Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the...

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Dr Majid Al-Homiedan Head ER/Trauma Radiology division Cardiothoracic and abdominal subspecialty consultant

Transcript of Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the...

Page 1: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Dr Majid Al-Homiedan

Head ER/Trauma Radiology division

Cardiothoracic and abdominal subspecialty consultant

Page 2: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

I. Technique

Learn the difference between PA vs. AP CXR

Learn the utility of a lateral decubitus CXR

Understand the terms inspiration, penetration, and rotation as they apply to determining a technically adequate film

II. Anatomy

Learn the basic anatomy of the fissures of the lungs, heart borders, bronchi, and vasculature that can be seen on a chest x-ray

III. Interpretation

Develop a consistent and thorough technique for reading images

Learn how the silhouette sign can help localize pathology

IV. Pathology

Objectives

Page 3: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PositioningPA

Page 4: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Positioning lateral

Page 5: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Always read together

Page 6: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

positioning

Page 7: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand
Page 8: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PositioningPA vs AP

Page 9: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PositioningPA vs AP

Page 10: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PositioningPA vs AP

Page 11: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PositioningLateral decubitus

Page 12: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Technically adequateinspiration

Page 13: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Technically adequateinspiration

Page 14: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Technically adequatePenetration

Page 15: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Technically adequatePenetration

Page 16: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Technically adequatePenetration

Page 17: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Technically adequateRotation

Page 18: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Technically adequateRotation

Page 19: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Technically adequateRotation

Page 20: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

AnatomyLobes and Fissures

Page 21: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

AnatomyLobes and Fissures

Page 22: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

AnatomyLobes and Fissures

Page 23: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

AnatomyLobes and Fissures

Page 24: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

AnatomyMediastinum and Lungs

Page 25: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Anatomy

Page 26: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Anatomy Bronchi

Page 27: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pulmonary vasculature

Page 28: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Turn off stray lights, optimize room lighting, view images in order

Patient Data (name history #, age, sex, old films)

Routine Technique: AP/PA, exposure, rotation, supine or erect

Trachea: midline or deviated, caliber, mass

Lungs: abnormal shadowing or lucency

Pulmonary vessels: artery or vein enlargement

Hila: masses, lymphadenopathy

Heart: thorax: heart width > 2:1 ? Cardiac configuration?

Mediastinal contour: width? mass?

Pleura: effusion, thickening, calcification

Bones: lesions or fractures

Soft tissues: don’t miss a mastectomy

ICU Films: identify tubes first and look for pneumothorax

How to read a Chest X-Ray

Page 29: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Your eye gaze should scan all portions of the film, follow lung/mediastinal interfaces and look again carefully in areas where you know that mistakes are easily made, such as over the spine on the lateral view and in the apex on the PA view.

Looking for abnormalities

Page 30: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Looking for abnormalities

Page 31: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Looking for abnormalities

Page 32: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Looking for abnormalities

Page 33: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Silhouette sign

Page 34: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Air Bronchogram

Page 35: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Solitary pulmonary nodule

Page 36: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Cont.

Page 37: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PathologyAtelectasis

Page 38: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PathologyAtelectasis

Page 39: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

left lower lobe atelectasis followed by partial resolution

PathologyAtelectasis

Page 40: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Note the elevation of the left hemidiaphragm

Page 41: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PathologyAtelectasis

Page 42: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PathologyAtelectasis

Page 43: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PathologyAtelectasis

Page 44: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Mucus Plug

Page 45: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pulmonary edema

Page 46: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pulmonary edema

Page 47: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Kerley B lines

Page 48: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pneumonia

Page 49: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Atelectasis Pneumonia

Volume Loss

Associated Ipsilateral Shift

Linear, Wedge-Shaped

Apex at Hilum

Normal or Increased Volume

No Shift, or if Present Then

Contralateral

Consolidation, Air Space Process

Not Centered at Hilum

Air bronchograms can occur in both.

Page 50: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pulmonary hemorrhage

Page 51: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pulmonary embolism

What is the most common chest X-ray finding in PE?

Page 52: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pulmonary embolism

Page 53: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pleural effusion

Page 54: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pneumothorax

Page 55: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

PTX deep sulcus sign

Page 56: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

hydropneumothorax

Page 57: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Emphysema

Page 58: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Rib Fracture

Page 59: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Flail Chest

Page 60: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Anterior Mediastinal Mass

Page 61: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Pneumomediastinum

Page 62: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand
Page 63: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

Hiatal Hernia

Page 64: Dr Majid Al-Homiedan Head ER/Trauma Radiology division … · 2019-10-13 · I. Technique Learn the difference between PA vs. AP CXR Learn the utility of a lateral decubitus CXR Understand

THANK YOU…..


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