Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Malignant Pneumothorax
• Lung Mass
• Retained Bullet
• Cavitary Lesion
• Pleural Effusion
• Mucus Plug with Atelectasis
• Rib Fracture
• Mediastinal Lymphadenopathy
Drs. Milam and Thomas's CMC X-Ray Mastery Project: July Cases
Adult Chest X-Rays Of The Month
Alyssa Thomas MD & Claire Milam MD
Travis Barlock MD & Breeanna Lorenzen, MD
Department of Emergency Medicine
Carolinas Medical Center & Levine Children’s Hospital
Michael Gibbs MD, Faculty Editor
Chest X-Ray Mastery Project™
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.
Many are providing cases and these slides are shared with all contributors.
Contributors from many CMC/LCH departments, and now from EM
colleagues in Brazil, Chile and Tanzania.
Cases submitted this month will be distributed next month.
When reviewing the presentation, the 1st image will show a chest X-ray
without identifiers and the 2nd image will reveal the diagnosis.
Visit Our Website
For A Complete Archive Of Chest X-Ray Presentations And Much More!
of a CT Chest…
CT Chest Revealed Obstruction
of Left Lower Lobe (LLL)
Bronchus Due to Mucus Plugging
Diagnosis: Atelectatic Left Lower Lobe
Let’s Go Back to the
The LLL Collapse is Difficult
Do Not Forget Anatomy!
Get The Lateral
CXR if Possible!
Little of the
The conditions that are best-known to cause mucus plugging are the following:
• Allergic Bronchopulmonary aspergillosis
• Plastic Bronchitis
Mucus can become abnormally thick due to
- Pathologic diseases causing stagnation of flow and blockage of tracheobronchial tree
- Anticholinergic medications
Resulting in a Mucus Plug
Mucus plugs can partially or completely obstruct one or more airways resulting in
atelectasis or recurrent infection.
Diagnosis: Cavitary Lesion
Diagnosis: Spontaneous Pneumothorax
Pigtail Chest Tube
The Parenchyma Shows Signs
of Chronic Changes – Which
Likely Contributed to the
Etiology of Her Spontaneous
Pneumothorax. i.e. Blebs.
Partially Necrotic Left Upper Lobe Mass
This Mass is
Loculated and Has a
Large Component of
Air, As Can Be Seen
on the CT Lung
Window, and Helps
Explains the Change
in the Mass of CXR.
Presents with Lateral
Chest Pain After
Presents with Lateral
Chest Pain After
Diagnosis: Non-Displaced Rib Fracture With Surrounding Hematoma.
62-Year-Old Male Presents with Lateral
Chest Pain After Coughing and Normal CXR
Rib Fractures and Chest X-rays
Rib Fractures May Be Missed on Chest x-ray.
Studies Have Shown That Up to 75% of Rib Fractures
Will Be Missed with AP/Lateral Chest x-ray.
Citation: Chapman BC, Overbey DM, Tesfalidet F, et al. Clinical Utility of
Chest Computed Tomography in Patients with Rib Fractures CT Chest and
Rib Fractures. Arch Trauma Res. 2016;5(4):e37070. Published 2016 Sep 13.
What is the clinical significance of chest CT when the
chest x-ray result is normal in patients with blunt trauma?
Citation: Kea B, Gamarallage R, Vairamuthu H, et al. What is the clinical significance of chest
CT when the chest x-ray result is normal in patients with blunt trauma?. Am J Emerg Med.
Study design: Retrospective observational study of 589 patients.
Methods: Patients over age 14 with blunt trauma who received a chest X-ray were enrolled.
Results: Of the 589 patients who had a chest CT after a normal chest X-ray, 66 (11%) had undiagnosed rib
fractures, but only 12 (2%) were clinically significant.
Conclusions: Chest CT after a normal Chest X-ray in blunt trauma will detect more injuries, but likely not
changes in patient management
Summary Of Diagnoses This Month
Mucus Plug with Atelectasis
Rib Fracture with Hematoma