Chest X-ray a (1)
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![Page 1: Chest X-ray a (1)](https://reader031.fdocuments.us/reader031/viewer/2022013103/563db80d550346aa9a901d00/html5/thumbnails/1.jpg)
1Diagnosis
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Can you tell why this patient is short of breath?
![Page 3: Chest X-ray a (1)](https://reader031.fdocuments.us/reader031/viewer/2022013103/563db80d550346aa9a901d00/html5/thumbnails/3.jpg)
Tension pneumothorax
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Complete right-sided
pneumothorax
Lung is compressed
against mediastinum
Shift of heart and trachea to
left
Tension pneumothorax
![Page 5: Chest X-ray a (1)](https://reader031.fdocuments.us/reader031/viewer/2022013103/563db80d550346aa9a901d00/html5/thumbnails/5.jpg)
Pneumothorax
Post
Ant
With person lying on their back, air in
pleural space rises to top and displaces
normal lung
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2Diagnosis
![Page 7: Chest X-ray a (1)](https://reader031.fdocuments.us/reader031/viewer/2022013103/563db80d550346aa9a901d00/html5/thumbnails/7.jpg)
This person developed chest pain after vomiting
![Page 8: Chest X-ray a (1)](https://reader031.fdocuments.us/reader031/viewer/2022013103/563db80d550346aa9a901d00/html5/thumbnails/8.jpg)
Pneumomediastinum
Streaky, linear densities due
to air in the mediastinumStreaky, linear
densities due to air in the mediastinum
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Pneumomediastinum – CT scan
Air surrounding esophagus in mediastinum
Extraluminal contrast from
perforation along left
lateral wall of distal
esophagus
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3Diagnosis
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Why does this patient have abdominal pain?
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Pneumoperitoneum
Air outlines under surface of left hemidiaphragm
Air outlines under surface of
right hemidiaphragm
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Pneumoperitoneum
Air outlines both sides of the wall of the stomach-a sign of free air in
the peritoneal cavity
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Pneumoperitoneum - CT
CT scans on 2 different people show a small and large amount of free air in the peritoneal cavity which rises to the highest point (anterior abdomen with the
person lying on their back) and is not contained within bowel
Free airFree air
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4Diagnosis
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57 year-old female with shortness of breath
![Page 17: Chest X-ray a (1)](https://reader031.fdocuments.us/reader031/viewer/2022013103/563db80d550346aa9a901d00/html5/thumbnails/17.jpg)
Pleural Effusions
Meniscus-shaped density at left base from a pleural effusion
Meniscus-shaped density
at right base from a pleural
effusion
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Pleural Effusions
Meniscus-shaped density
at right base from a pleural
effusion Meniscus-shaped density at left base from a pleural effusion
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Effect of Position - Layering
Supine Erect
In the supine position, the fluid layers out posteriorly and produces a haziness, especially near the bases (since the patient is actually semi-
recumbent). In the erect position, the fluid falls even more to the bases.
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5Diagnosis
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This patient has atrial fibrillation and a heart murmur
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Pulmonary Venous Hypertension from Mitral Stenosis
Size (not number) of vessels at the apex exceeds size of vessels at the base in this upright person. This is called “cephalization.” Normally the vessels at the base exceed the size of the vessels at the apex
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Pulmonary Interstitial Edema
Pulmonary interstitial edema produced by Kerly A and C lines
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Pulmonary Alveolar Edema
Bilateral, diffuse airspace disease more marked centrally than at the periphery of the lung (“bat-wing appearance”)
![Page 25: Chest X-ray a (1)](https://reader031.fdocuments.us/reader031/viewer/2022013103/563db80d550346aa9a901d00/html5/thumbnails/25.jpg)
6Diagnosis
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63 year-old man with chest pain
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Aortic Dissection
Linear lucency in the contrast-filled descending aorta is the intimal flap of an aortic dissection
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Aortic Dissection
• Widened mediastinum
• Left pleural effusion
• Chest pain
Should make you think of an aortic dissection
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Classification of Dissecting Aneurysms
Stanford classification
• Widened mediastinum
• Left pleural effusion
• Chest pain
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7Diagnosis
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Why did this 85 year-old have abrupt onset of abdominal pain?
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Aortic rupture
Red arrows point to active extravasation of contrast from the aorta into the retroperitoneum
Thrombus inside the lumen of the aorta
Red arrows point to active extravasation of contrast from the aorta into the retroperitoneum
AortaAorta
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Ruptured Aortic Aneurysm
Enlargement of abdominal aorta > 3cm Usually 2 to atherosclerosis Below renals, above iliacs
About 20-25% rupture <4cm~10%; >10 cm~60% Retroperitoneal, usually on left Into GI tract: massive hemorrhage Into IVC: rapid cardiac decompensation
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8Diagnosis
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Newborn with tachypnea
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Diaphragmatic Rupture
Left hemithorax contains multiple lucencies--air in the lumen of bowel, now located in the chest
Heart and trachea are
displaced to right by bowel in
opposite hemithorax
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Diaphragmatic RuptureGeneral
5% of all diaphragmatic hernias Most (90%) are left-sided
Central and posterior >10cm in length Contain stomach, colon, small bowel,
omentum, spleen
Half have no initial abnormal radiographic findings
Half are missed clinically
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Diaphragmatic Rupture General
Associated with Fx ribs Pneumoperitoneum Ruptured spleen
Delayed diagnosis = higher mortality MRI most useful in showing site of tear
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The End