Respiratory Case Study Discussions

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Respiratory Case Study Discussions
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Chest X-Ray Images

• Chest film shadows of x-ray energy
• Radiopaque dense materials (metal or bone)
  appear as white
• Radiolucent materials with little density (air
  or fat) appear as dark
• Variations in density (soft tissue or fluid)
  appear as shades of gray
• Border interface between densities

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Most Frequent Views

• Posterior-Anterior
• Anterior-Posterior (portable)
• Lateral

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http//www2.kumc.edu/kclp
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http//www.fhsu.edu.nursing/cxr/

• Bryan Mann, MD
• Fort Hays State University
• Department of Nursing

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Chest X-Ray Posterior-Anterior

• 1 Bone
• 2 Soft Tissue
• 3 Fluid
• 4 Air

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Chest X-Ray Lateral

• Adds dimension
• Note clear areas substernal retrocardiac

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Evaluation of Film

• Penetration
• Overexposed too dark, under interpretation
• Underexposed too light, over interpretation
• Inspiratory breath
• Count 10 ribs above diaphram
• Symmetry alignment
• Compare clavicles for rotation
• Sharp costophrenic angles

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Evaluation of Film

• PA or
• AP (heart may appear enlarged)
• Right patient

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Systematic Inspection

• Bones
• Mediastinum (midline)
• Heart
• Hilar markings
• Lung markings
• Diaphragm gastric bubble
• Costophrenic angles

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Chest X-Ray Posterior-Anterior

• Systematic
• Inspection

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Case 1

• A 23 year old male presents with a 6 day history
  of cough productive of scant white mucous, and
  intermittent low grade fevers, without high fever
  spikes. Past medical history is negative. Lung
  exam is positive for bilateral scattered crackles
  with occasional expiratory wheezes in lung bases,
  and negative for asymmetry of fremitus or
  dullness to percussion.
• Assessment considerations

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Case 2

• A 64 year old man with a 30 pack year smoking
  history and a 3 year history of difficulty
  starting his urinary stream presents with
  shortness of breath on exertion and a new cough.
  Lung exam is positive for scattered wheezes and
  rhonchi bilaterally.
• Assessment considerations

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Case 3

• A 54 year old man with history of alcoholism
  presents with a complaint of fever, night sweats,
  chills, shortness of breath and a cough
  productive of green sputum. His temperature is
  101.2 degrees F. Lung exam is positive for
  decreased breath sounds and dullness to
  percussion in right upper lobe.
• Assessment considerations

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Case 4

• A 19 year old male presents with sudden onset of
  shortness of breath. Past history is negative.
  Lung exam is positive for dullness to percussion
  and decreased breath sounds over the left lateral
  lung field.
• Assessment considerations

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Case 5

• a 26 year old female presents with a history of
  sudden onset of purulent sputum (rust-tinged),
  fevers to 102.4 degrees F, shortness of breath
  and chills. Past history negative. Lung exam is
  positive for fremitus in RLL with rales
  (crackles) and dullness to percussion.
• Assessment considerations

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Basic Pulmonary Pathology http//www.vh.org/Pr
oviders/Lectures/icmrad/chest/parts/Pneumonia1.htm
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