Chest XRay Interpretation Gary M. Shayne P.A., M.S. - PowerPoint PPT Presentation

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Chest XRay Interpretation Gary M. Shayne P.A., M.S.

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Evaluate technique(rotation, penetration, lung expansion) Examine soft tissues and bones ... Breast tissue variations. KEY Method: Look side-side. Diaphragms ... – PowerPoint PPT presentation

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Title: Chest XRay Interpretation Gary M. Shayne P.A., M.S.


1
Chest X-RayInterpretationGary M. Shayne P.A.,
M.S.
2
General Principles
  • Read X-Rays yourself
  • Be systematic
  • Be aware of common artifacts
  • Serially compare
  • Observe symmetry
  • Believe you missed a finding

3
CXR Interpretation Format
  • Check info on CXR
  • Evaluate technique(rotation, penetration, lung
    expansion)
  • Examine soft tissues and bones
  • Find Alien equiptment
  • Evaluate structures(diaphragms, trachea, hilum,
    heart shadows)
  • Evaluate lung pathology last

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CXR Interpretation Format
  • Check info on CXR
  • Evaluate technique(rotation, penetration, lung
    expansion)
  • Examine soft tissues and bones
  • Find Alien equiptment
  • Evaluate structures(diaphragms, trachea, hilum,
    heart shadows)
  • Evaluate lung pathology last

10
Soft Tisues, Bones Survey
  • SubQ emphysema
  • Tissue swelling
  • Rib, Shoulder, Clavicles, Humerus Fxs
  • Metastatic lesions, rib erosions
  • Vertebral column abnormalities
  • Breast tissue variations
  • KEY Method Look side-side

11
Diaphragms
  • Costophrenic angles crisp?
  • Air under diaphragms?
  • Flattened diaphragms
  • Loss of diaphragm definition
  • Elevated hemidiaphragm
  • Tenting

12
Trachea
  • Deviation
  • Foreign bodies
  • Right, Left Mainstem bronchus cutoff
  • Endotracheal tube position

13
Mediastinal/Hilar Enlargement
  • Aortic dissection
  • Masses
  • Lymph nodes, Lymphoma
  • Goiter
  • Thymoma
  • Mitral stenosis

14
Heart Shadows
  • Abnormal CT ratio
  • Increased chamber sizes
  • Vertical heart
  • Straightened PA window
  • Widened Aortic arch
  • Pneumopericardium
  • Tamponade

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Common LooksofCommon Lung Presentations
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Atelectasis
  • Loss of diaphragm definition
  • Platelike or discoid atelectasis
  • Horizontal fissure down
  • Loss of aortic stripe
  • Decreased lung volume
  • Narrowed rib spaces
  • Lung collapse

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Pleural Effusions
  • Blunted costophrenic angles
  • Haze tracking up from diaphragms
  • Haze throughout lung field(fluid panning out
    effect)
  • Rib spaces widened
  • Loculated pleural effusions
  • Lateral decubitus X-rays

20
COPD
  • Hyperexpanded lungs
  • Flattened diaphragms
  • Vertical heart
  • Bullae
  • Widened rib spaces
  • Vascular crowding at bases
  • Domed apices

21
Most Common Diagnoses for Hypoxemia In-Hospital
  • Sepsis
  • P.E.
  • Microatelectasis CLEAR CXR
  • Acute Aspiration
  • Heavy Secretions/Plugged bronchial tree
  • Cardiac Ischemia
  • Hypoventiltion/drugs

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Pneumonia
  • Consolidation -lobar -segmental
  • Localized infiltrate
  • Diffuse infiltrates
  • Interstitial edema

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Pneumothorax
  • Narrowed rib spaces on side of pnthx
  • Loss of any vascular markings
  • Fine line of lung edge
  • Whole lung collapse into hilum
  • Tracheal, mediastinal, heart shift to side of
    pnthx
  • SubQ, mediastinal, pericardial emphysema
  • Sulcus sign

24
CHF
  • Increased vasculature cephalad
  • Plump vasculature peripherally
  • Pleural effusion
  • Filled-in horizontal fissure
  • Large heart
  • Kerley B lines
  • Interstitial edema
  • Alveolar edema
  • Acute pulmonary edema(butterfly pattern)

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CXR Interpretation Format
  • Check info on CXR
  • Evaluate technique(rotation, penetration, lung
    expansion)
  • Examine soft tissues and bones
  • Find Alien equiptment
  • Evaluate structures(diaphragms, trachea, hilum,
    heart shadows)
  • Evaluate lung pathology last
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