CXRInterpretation胸部医学影像解读

InterpretationofChestRadiographsUNCEmergencyMedicineMedicalStudentLectureSeries第1页ObjectivesTheBasicsApproachtointerpretationAnatomyInterstitaldiseaseAlveolardiseasePatternRecognitionPractice!第2页InterpretationUseasystematicapproachUseordeveloponeyoulikeUsethesameapproacheverytimeDescribewhatyouseeFormadifferentialbasedonpatientpresentationandappearanceofx-rayIfyoufindanabnormality,don’tstopthereFinishyoursystematicreadingThesecondlesionisoftenmissed第3页SystematicApproachABCDEAirway(trachea)Midlinev.deviatedorrotated,FBintrachea,ETtubepositionBones(clavices,ribs,humeri,etc)CardiomediastinalsilhoutteDiaphragms(andthecostophrenicangles)EverythingElse(lungfields,softtissues,tubes,lines,wires,devices,etc)第4页NormalChestRadiograph第5页TracheaRightmainstembronchusLeftmainstembronchusPulmonaryarteryPulmonaryarteryAorticknobLeftventricleRightatriumAnatomy第6页LefthemidiaphragmRightcostophrenicangleStomachUpperlobesMiddlelobeLingulaLowerLobesAnatomy第7页LowerlobesUpperlobesRightmiddlelobeLingula

第8页CommonViewsPAAPLeftLateralRightanteriorobliqueAPsupineRightlateraldecubitusPortableCXRPA/LateralCXR第9页ThesearefromtheSamePatient

Explainthedifference…..第10页PAAPAlwaysgetaPAfilmtoavoidcardiacmagnificationExceptions:trauma,activecardiacchestpain,unstable,unabletocooperatewithprocedure第11页SilhouetteSignTwosubstancesofthesamedensity,indirectcontact,cannotbedifferentiatedfromeachotheronx-rayCommonlocationsLowerlobes-diaphragmsRightheartborder–RMLLeftheartborder–LingulaLeftdiaphragm–Heart(onlateralview)第12页AirBronchogramSignVisualizationofairintheintrapulmonarybronchiAbnormalDenotesapulmonarylesion/consolidation(excludesapleuralormediastinallesion)Seeninpneumonia,pulmonaryedemaorpulmonaryinfarctAnairbronchogramwithintheheartshadowsuggestsLLLconsolidationSilhouettesign第13页InterstitialLungDiseaseThevessels(lungmarkings)appearmoreprominentAlveoliarestillaeratedDDx:Pulmonaryedema,inflammation,tumor,fibrosis第14页AlveolarDiseaseVesselsarelessvisibleintheareaofdiseaseLungisnotaeratedMayhaveairbronchogramsorsilhouettesignDDx:Bacterialpneumonia,pulmonaryedema第15页Let’sPracticeWhattypeoffilmDescribewhatyouseeConsolidation,infiltrate,nodular,diffuse,streaky,opacificationLookforSilhouettesignandairbronchogramsIsitaninterstitialoralveolarpattern?Otherfindings…Givedifferentialordiagnosis第16页75yoFwithhxofMInowpresentingwithSOB,hypoxia第17页Pulmonaryedema第18页第19页Opacificationofrighthemithorax,obscuredlefthemidiaphramDDx:Massivepleuraleffusion,rightpneumonectomy第20页第21页MultipleRsidedribfractures–flailchest第22页

第23页

Opacificationoflefthemithorax,air-fluidlevelinleftupperlobe,leftclavicularfractureDiagnosis:LeftempyemaaftertraumaAir-fluid(cavitary)lesion第24页SamepatientLateralview

Air-fluidlevel第25页48yoMwithhxofPUDpresentingwithabdominalpain第26页pneumoperitoneum第27页67yosmokerwithoneweekofcough,sob,fevers第28页Leftlowerlobepneumonia第29页“SpineSign”/imgres?imgurl=/content/RSP/2023/07/img/Case_pneum_1.jpg&imgrefurl=/issues/articles/2023-07_02.asp&h=572&w=580&sz=72&hl=en&start=23&um=1&tbnid=wBsgta58mO7XPM:&tbnh=132&tbnw=134&prev=/images%3Fq%3Dleft%2Blower%2Blobe%2Batelectasis%26start%3D21%26ndsp%3D21%26um%3D1%26hl%3Den%26sa%3DN第30页第31页Dx:Subcutaneousairinneckandshoulderandpneumomediastinum(leftheartborder)第32页第33页Lackoflungmarkingsonright,collapsedlungDx:CompleterightpneumothoraxCollapsedlungIsitatensionpneumothorax?第34页NO!TensionPneumothoraxMediastinumisshiftedtooppositesiteofpneumothoraxLookattrac