How read chest xr 8


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How read chest xr 8

  2. 2. Brief review
  3. 3. POSITION PA AP QUALITY ROTATION PENETRATION INSPIRATION LESION OPACI OPACITY Homo Heterogenous Wellill defined Zone Centralperiph Silhouet eral sign TY Necrotic PATCHY MEDIASTINAL NODULE Central deviasionwided MASS COSTO-PHRENIC ANGEL Freeoblitern CAVITARY OTHERINFILTIRATION Bone soft tissuediaphragm
  4. 4. ConsolidationInfection causes Non-infection causes Broncho- WEGNER CardiacPneumonia Lymphoma alveolar COP Sarcoid disease failure carcinoma
  5. 5. Solitary Pulmonary Nodule(SPN)• Is • Single. • Discrete. • intrapulmonary density. • < 3cm in diameter. • completely surrounded by aerated lung.• DDX: • Bronchogenic ca. • Solitary metastasis. • Granuloma (infectioninflamation). • Benign lung tumor(hamartoma). • Round pneumonia. • Round atelectasis. • AVM.
  6. 6. Solitary Pulmonary Nodule(SPN) Appearance Margin Calcification cavitation Comparison with a Size previous x-ray to >8mm <8mm Assess growth over time. Location Upperhillar zone Lowerbasesup-pleural Associated abnormalitiesLymph node enlargement Rib destruction/erosion
  7. 7. Nodule Mass Nodule Mass• Well defined opacity it s • Well defined opacity more diameter up to 3cm. than 3cm.• The most common is: • The most common is: – Tuberculoma – Bronchgenic CA – Hamartoma – Hydatid cyst – Bronchogenic CA – metastases – Hydatid cyst – Metastases – AVM
  8. 8. Cavitary lesionAir-fluid level Air only Wall thicknessStraight Wavy Thick Thin site ruptured Irregular inner Regular innerAbscess Hydatid wall wall Peripheral Central cyst Cavitating Chronic Emphesematous pneumatocele neoplasm abscess bulla
  9. 9. Case-1• A 40-year-old man with a history of substance abuse and HIV infection is seen in the ER with complaints of: • fever, • weight loss, • production of foul-smelling sputum, • and shortness of breath for 2 wk.• On physical exam he is : • tachypneic • has clubbing of his digits.• Lung exam reveals: • diffuse rhonchi • and an area of egophony with whispering pectoriloquy in the right chest posteriorly.• ABGs reveal PaO2 of 59 mm Hg on room air.
  10. 10. CASE-1What is the most likelydiagnosis?a. Pneumococcalpneumoniab. PCP pneumoniac. Lung abscessd. Squamous cellcarcinoma
  11. 11. POSITION •PA CXRQUALITY •Good Technical Quality •Round opacitiy with air-fluid level •In right upper zone near hilumLESION •Ill-defined linear opacity surrond it •Central trachea and mediasteinal.MEDIASTINALANGELS •Free costo-phrenic angels.OTHER •No
  12. 12. Case-2• A 60-year-old man with a history of COPD and old TB is seen with• mild hemoptysis and chronic cough.• He is HIV negative and has been ill for about 2 wk.• Vital signs: pulse 110 bpm; temperature 101°F; respirations 24/min; blood pressure 108/70 mm Hg.• No skin lesions are noted.• Laboratory data: Hb 14 g/dL; HCA 42%; WBCs 8.7/μL; BUN 24 mg/dL; creatinine 0.8 mg/dL; sodium 131 mEq/L; potassium 4.3 mEq/L.• ABGs on RA: pH 7.37; PCO2 43 mm Hg; PO2 87 mm Hg.• Sputum tests reveal numerous AFB-positive organisms on smear.• Spirometry shows an obstructive ventilatory impairment with marginal reversibility.
  13. 13. Case-2
  14. 14. POSITION •PA CXRQUALITY •Poor Technical Quality •Cavitary lesion •In right upper zoneLESION •Central trachea and mediasteinal.MEDIASTINALHilum •Right hilum pulled upwardANGELS •Disappear . •NoOTHER
  15. 15. Case-2• the most likely diagnosis is – a. Lung abscess – b. Non-TB mycobacteria – c. Actinomycosis – d. Aspiration pneumonia
  16. 16. Case-3• A 60-year-old man with a past history of smoking for 30 years (he stopped 3 years ago, prior to cardiac bypass surgery).• is admitted with cough and mild hemoptysis.• He is afebrile with no shortness on breath.• Physical exam is negative except that the lung exam reveals rhonchi in the left upper lung zone.
  17. 17. Case-3
  18. 18. POSITION •PA CXRQUALITY •Poor Technical Quality •Well defined round density •(mass lesion)LESION •7*11cm. •In left para-hilar area. •Obscured aortic •Right deviated trachea.MEDIASTINALHilumANGELS •Disappear . •NoOTHER
  19. 19. Case-3• The finding/abnormality most likely to occur with the lesion seen on the CXR:• Serum calcium of 13.6 mg/dL.• b. Sputum positive for fungal elements• c. Increased D-dimer levels.• d. Koilonychia.
  20. 20. Case-4• A 38-year-old city worker presents with fever, chills, and cough with left-sided chest pain 2 days after the Mardi Gras festival.• She denies any hemoptysis, weight loss, or chronic illness.• Past history is unremarkable.• On physical exam, she has a BMI of 32; temperature is 101°F.• She was observed to have splinting of her right side during the inspiration.
  21. 21. Case-4
  22. 22. POSITION •PA CXRQUALITY •Poor Technical Quality •Well defined round density •(mass lesion)LESION •3*2,5 cm. •In right middle zone. •Cardiomegaly .MEDIASTINALHilumANGELS •Hazy . •NoOTHER
  23. 23. Case-4• 1.The most likely diagnosis is:• a. Bronchogenic carcinoma• b. Round pneumonia• c. Alveolar sarcoidosis• d. Fungus ball• 2. Associated findings may include:• a. Hyponatremia• b. Increased ACE levels• c. Hypercalcemia• d. Clubbing
  24. 24. Case-5• A 62-year-old female smoker presents with a history of “pneumonia” 6 wk ago.• She has been on multiple antibiotics, and although she feels relatively better now,• her CXR remains unchanged.
  25. 25. Case-5
  26. 26. POSITION •PA CXRQUALITY •Poor Technical Quality •Ill defined mass-like density •Behined heart shadowLESION •7*4 cm. •Silhoutte descending aorta. •Central tracheamediastinum .MEDIASTINALHilumANGELS •Hazy . •NoOTHER
  27. 27. Case-5• The next step in the management of this patient will include:• a. Change of antibiotics• b. Sputum for TB• c. Flexible bronchoscopy.• d. Open lung biopsy