CXRInterpretation胸部医学影像解读

InterpretationofChestRadiographsUNCEmergencyMedicineMedicalStudentLectureSeriesObjectivesTheBasicsApproachtointerpretationAnatomyInterstitaldiseaseAlveolardiseasePatternRecognitionPractice!InterpretationUseasystematicapproachUseordeveloponeyoulikeUsethesameapproacheverytimeDescribewhatyouseeFormadifferentialbasedonpatientpresentationandappearanceofx-rayIfyoufindanabnormality,don’tstopthereFinishyoursystematicreadingThesecondlesionisoftenmissedSystematicApproachABCDEAirway(trachea)Midlinev.deviatedorrotated,FBintrachea,ETtubepositionBones(clavices,ribs,humeri,etc)CardiomediastinalsilhoutteDiaphragms(andthecostophrenicangles)EverythingElse(lungfields,softtissues,tubes,lines,wires,devices,etc)NormalChestRadiographTracheaRightmainstembronchusLeftmainstembronchusPulmonaryarteryPulmonaryarteryAorticknobLeftventricleRightatriumAnatomyLefthemidiaphragmRightcostophrenicangleStomachUpperlobesMiddlelobeLingulaLowerLobesAnatomyLowerlobesUpperlobesRightmiddlelobeLingula

CommonViewsPAAPLeftLateralRightanteriorobliqueAPsupineRightlateraldecubitusPortableCXRPA/LateralCXRThesearefromtheSamePatient

Explainthedifference…..PAAPAlwaysgetaPAfilmtoavoidcardiacmagnificationExceptions:trauma,activecardiacchestpain,unstable,unabletocooperatewithprocedureSilhouetteSignTwosubstancesofthesamedensity,indirectcontact,cannotbedifferentiatedfromeachotheronx-rayCommonlocationsLowerlobes-diaphragmsRightheartborder–RMLLeftheartborder–LingulaLeftdiaphragm–Heart(onlateralview)AirBronchogramSignVisualizationofairintheintrapulmonarybronchiAbnormalDenotesapulmonarylesion/consolidation(excludesapleuralormediastinallesion)Seeninpneumonia,pulmonaryedemaorpulmonaryinfarctAnairbronchogramwithintheheartshadowsuggestsLLLconsolidationSilhouettesignInterstitialLungDiseaseThevessels(lungmarkings)appearmoreprominentAlveoliarestillaeratedDDx:Pulmonaryedema,inflammation,tumor,fibrosisAlveolarDiseaseVesselsarelessvisibleintheareaofdiseaseLungisnotaeratedMayhaveairbronchogramsorsilhouettesignDDx:Bacterialpneumonia,pulmonaryedemaLet’sPracticeWhattypeoffilmDescribewhatyouseeConsolidation,infiltrate,nodular,diffuse,streaky,opacificationLookforSilhouettesignandairbronchogramsIsitaninterstitialoralveolarpattern?Otherfindings…Givedifferentialordiagnosis75yoFwithhxofMInowpresentingwithSOB,hypoxiaPulmonaryedemaOpacificationofrighthemithorax,obscuredlefthemidiaphramDDx:Massivepleuraleffusion,rightpneumonectomyMultipleRsidedribfractures–flailchest

Opacificationoflefthemithorax,air-fluidlevelinleftupperlobe,leftclavicularfractureDiagnosis:LeftempyemaaftertraumaAir-fluid(cavitary)lesionSamepatientLateralview

Air-fluidlevel48yoMwithhxofPUDpresentingwithabdominalpainpneumoperitoneum67yosmokerwithoneweekofcough,sob,feversLeftlowerlobepneumonia“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%3DNDx:Subcutaneousairinneckandshoulderandpneumomediastinum(leftheartborder)Lackoflungmarkingsonright,collapsedlungDx:CompleterightpneumothoraxCollapsedlungIsitatensionpneumothorax?NO!TensionPneumothoraxMediastinumisshiftedtooppositesiteofpneumothoraxLooka