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

第8頁CommonViewsPAAPLeftLateralRightanteriorobliqueAPsupineRightlateraldecubitusPortableCXRPA/LateralCXR第9頁ThesearefromtheSamePatient

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

第23頁

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

Air-fluidlevel第25頁48yoMwithhxofPUDpresentingwithabdominalpain第26頁pneumoperitoneum第27頁67yosmokerwithoneweekofcough,sob,fevers第28頁Leftlowerlobepneumonia第29頁“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頁第31頁Dx:Subcutaneousairinneckandshoulderandpneumomediastinum(leftheartborder)第32頁第33頁Lackoflungmarkingsonright,collapsedlungDx:CompleterightpneumothoraxCollapsedlungIsitatensionpneumothorax?第34頁NO!TensionPneumothoraxMediastinumisshiftedtooppositesiteofpneumothoraxLookattrac