laroia pa annual conference presentation€¦ · archana laroia, m.d clinical assistant professor...
TRANSCRIPT
11/5/14
1
Archana Laroia, M.D
Clinical Assistant Professor Section of Chest and cardiovascular Imaging
University of Iowa Hospitals and Clinics
Objectives:
� Emphasize a systematic approach for CXR
� Variants and hidden areas
� Recognition of common entities- case based approach
Why is CXR so important ?
• “Internal physical examination"
• Physical exam and chest x-ray are complimentary …… not mutually exclusive.
Systematic approach
Quality Control
Findings Localize
Differential diagnosis
Etiology
ABCDEF Approach
� Airway & Abdomen � Bones & soft tissue � Cardiac (includes
pulmonary vasculature) � Diaphragms � Effusions � Fields (lung)
11/5/14
2
My Approach- Outside to Inside
11/5/14
3
Epicardial fat pad
Pectus excavatum
Right middle lobe collapse
Normal lateral CXR Spine sign
Fever and chest pain
11/5/14
4
Hampton’s Hump- Pulmonary infarct secondary to PE!!!
Hemoptysis, weight loss, hyponatremia on labs
Reverse S sign of Golden- Right upper lobe collapse consolidation with hilar mass
Check ET tube placement
11/5/14
5
Check central line placement Check ET tube placement- s/p trauma
Deep sulcus sign
Tension Pneumothorax- Life threatening emergency!!!! POST CHEST TUBE PLACEMENT
Stat CXR - Presented with acute on Chronic SOB in ER CT scan obtained few hours later
11/5/14
6
Interstitial pulmonary edema
ER patient with SOB Patient with massive intracranial bleed
What study should I order?
� Have a question about the Aorta, Pulmonary arteries, Heart- IV contrast will be necessary for proper evaluation
� Lung parenchyma can be evaluated without IV contrast.
� Keep the low dose CT chest in mind for follow up of lung nodules!
ST is a 32 year old life long non-smoker with no significant medical history. She presented to the emergency department with a short history of unilateral chest pain with mild shortness of breath Examination findings Pulse - 98 beats per minute at rest Blood pressure - 120/80 Respiratory rate - 24 per minute But she is able to speak in full sentences
11/5/14
7
Pre-op Chest x-ray in an asymptomatic 48 M
Obtain old CT images; 2-year stability usually requires no further follow-up. If no previous images are available- For small solid SPNs (≤8 mm), follow the Fleischner Society guidelines on intervals for repeat CT For large solid SPNs (>8 mm), assess the probability of malignancy according to clinical and imaging characteristics . Consider pulmonology consult. Pure GG nodules (≤5 mm) require no follow-up Algorithm for follow-up imaging is provided for larger GG SPNs.
Key points
• Interpret chest X-rays in view of the clinical setting .
• When requesting a chest X-ray always provide specific clinical information.
• When ordering cross-sectional imaging may consult your friendly radiologist!