Chest Radiographs Loyola University Stritch School of Medicine Drs. Pierce and Demos Loyola...
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![Page 1: Chest Radiographs Loyola University Stritch School of Medicine Drs. Pierce and Demos Loyola University Medical Center Department of Radiology.](https://reader035.fdocuments.in/reader035/viewer/2022062806/56649c7f5503460f9493631d/html5/thumbnails/1.jpg)
Chest Radiographs
Loyola University Stritch School of Medicine
Drs. Pierce and Demos
Loyola University Medical CenterDepartment of Radiology
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Radiographs
• Free Intraperitoneal Gas
• Pneumothorax
• Pleural Effusion
• Pulmonary Edema
![Page 3: Chest Radiographs Loyola University Stritch School of Medicine Drs. Pierce and Demos Loyola University Medical Center Department of Radiology.](https://reader035.fdocuments.in/reader035/viewer/2022062806/56649c7f5503460f9493631d/html5/thumbnails/3.jpg)
Free Intraperitoneal Gas
Free Air
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Free Intraperitoneal Gas
FREE AIR SENSITIVITY OF IMAGING STUDIES
• COMPUTED TOMOGRAPHY 99%
• LATERAL UPRIGHT CHEST RADIOGRAPH 98%
• AP UPRIGHT CHEST RADIOGRAPH 80 - 90%
• LEFT DECUBITUS ABDOMEN RADIOGRAPH 80- 90%
• SUPINE ABDOMEN RADIOGRAPH ?
Upright chest
Left lateral decubitus abdomen
![Page 5: Chest Radiographs Loyola University Stritch School of Medicine Drs. Pierce and Demos Loyola University Medical Center Department of Radiology.](https://reader035.fdocuments.in/reader035/viewer/2022062806/56649c7f5503460f9493631d/html5/thumbnails/5.jpg)
Free Intraperitoneal GasPatient Supine
FREE AIRCENTRAL TENDON
SUPINE
UPRIGHT
FREE AIRCENTRAL TENDON
SUPINE
LEFT DECUBITUS
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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
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Free Air in Supine PatientRIGLER’S SIGN
BOTH SIDES OF BOWEL WALL VISIBLE
DOUBLE WALL SIGNIN THREE PATIENTS
1
23
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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
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Pneumothorax
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Pneumothorax Displaced Visceral Pleura
Pneumothorax Displaced pleura (arrows)
Skin Fold
Look for displaced Visceral Pleura
Skin fold extends outside ribs
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Tension Pneumothorax
TENSION PNEUMOTHORAX ** Examine patient
* Look for deviated heart and mediastinum, depressed hemidiaphragm
* Compare to previous radiographs
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Supine Patient Medial Pneumothorax
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Supine PatientDeep Sulcus Sign
Before….No pneumothorax After….Pneumothorax
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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
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Pleural Effusion
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Pleural Effusion
Upright…Meniscus
Decubitus…Effusion layered on downside
Supine…Unilateral increased density
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Pleural EffusionSupine patient
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Pleural Effusion
Semiupright…..Lung base opacity fades superiorly
63-year-old man recovering from congestive heart failure…Effusion loculated in fissure
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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
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Pleural Effusion
• Most sensitive way to show pleural effusion- Decubitus chest radiograph
• Least sensitive way to show pleural effusion- Supine chest radiograph
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Pulmonary Edema
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Normal Chest PA and Lateral Radiographs
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Pulmonary Edema
Normal pulmonary vessels
Interstitial pulmonary edema
Alveolar pulmonary edema
Septal (Kerley B) lines due to interstitial pulmonary edema are thickened interlobular septae
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Pulmonary Edema
• Interstitial 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
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Left Upper Lobe Pneumonia
27-year-old man with productive cough, dyspnea, and fever
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Monty Python
Gumbies