Basic Overview of Chest X-rays

Diane Rimple, MD

Wednesday Conference

2010

For a full discussion of viewing chest x-rays:

http://rad.usuhs.mil/rad/chest_review/index.html

Basic Chest X-Ray Review

Edited by W. Carpenter, Ph.D., M.D. Original Laserdisc Developed by:

Sherry L. Pulaski, M.D.J. A. Thomas, CAPT, MSC, USNMSgt Earl D. Jones Jr., RTR

The Department of Radiology and Nuclear MedicineThe Uniformed Services University of the Health SciencesBethesda, MD

Check patient name, position, technical quality.

A nice system: ABCD

A = airway B = bones C = cardiac D = diaphragm E = everything else

All of the following x-rays are from the Wayne State University Radiology Teaching Files unless otherwise attributed.

http://www.med.wayne.edu/diagRadiology/

TeachingFile.html

CHF XRay Findings

Enlarged cardiac silhouette Interstitial edema Kerley B and A lines Pleural effusions

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Hantavirus: Xray Findings

Evolution over about 2 days Subtle interstitial pulmonary edema

progressed to fulminate bilateral edema Frequently with pleural effusions Cardiac size is normal

Lab findings with Hantavirus

Hematology: Thrombocytopenia Atypical lymphs Elevated WBC Elevated Hct

Chemistries Low albumin Elevated LDH Elevated AST/ALT

Fulminant Hantavirus Pulmonary Syndrome

Differential: Pulmonary Edema and Normal Heart Size

Anaphylaxis AMI Mitral Stenosis (?) ARDS Hantavirus

Near drowning HAPE Narcotics OD

PCP Pneumonia

Normal CXRs in 25% of cases Bilateral Symmetric Diffuse – maybe more perihilar and in lower

lobe Reticular/nodular

Clinical Picture of PCP pneumonia

AIDs (if known) Shortness of breath Fever Nonproductive cough hypoxia

http://www.info.gov.hk/dh/diseases/CD/TB.htm

http://www.orchd.com/tb/images/CavitatoryPulmonaryTB.JPG

NEJM Volume 342:1333 May 4, 2000 Number 18