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Patients goes to his doctor with complaints of chest pain and fever.

Patients goes to his doctor with complaints of chest pain and fever. 1. Diagnosis:__Rt. Middle lobe pneumonia. Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures . . 1. Lt clavicle. Lt. pulmonary

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Patients goes to his doctor with complaints of chest pain and fever.

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  1. Patients goes to his doctor with complaints of chest pain and fever. 1 Diagnosis:__Rt. Middle lobe pneumonia

  2. Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures . 1 Lt clavicle Lt. pulmonary artery RADIOLOGY EXAM: PA & Lateral Chest X-ray CLINICAL INDICATION: Chest pain & cough REPORT: Blurred right heart border in the area of the right middle lobe(Silhouette sign) Wedged shaped density in the right middle lobe seen on the lateral view. CONCLUSION: Right Middle lobe pneumonia Opacified Rt . middle lung Lt. Lung Opacified Rt. middle lobe

  3. 1 Three bullet points about pathology identified OR Management of the identified process 50 words or less 1-Blurred right heart border indicative of loss of normal volume of right middle lobe. 2-Wedge shaped density in the right middle lobe indicative of pneumonia. 3- Patient will likely need antibiotic therapy.

  4. 2 56 year old female goes to ED with cough and fever. Diagnosis: Rt. Upper lobe Pneumonia

  5. Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures. 2 Lt clavicle Lung RADIOLOGY EXAM: Frontal & Lateral chest x-ray CLINICAL INDICATION: 56 yoF with a cough and fever. REPORT: Chest radiograph shows abnormal density in the upper lobe of the right lung. CONCLUSION: Soft tissue density in the upper lobe most typical for segmental pneumonia. Abnormal density in upper Rt. lung Lt. ventricular border

  6. 2 Three bullet points about pathology identified OR Management of the identified process 50 words or less Pneumonia is an infection of the lungs that causes the alveoli to become inflamed and fill with fluid. It can be bacterial, viral or fungal, and symptoms can vary from mild to severe. It is most serious in the very young and very old. Pneumonia can be diagnosed via chest x-ray (seen as abnormal densities in the lungs), physical exam (abnormal lung sounds, such as rales and ronchi, and/or blood and mucus testing. (white blood cell count or testing for specific pathogens).

  7. 3 4 week old infant taken to the ED because of a cough x 2 weeks Diagnosis: Normal Chest Normal Thymus

  8. Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures 3 RADIOLOGY EXAM: AP Chest CLINICAL INDICATION: Cough x 2 weeks REPORT: Large wing shaped soft tissue structure that appears to be located anterior to the Upper lobe of the Rt. lung. The lungs overall appear normal. The cardiac size and shape are as expected. CONCLUSION: Normal pediatric chest-normal Thymus. Clavicle Thymus Snap on Shirt Liver

  9. 3 Three bullet points about pathology identified OR Management of the identified process 50 words or less The Thymus gland varies greatly during infancy and early childhood. Enlarged but normal for this stage in life. During infancy, the thymus makes up the greatest proportion of overall body weight compared to any other time of life.

  10. 4 Patient in Doctor’s office with peripheral edema. Diagnosis: Cardiomegaly

  11. Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to identify 3 normal structures. 4 RADIOLOGY EXAM: Frontal Chest x-ray CLINICAL INDICATION: Peripheral edema REPORT: The heart is enlarged and causes a widened mediastinum. CONCLUSION: Cardiomegaly . Lt. Lung 5th Rib Hemi diaphragm

  12. 4 • Three bullet points about pathology identified • OR • Management of the identified process • 50 words or less • Cardiomegaly is defined as a cardiothoracic ratio of more than .50. • Cardiomegaly can be the result of Left or Right ventricular hypertrophy. • It is the result of low cardiac output with dilation of the ventricle as compensation.

  13. 5 Patient in the ICU with decreased 02 saturation over 12 hours. Diagnosis :Congestive edema Alveolar edema

  14. 5 Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures. RADIOLOGY EXAM: Supine Chest x-ray CLINICAL INDICATION: Decreased O2 sat. REPORT: Vascular engorgement indicating pulmonary venous hypertension . Bilateral opacity of the lungs indicating alveolar edema CONCLUSION: Alveolar Edema/ Congestive Edema Lt. Clavicle Cardiac electrode Alveolar edema Rt. lobe of the liver

  15. 5 Three bullet points about pathology identified OR Management of the identified process (50 words or less) Left ventricular failure leads to pulmonary venous congestion in the lungs. With increasing failure interstitial edema and subsequently alveolar edema develop.

