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Chest Radiographs

Chest Radiographs. Loyola University Stritch School of Medicine Drs. Pierce and Demos Loyola University Medical Center Department of Radiology. Radiographs. Free Intraperitoneal Gas Pneumothorax Pleural Effusion Pulmonary Edema. Free Intraperitoneal Gas. Free Air. Upright chest.

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Chest Radiographs

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  1. Chest Radiographs Loyola University Stritch School of Medicine Drs. Pierce and Demos Loyola University Medical Center Department of Radiology

  2. Radiographs • Free Intraperitoneal Gas • Pneumothorax • Pleural Effusion • Pulmonary Edema

  3. Free Intraperitoneal Gas Free Air

  4. Upright chest Left lateral decubitus abdomen Free Intraperitoneal Gas

  5. Free Intraperitoneal GasPatient Supine

  6. 58-year-old man with acute abdominal pain Supine abdomen Free air under right hemidiaphragm Upright abdomen Neonate with distended abdomen Supine abdomen Free Intraperitoneal Gas

  7. Free Air in Supine Patient

  8. 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

  9. Pneumothorax

  10. Skin fold extends outside ribs Skin Fold Pneumothorax Displaced Visceral Pleura Pneumothorax Displaced pleura (arrows) Look for displaced Visceral Pleura

  11. Tension Pneumothorax TENSION PNEUMOTHORAX ** Examine patient * Look for deviated heart and mediastinum, depressed hemidiaphragm * Compare to previous radiographs

  12. Supine Patient Medial Pneumothorax

  13. Before….No pneumothorax After….Pneumothorax Supine PatientDeep Sulcus Sign

  14. 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

  15. Pleural Effusion

  16. Upright…Meniscus Supine…Unilateral increased density Decubitus…Effusion layered on downside Pleural Effusion

  17. Pleural EffusionSupine patient

  18. Semiupright…..Lung base opacity fades superiorly Pleural Effusion 63-year-old man recovering from congestive heart failure…Effusion loculated in fissure

  19. 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

  20. Pleural Effusion • Most sensitive way to show pleural effusion • Decubitus chest radiograph • Least sensitive way to show pleural effusion • Supine chest radiograph

  21. Pulmonary Edema

  22. Normal Chest PA and Lateral Radiographs

  23. Normal pulmonary vessels Interstitial pulmonary edema Alveolar pulmonary edema Septal (Kerley B) lines due to interstitial pulmonary edema are thickened interlobular septae Pulmonary Edema

  24. 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

  25. Left Upper Lobe Pneumonia 27-year-old man with productive cough, dyspnea, and fever

  26. Monty Python Gumbies

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