  10. 10. Before Now 78 Year Old With HPTN & Afib Presents With Dyspnea
  11. 11. Before Now 78 Year Old With HPTN & Afib Presents With Dyspnea The Cardiac Silhouette Now Looks Bigger And More Globular
  12. 12. 78 Year-Old With HPTN, Atrial Fibrillation Presents With Dyspnea. * * * * * * A Chest CT Obtained To Rule Out Pulmonary Embolus Instead Reveals A Large Pericardial Effusion.
  13. 13. On Presentation 78 Year Old With HPTN & Afib Presents With Dyspnea Pericardiocentesis  300 cc of fluid removed  Cardiac silhouette smaller Post-Procedure
  14. 14. Thoughts On Pericardial Effusions • Think about the possibility of a pericardial effusion in patients with chest pain, dyspnea, syncope or pre-syncope. • Slowly accumulating pericardial effusions stretch the pericardium and enlarge the cardiac silhouette on CXR. A careful comparison with old CXRs is helpful. • Rapidly accumulating pericardial effusions (e.g.: stab wounds, blunt trauma) typically ARE NOT associated with cardiac silhouette enlargement on CXR • The liberal use of bedside point-of-care ultrasound is diagnostic
  15. 15. 33 Year-Old In A Roll Over Motor Vehicle Crash.
  16. 16. 33 Year-Old In A Roll Over Motor Vehicle Crash. Deep Sulcus Sign Deep Sulcus Sign Bilateral Pneumothoraces
  17. 17. 56 Year Old Ventilated ICU Patient Who Develops Acute Hypoxia
  18. 18. 56 Year Old Ventilated ICU Patient Who Develops Acute Hypoxia Pneumothorax: Subpulmonic & Along The Medial Pleural Reflection
  19. 19. Spontaneous Pneumothorax
  20. 20. 41 Year-Old With Marfan Syndrome Presents With Chest Pain
  21. 21. 41 Year-Old With Marfan Syndrome Presents With Chest Pain Thoracic Aneurysm & Chronic Type-B Aortic Dissection
  22. 22. 41 Year-Old With Marfan Syndrome. Thoracic Aneurysm & Chronic Type-B Aortic Dissection
  23. 23. 63 Year-Old With Metastatic Breast Cancer
  24. 24. 63 Year-Old With Metastatic Breast Cancer Malignant Left Pleural Effusion
  25. 25. 60 Year-Old With Metastatic Ovarian Cancer
  26. 26. 60 Year-Old With Metastatic Ovarian Cancer Metastases To RUL + Bilateral Malignant Left Pleural Effusions
  27. 27. Cardiomegaly From Longstanding HPTN
  28. 28. 51 Year-Old With HPTN And Severe Heart Failure In The Dickson Heart Unit
  29. 29. 51 Year-Old With HPTN And Severe Heart Failure In The Dickson Heart Unit Swan Ganz Catheter Left Subclavian Central Line Cardiomegaly From Longstanding HPTN
  30. 30. 5 Year-Old With Fever, Cough And Tachypnea
  31. 31. 5 Year-Old With Fever, Cough And Tachypnea RUL Collapse + RLL Necrotizing Pneumonia
  32. 32. 5 Year-Old With Fever, Cough And Tachypnea RUL Collapse + RLL Necrotizing Pneumonia
  33. 33. 81 Year-Old With Cough And Fever
  34. 34. 81 Year-Old With Cough And Fever RUL Density
  35. 35. 81 Year-Old With Cough And Fever Chest CT Suggests Bronchogenic Carcinoma
  36. 36. Summary Of Diagnoses This Week • Pericardial effusions • Various spontaneous and traumatic pneumothoraces • Marfan syndrome: thoracic aneurysm + chronic Type-B aortic dissection • Malignant pleural effusion • Pulmonary metastatic disease • Cardiomegaly • Necrotizing pneumonia • Bronchogenic carcinoma
  37. 37. See You Next Week!

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