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Chest Radiographs Loyola University Stritch School of Medicine

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Presentation on theme: "Chest Radiographs Loyola University Stritch School of Medicine"— Presentation transcript:

1 Chest Radiographs Loyola University Stritch School of Medicine
Drs. Pierce and Demos Loyola University Medical Center Department of Radiology

2 Radiographs Free Intraperitoneal Gas Pneumothorax Pleural Effusion
Pulmonary Edema

3 Free Intraperitoneal Gas
Free Air

4 Free Intraperitoneal Gas
Upright chest Left lateral decubitus abdomen

5 Free Intraperitoneal Gas Patient Supine

6 Free Intraperitoneal Gas
Neonate with distended abdomen Supine abdomen 58-year-old man with acute abdominal pain Supine abdomen Free air under right hemidiaphragm Upright abdomen

7 Free Air in Supine Patient

8 Free Intraperitoneal Gas
When diagnosis is uncertain If the patient can stand Upright chest and abdomen If the patient can not stand Left lateral decubitus abdomen radiograph Most sensitive Computed tomography

9 Pneumothorax

10 Pneumothorax Displaced Visceral Pleura
Skin Fold Skin fold extends outside ribs Pneumothorax Displaced pleura (arrows) Look for displaced Visceral Pleura

11 Tension Pneumothorax TENSION PNEUMOTHORAX ** Examine patient * Look for deviated heart and mediastinum, depressed hemidiaphragm * Compare to previous radiographs

12 Supine Patient Medial Pneumothorax

13 Supine Patient Deep Sulcus Sign
Before….No pneumothorax After….Pneumothorax

14 Is there a pneumothorax or isn’t there?
Order a Lateral Decubitus chest radiograph With the side of the chest in question as the upside Possible left pneumothorax get right lateral decubitus chest Look for displaced visceral pleura along upside lateral chest wall Order Upright Expiratory chest radiograph Look for pneumothorax at lung apex

15 Pleural Effusion

16 Pleural Effusion Upright…Meniscus Supine…Unilateral increased density
Decubitus…Effusion layered on downside

17 Pleural Effusion Supine patient

18 Pleural Effusion Semiupright…..Lung base opacity fades superiorly
63-year-old man recovering from congestive heart failure…Effusion loculated in fissure

19 Massive Pleural Effusion or Total Lung Atelectasis
Total Atelectasis Heart and mediastinum shifted toward whited out hemithorax Massive pleural effusion Heart and mediastinum shifted away from whited out hemithorax

20 Pleural Effusion Most sensitive way to show pleural effusion
Decubitus chest radiograph Least sensitive way to show pleural effusion Supine chest radiograph

21 Pulmonary Edema

22 Normal Chest PA and Lateral Radiographs

23 Pulmonary Edema Normal pulmonary vessels Interstitial pulmonary edema Alveolar pulmonary edema Septal (Kerley B) lines due to interstitial pulmonary edema are thickened interlobular septae

24 Pulmonary Edema Interstitial pulmonary edema Alveolar pulmonary edema
Poorly defined pulmonary vessels Visible lung fissures Septal lines Thick bronchial walls Alveolar pulmonary edema Bilateral symmetric perihilar lung consolidation Enlarged heart, Pleural effusion COMPARE TO PREVIOUS RADIOGRAPHS

25 Left Upper Lobe Pneumonia
27-year-old man with productive cough, dyspnea, and fever

26 Monty Python Gumbies

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