how read chest xr 3
TRANSCRIPT
HOW READ CHEST XR -3
ANAS SAHLE ,MD
Consolidation
Consolidation
Infection causes
Pneumonia Non-infection causes
Lymphoma
Broncho-
alveolar
carcinoma
COP
WEGNER disease
Sarcoi
d
Cardiac
failure
Case-1
A 35-year-old male presented
with:1. fever,
2. cough, 3. purulent
sputum for one week.
POSITION •PA CXR
QUALITY •GOOD Technical Quality
LESION •Homogenous density in the right lower zone (with bronchogram) obscured hemidiaphragm
MEDIASTINAL •Central trachea? and mediasteinal.
ANGELS •free left costo-phrenic angels
OTHER •NO
Lower lobe
Case-2
This 75-year-old female presented
with: acute respiratory
failure. She had been sick
for two weeks with:1. fever, 2. cough, 3. purulent
sputum
POSITION •AP CXR
QUALITY •Poor Technical Quality•(HIGH penetration).
LESION •Tow homogenous opacification in both lung:•in the left and right (middle,lower ) zone obscured aortic arc, and left border of heart extend to chest wall,(air bronchodram)
MEDIASTINAL •Central trachea and mediasteinal
ANGELS •Free costo-phrenic angels
OTHER •NO
Case-3
• A 30-year-old male presented with cough, shortness of breath
• and loss of weight over four months
POSITION •AP? CXR
QUALITY •Good Technical Quality
LESION •Bilateral infiltrate at lower zone •(air bronchogram??)•No kerley line.•No upper zone venous diversion
MEDIASTINAL •Central trachea and mediasteinal
ANGELS •Free costo-phrenic angels
OTHER •NO
disscusion
• The CXR shows bilateral infiltrates and air bronchograms with a perihilar distribution.
• The heart size is normal. • There are no Kerley B lines or evidence of
upper lobe venous diversion. • All these are typical features of PCP
Case-4
• This middle-aged male had low-grade fever of one month’s duration
• associated with productive cough and loss of weight.
POSITION •PA CXR
QUALITY •POOR Technical Quality•rotation
LESION •Hetero-genous density at right lower zone (bronchogram) obscured hemidiaphragm
MEDIASTINAL •Central trachea and mediasteinal
ANGELS •Free left costo-phrenic angels
OTHER •NO
Case-5
• This patient presented with stridor due to thyroid goiter.
• was intubated (Fig. 1). • Repeat CXR was done six hours later (Fig.2). • What is the main radiological abnormality?
AFTER INTUBATED
POSITION •AP CXR
QUALITY •ACCEPT Technical Quality
LESION •Bilateral perihilar patchy opaciteis•Diffused but Most in middle zone .•Obscured aortic arc(bronchgram)
MEDIASTINAL •Central trachea and mediasteinal
ANGELS •Free left costo-phrenic angels
OTHER •NO
AFTER SIX HOURS
discussion• The first CXR shows a normal cardiac shadow
associated with bilateral perihilar alveolar infiltrates suggestive of acute pulmonary edema.
• The development of pulmonary edema with a normal heart size is indicative of an acute event.
• The rapid clearance of the pulmonary infiltrates here indicates that the process is rapidly corrected by positive pressure.
• In this patient, an important consideration is negative pressure pulmonary edema due to upper airway obstruction from the thyroid Goiter
