CXR Interpretation胸部医学影像解读

InterpretationofChestRadiographs UNCEmergencyMedicineMedicalStudentLectureSeries Objectives TheBasicsApproachtointerpretationAnatomyInterstitaldiseaseAlveolardiseasePatternRecognitionPractice Interpretation UseasystematicapproachUseordeveloponeyoulikeUsethesameapproacheverytimeDescribewhatyouseeFormadifferentialbasedonpatientpresentationandappearanceofx rayIfyoufindanabnormality don tstopthereFinishyoursystematicreadingThesecondlesionisoftenmissed SystematicApproach ABCDEAirway trachea Midlinev deviatedorrotated FBintrachea ETtubepositionBones clavices ribs humeri etc CardiomediastinalsilhoutteDiaphragms andthecostophrenicangles EverythingElse lungfields softtissues tubes lines wires devices etc NormalChestRadiograph Trachea Rightmainstembronchus Leftmainstembronchus Pulmonaryartery Pulmonaryartery Aorticknob Leftventricle Rightatrium Anatomy Lefthemidiaphragm Rightcostophrenicangle Stomach Upperlobes Middlelobe Lingula LowerLobes Anatomy Lowerlobes Upperlobes Rightmiddlelobe Lingula CommonViews PA AP LeftLateral Rightanterioroblique APsupine Rightlateraldecubitus PortableCXR PA LateralCXR ThesearefromtheSamePatient Explainthedifference PA AP AlwaysgetaPAfilmtoavoidcardiacmagnificationExceptions trauma activecardiacchestpain unstable unabletocooperatewithprocedure SilhouetteSign Twosubstancesofthesamedensity indirectcontact cannotbedifferentiatedfromeachotheronx rayCommonlocationsLowerlobes diaphragmsRightheartborder RMLLeftheartborder LingulaLeftdiaphragm Heart onlateralview AirBronchogramSign VisualizationofairintheintrapulmonarybronchiAbnormalDenotesapulmonarylesion consolidation excludesapleuralormediastinallesion Seeninpneumonia pulmonaryedemaorpulmonaryinfarct AnairbronchogramwithintheheartshadowsuggestsLLLconsolidation Silhouettesign InterstitialLungDisease Thevessels lungmarkings appearmoreprominentAlveoliarestillaeratedDDx Pulmonaryedema inflammation tumor fibrosis AlveolarDisease VesselsarelessvisibleintheareaofdiseaseLungisnotaeratedMayhaveairbronchogramsorsilhouettesignDDx Bacterialpneumonia pulmonaryedema Let sPractice WhattypeoffilmDescribewhatyouseeConsolidation infiltrate nodular diffuse streaky opacificationLookforSilhouettesignandairbronchogramsIsitaninterstitialoralveolarpattern Otherfindings Givedifferentialordiagnosis 75yoFwithhxofMInowpresentingwithSOB hypoxia Pulmonaryedema Opacificationofrighthemithorax obscuredlefthemidiaphramDDx Massivepleuraleffusion rightpneumonectomy MultipleRsidedribfractures flailchest Opacificationoflefthemithorax air fluidlevelinleftupperlobe leftclavicularfractureDiagnosis Leftempyemaaftertrauma Air fluid cavitary lesion SamepatientLateralview Air fluidlevel 48yoMwithhxofPUDpresentingwithabdominalpain pneumoperitoneum 67yosmokerwithoneweekofcough sob fevers Leftlowerlobepneumonia SpineSign Dx Subcutaneousairinneckandshoulderandpneumomediastinum leftheartborder Lackoflungmarkingsonright collapsedlungDx Completerightpneumothorax Collapsedlung Isitatensionpneumothorax NO TensionPneumothoraxMediastinumisshiftedtooppositesiteofpneumothoraxLookattracheaand