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Basic Overview of Chest X-rays
Diane Rimple, MD
Wednesday Conference
2010
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For a full discussion of viewing chest x-rays:
http://rad.usuhs.mil/rad/chest_review/index.html
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Basic Chest X-Ray Review
Edited by W. Carpenter, Ph.D., M.D. Original Laserdisc Developed by:
Sherry L. Pulaski, M.D.J. A. Thomas, CAPT, MSC, USNMSgt Earl D. Jones Jr., RTR
The Department of Radiology and Nuclear MedicineThe Uniformed Services University of the Health SciencesBethesda, MD
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Check patient name, position, technical quality.
A nice system: ABCD
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A = airway B = bones C = cardiac D = diaphragm E = everything else
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All of the following x-rays are from the Wayne State University Radiology Teaching Files unless otherwise attributed.
http://www.med.wayne.edu/diagRadiology/
TeachingFile.html
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CHF XRay Findings
Enlarged cardiac silhouette Interstitial edema Kerley B and A lines Pleural effusions
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
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Hantavirus: Xray Findings
Evolution over about 2 days Subtle interstitial pulmonary edema
progressed to fulminate bilateral edema Frequently with pleural effusions Cardiac size is normal
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Lab findings with Hantavirus
Hematology: Thrombocytopenia Atypical lymphs Elevated WBC Elevated Hct
Chemistries Low albumin Elevated LDH Elevated AST/ALT
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Fulminant Hantavirus Pulmonary Syndrome
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Differential: Pulmonary Edema and Normal Heart Size
Anaphylaxis AMI Mitral Stenosis (?) ARDS Hantavirus
Near drowning HAPE Narcotics OD
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PCP Pneumonia
Normal CXRs in 25% of cases Bilateral Symmetric Diffuse – maybe more perihilar and in lower
lobe Reticular/nodular
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Clinical Picture of PCP pneumonia
AIDs (if known) Shortness of breath Fever Nonproductive cough hypoxia
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http://www.info.gov.hk/dh/diseases/CD/TB.htm
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http://www.orchd.com/tb/images/CavitatoryPulmonaryTB.JPG
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NEJM Volume 342:1333 May 4, 2000 Number 18