CXR Interpretation胸部医学影像解读ppt课件

InterpretationofChestRadiographs,UNCEmergencyMedicineMedicalStudentLectureSeries,1,PPT学习交流,Objectives,TheBasicsApproachtointerpretationAnatomyInterstitaldiseaseAlveolardiseasePatternRecognitionPractice!,2,PPT学习交流,Interpretation,UseasystematicapproachUseordeveloponeyoulikeUsethesameapproacheverytimeDescribewhatyouseeFormadifferentialbasedonpatientpresentationandappearanceofx-rayIfyoufindanabnormality,dontstopthereFinishyoursystematicreadingThesecondlesionisoftenmissed,3,PPT学习交流,SystematicApproach,ABCDEAirway(trachea)Midlinev.deviatedorrotated,FBintrachea,ETtubepositionBones(clavices,ribs,humeri,etc)CardiomediastinalsilhoutteDiaphragms(andthecostophrenicangles)EverythingElse(lungfields,softtissues,tubes,lines,wires,devices,etc),4,PPT学习交流,NormalChestRadiograph,5,PPT学习交流,Trachea,Rightmainstembronchus,Leftmainstembronchus,Pulmonaryartery,Pulmonaryartery,Aorticknob,Leftventricle,Rightatrium,Anatomy,6,PPT学习交流,Lefthemidiaphragm,Rightcostophrenicangle,Stomach,Upperlobes,Middlelobe,Lingula,LowerLobes,Anatomy,7,PPT学习交流,Lowerlobes,Upperlobes,Rightmiddlelobe,Lingula,8,PPT学习交流,CommonViews,PA,AP,LeftLateral,Rightanterioroblique,APsupine,Rightlateraldecubitus,PortableCXR,PA/LateralCXR,9,PPT学习交流,ThesearefromtheSamePatient,Explainthedifference.,10,PPT学习交流,PA,AP,AlwaysgetaPAfilmtoavoidcardiacmagnificationExceptions:trauma,activecardiacchestpain,unstable,unabletocooperatewithprocedure,11,PPT学习交流,SilhouetteSign,Twosubstancesofthesamedensity,indirectcontact,cannotbedifferentiatedfromeachotheronx-rayCommonlocationsLowerlobes-diaphragmsRightheartborderRMLLeftheartborderLingulaLeftdiaphragmHeart(onlateralview),12,PPT学习交流,AirBronchogramSign,VisualizationofairintheintrapulmonarybronchiAbnormalDenotesapulmonarylesion/consolidation(excludesapleuralormediastinallesion)Seeninpneumonia,pulmonaryedemaorpulmonaryinfarct,AnairbronchogramwithintheheartshadowsuggestsLLLconsolidation,Silhouettesign,13,PPT学习交流,InterstitialLungDisease,Thevessels(lungmarkings)appearmoreprominentAlveoliarestillaeratedDDx:Pulmonaryedema,inflammation,tumor,fibrosis,14,PPT学习交流,AlveolarDisease,VesselsarelessvisibleintheareaofdiseaseLungisnotaeratedMayhaveairbronchogramsorsilhouettesignDDx:Bacterialpneumonia,pulmonaryedema,15,PPT学习交流,LetsPractice,WhattypeoffilmDescribewhatyouseeConsolidation,infiltrate,nodular,diffuse,streaky,opacificationLookforSilhouettesignandairbronchogramsIsitaninterstitialoralveolarpattern?OtherfindingsGivedifferentialordiagnosis,16,PPT学习交流,75yoFwithhxofMInowpresentingwithSOB,hypoxia,17,PPT学习交流,Pulmonaryedema,18,PPT学习交流,19,PPT学习交流,Opacificationofrighthemithorax,obscuredlefthemidiaphramDDx:Massivepleuraleffusion,rightpneumonectomy,20,PPT学习交流,21,PPT学习交流,MultipleRsidedribfracturesflailchest,22,PPT学习交流,23,PPT学习交流,Opacificationoflefthemithorax,air-fluidlevelinleftupperlobe,leftclavicularfractureDiagnosis:Leftempyemaaftertrauma,Air-fluid(cavitary)lesion,24,PPT学习交流,SamepatientLateralview,Air-fluidlevel,25,PPT学习交流,48yoMwithhxofPUDpresentingwithabdominalpain,26,PPT学习交流,pneumoperitoneum,27,PPT学习交流,67yosmokerwithoneweekofcough,sob,fevers,28,PPT学习交流,Leftlowerlobepneumonia,29,PPT学习交流,“SpineSign”,30,PPT学习交流,31,PPT学习交流,Dx:Subcutaneousairinneckandshoulderandpneumomediastinum(leftheartborder),32,PPT学习交流,33,PPT学习交流,Lackoflungmarkingsonright,collapsedlungDx:Completerightpneumothorax,Collapsedlung,Isitatensionpneumothorax?,34,PPT学习交流,NO!,TensionPneumothoraxMediastinumisshiftedtooppositesiteofpneumothoraxLookattracheaandbronchiLookathea