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Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #4 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: RUL pneumonia, tension hemothorax, blunt bronchial injury, pneumomediastinum, Free air under the diaphragm, Lung Cancer and pleural effusion, Tension pneumothorax, cardiomegaly

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Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #4 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 March 4th 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. Prior CXR Now 54 Year-Old With COPD & Diabetes Fever, Hypoxia, Altered Mental Status
  7. 7. Prior CXR Now 54 Year-Old With COPD & Diabetes Fever, Hypoxia, Altered Mental Status RUL Pneumonia
  8. 8. 42 Year-Old In A High Speed Motor Vehicle Crash.
  9. 9. 42 Year-Old In A High Speed Motor Vehicle Crash. Traumatic Right Tension Hemothorax
  10. 10. 31 Year-Old In A High Speed Motor Vehicle Crash. Ejected.
  11. 11. 31 Year-Old In A High Speed Motor Vehicle Crash. Ejected. Right Chest Tube Multiple Rib Fractures And A Persistent Right Pneumothorax Despite A Well Place Chest Tube
  12. 12. 42 Year-Old In A High Speed Motor Vehicle Crash. Ejected. 1st Right Chest Tube 2nd Right Chest Tube So, Why Does The Pneumothorax Persist After TWO Chest Tubes?
  13. 13. 42 Year-Old In A High Speed Motor Vehicle Crash. Ejected. 1st Right Chest Tube 2nd Right Chest Tube So, Why Does The Pneumothorax Persist After TWO Chest Tubes? Our Patient Has A Large Bronchial Laceration That Leaks Air Into The Pleural Space Faster Than The Chest Tubes Can Remove It.
  14. 14. 42 Year-Old In A High Speed Motor Vehicle Crash. Ejected. Our Patient Has A Large Bronchial Laceration That Leaks Air Into The Pleural Space Faster Than The Chest Tubes Can Remove It. The Next Step Is To Isolate & Occlude The Right Lung Balloon Catheter Occlusion Of The Right Lung
  15. 15. Healthy 13 Year-Old With Throat And Upper Chest Pain
  16. 16. Healthy 13 Year-Old With Throat And Upper Chest Pain Pneumomediastinum & Pneumopericardium
  17. 17. Healthy 13 Year-Old With Throat And Upper Chest Pain Pneumomediastinum & Pneumopericardium
  18. 18. Healthy 13 Year-Old With Throat And Upper Chest Pain Pneumomediastinum & Pneumopericardium
  19. 19. 39 Year-Old With A Past History of Large Bowel Obstruction Presents With Severe Abdominal Pain
  20. 20. 39 Year-Old With A Past History of Large Bowel Obstruction Presents With Severe Abdominal Pain Free Air Under The Diaphragm: Colonic Perforation
  21. 21. 48 Year-Old With Gallstone Pancreatitis Develops Acute Severe Peritonitis.
  22. 22. 48 Year-Old With Gallstone Pancreatitis Develops Acute Severe Peritonitis. Free Air Under The Diaphragm: Duodenal Perforation
  23. 23. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath
  24. 24. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath Prior CXR: Right Hilar Mass + RUL Density RUL Density
  25. 25. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath
  26. 26. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath Current CXR: New Malignant Right Pleural Effusion New (Malignant) Pleural Effusion
  27. 27. Left Tension Pneumothorax After Central Line Placement
  28. 28. Left Tension Pneumothorax – After Chest Tube
  29. 29. RLL Pneumonia – The Lateral Views Helps Differentiate From RML Involvement
  30. 30. 28 Year Old With Progressive Dyspnea.
  31. 31. 28 Year Old With Progressive Dyspnea. LLL Pleural Effusion – The Lateral Helps Define The Size Of The Effusion
  32. 32. Cardiomegaly AICD
  33. 33. AICD LVAD Cannula Cardiomegaly
  34. 34. Cardiomegaly Swan Ganz Catheter Subclavian Central Line
  35. 35. Summary Of Diagnoses This Week • Right upper lobe pneumonia • Traumatic tension hemothorax • Blunt bronchial injury • Pneumomediastinum • Free air under the diaphragm • Lung cancer + malignant pleural effusion • Tension pneumothorax after central line placement • Right lower lobe pneumonia • Pleural effusion • Cardiomegaly
  36. 36. See You Next Week!

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