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Chest X-Ray Interpretation Gary M. Shayne P.A., M.S.

Chest X-Ray Interpretation Gary M. Shayne P.A., M.S. General Principles. Read X-Rays yourself Be systematic Be aware of common artifacts Serially compare Observe symmetry Believe you missed a finding. CXR Interpretation Format. Check info on CXR

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Chest X-Ray Interpretation Gary M. Shayne P.A., M.S.

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  1. Chest X-RayInterpretationGary M. Shayne P.A., M.S.

  2. General Principles • Read X-Rays yourself • Be systematic • Be aware of common artifacts • Serially compare • Observe symmetry • Believe you missed a finding

  3. CXR Interpretation Format • Check info on CXR • Evaluate technique(rotation, penetration, lung expansion) • Examine soft tissues and bones • Find Alien equiptment • Evaluate structures(diaphragms, trachea, hilum, heart shadows) • Evaluate lung pathology last

  4. CXR Interpretation Format • Check info on CXR • Evaluate technique(rotation, penetration, lung expansion) • Examine soft tissues and bones • Find Alien equiptment • Evaluate structures(diaphragms, trachea, hilum, heart shadows) • Evaluate lung pathology last

  5. Soft Tisues, Bones Survey • SubQ emphysema • Tissue swelling • Rib, Shoulder, Clavicles, Humerus Fxs • Metastatic lesions, rib erosions • Vertebral column abnormalities • Breast tissue variations • KEY Method: Look side-side

  6. Diaphragms • Costophrenic angles crisp? • Air under diaphragms? • Flattened diaphragms • Loss of diaphragm definition • Elevated hemidiaphragm • Tenting

  7. Trachea • Deviation • Foreign bodies • Right, Left Mainstem bronchus cutoff • Endotracheal tube position

  8. Mediastinal/Hilar Enlargement • Aortic dissection • Masses • Lymph nodes, Lymphoma • Goiter • Thymoma • Mitral stenosis

  9. Heart Shadows • Abnormal CT ratio • Increased chamber sizes • Vertical heart • Straightened PA window • Widened Aortic arch • Pneumopericardium • Tamponade

  10. Common LooksofCommon Lung Presentations

  11. Atelectasis • Loss of diaphragm definition • Platelike or discoid atelectasis • Horizontal fissure down • Loss of aortic stripe • Decreased lung volume • Narrowed rib spaces • Lung collapse

  12. Pleural Effusions • Blunted costophrenic angles • Haze tracking up from diaphragms • Haze throughout lung field(fluid panning out effect) • Rib spaces widened • Loculated pleural effusions • Lateral decubitus X-rays

  13. COPD • Hyperexpanded lungs • Flattened diaphragms • Vertical heart • Bullae • Widened rib spaces • Vascular crowding at bases • Domed apices

  14. Most Common Diagnoses for Hypoxemia In-Hospital • Sepsis • P.E. • Microatelectasis *CLEAR CXR • Acute Aspiration • Heavy Secretions/Plugged bronchial tree • Cardiac Ischemia • Hypoventiltion/drugs

  15. Pneumonia • Consolidation -lobar -segmental • Localized infiltrate • Diffuse infiltrates • Interstitial edema

  16. Pneumothorax • Narrowed rib spaces on side of pnthx • Loss of any vascular markings • Fine line of lung edge • Whole lung collapse into hilum • Tracheal, mediastinal, heart shift to side of pnthx • SubQ, mediastinal, pericardial emphysema • Sulcus sign

  17. CHF • Increased vasculature cephalad • Plump vasculature peripherally • Pleural effusion • Filled-in horizontal fissure • Large heart • Kerley B lines • Interstitial edema • Alveolar edema • Acute pulmonary edema(butterfly pattern)

  18. CXR Interpretation Format • Check info on CXR • Evaluate technique(rotation, penetration, lung expansion) • Examine soft tissues and bones • Find Alien equiptment • Evaluate structures(diaphragms, trachea, hilum, heart shadows) • Evaluate lung pathology last

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