  16. 6 CHEST CASE #6 35 YEAR OLD MALE PRESENTS TO THE ED WITH SOB Diagnosis: Pneumothorax tension component

  17. Your report here 6 RADIOLOGY EXAM:Frontal Chest X-Ray CLINICAL INDICATION: SOB REPORT: 35 yo male reports to ED with SOB. Auscultation of right lung revealed decreased breath sounds. Tension Pneumothorax is suspected REPORT: Chest X-ray revealed mediastinal shift to left, collapsed right lung, and an accumulation of air under pressure in the right pleural space. CONCLUSION: Right Pneumothorax Tension Component Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures. Trachea Aorta Pneumothorax Collapsed Lung Left Ventricle

  18. 6 • Three bullet points about pathology identified • OR • Management of the identified process • (50 words or less) • Management: • Place patient on oxygen • Perform emergency needle decompression of right pleural space • After needle decompression, insert thoracostomy tube and continue to monitor and assess breathing.

  19. 7 Patient in the ICU becomes SOB Diagnosis: Rt. Pleural effusion

  20. Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures. 7 RADIOLOGY EXAM: CLINICAL INDICATION: REPORT: Excess fluid has accumulated between the parietal and visceral pleura. Displacement of the right lung medially is noted due to fluid. Affected area spans the diaphragm to clavicle. CONCLUSION: Right pleural effusion Clavicle Spine of scapula Excess fluid Costophrenic angle

  21. 7 • Three bullet points about pathology identified • OR • Management of the identified process • (50 words or less) • Occurs when the pleural space accumulates an abnormal amount of fluid due to an imbalence in production and resorbtion. • Pleural space has key role in respiration through strategic chest wall movement and lung movement.

  22. 8 Diagnosis: Lt. Pleural effusion

  23. 8 Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures. RADIOLOGY EXAM: Frontal chest x-ray CLINICAL INDICATION: Dyspnea REPORT: Large fluid density collection in the Lt lung base typical of a large pleural effusion. CONCLUSION: Large left effusion Fluid accumulation in pleural cavity Clavicle Rt. Hemi diaphragm

  24. 8 Three bullet points about pathology identified OR Management of the identified process (50 words or less) To improve patient comfort and lung function a thoracentesis is required. Fluid is analyzed in the lab to determine the etiology and respective treatment options of the effusion. For example , if caused by CHF diuretics can be used. In case of recurrent effusions, pleurodesis, via thoracoscopic talc poudrage placement has been shown to be safe an d effective on preventing future effusions.

  25. 9 Diagnosis: Et tube distally placed in Rt. main stem bronchus with atelectasis of the left lung.

  26. Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures. 9 RADIOLOGY EXAM: Frontal chest x-ray CLINICAL INDICATION: Patient in ED s/p MVA REPORT: An endotracheal tube has been placed in the trachea and extends inferolaterally down the Rt. main stem bronchus. This is limiting the ventilation of the lt. lung with secondary atelectasis CONCLUSION: ET tube placed into the Rt. main stem bronchus. Rt. clavicle Scapula ET tube in Rt. main stem bronchus Atelectatic Lt. Lung CVP in SVC

  27. 9 • Three bullet points about pathology identified • OR • Management of the identified process • (50 words or less) • ET tubes preferentially extend laterally into the Rt. bronchus if positioned too far. • Lt. hemithorax is opacified. • Typically opacified hemithorax is due to atelectasis or large effusion.

  28. 10 33 year old male post 4-wheeler accident Diagnosis: Fracture of the Lt. 7th & 8th ribs

  29. 10 Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures. RADIOLOGY EXAM: Chest X-Ray CLINICAL INDICATION: Trauma to chest REPORT: Patient is a 33 yr old male examined post 4 wheeler accident. Fracture of the lateral aspect of the 7th and 8th ribs is demonstrated. The cardiac silhouette is normal. No pneumothorax seen. Atelectasis of the lt. lung base is noted. CONCLUSION: Multiple rib fractures of the Lt. inferolateral thoracic cage secondary to trauma of the chest. Aortic arch Rt. pulmonary artery Carina Stomach Rib fractures

  30. 10 • Three bullet points about pathology identified • OR • Management of the identified process • (50 words or less) • Fractured ribs normally take 1-2 months to completely heal. • Ribs 4-10 are the ribs mostly likely to be broken. • Complications from rib fractures include: pneumothorax, internal bleeding damage to major blood vessels and internal organs.

  31. Mother brings child into the ED stating that the child has swallowed something and is now drooling extensively. 11 Diagnosis: Impacted coin in the esophagus.

  32. Add red arrows & captions that confirm the diagnosis and /or other abnormalities. Use blue arrows to indicate 3 normal structures. 11 RADIOLOGY EXAM: PA & Lateral Cheat X-ray CLINICAL INDICATION:Drooling due to inability to swallow properly. REPORT: X-ray exam shows a coin in the esophagus. There is normal ventilation of the lungs. CONCLUSION:  Coin in esophagus Rt. atria The size of the coin leads us to believe that it will not pass through the GI tract therefore it needs to be extracted via endoscopic removal. Sternum Trachea

  33. 11 • Three bullet points about pathology identified • OR • Management of the identified process • (50 words or less) • Coins are the most common esophageal foreign body in children. • Coins in esophagus do not generally result in airway obstruction. • In some cases, foreign bodies may pass through the GI tract without difficulties: however, they may need to be removed via endoscopy.

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