Checklist Lines, tubes and foreign bodies Endotracheal tubes 1 - - PDF document

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Chest Radiology Checklist: Tips, Tricks and Things You Should Never Miss! Case #1

Checklist

 Lines, tubes and foreign bodies

Endotracheal tubes

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Airway landmarks

3-7 cm

What is the ideal location?

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Tip position with changes in head Esophageal intubation Esophageal intubation

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Enteric tubes When is the tube post-pyloric?

GE junction 2nd duodenum 3rd duodenum 4th duodenum Ligament of Treitz 1st duodenum

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Tension PTX s/p feeding tube removal

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Central lines

AzV SCV SCV IJ IJ RBCV LBCV SVC

Venous anatomy

The Elusive Cavoatrial Junction

Venous landmarks

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Variation with expiration ? location

Right posterior oblique

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AzV SCV SCV IJ IJ RBCV LBCV SVC

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Left SVC

Duplicated SVC Duplicated SVC

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Pacemaker in left SVC PICC in internal mammary vein RIJ line in aorta

PICC line in aorta

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Arterial line Venous line

Central line free in mediastinum

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Pulmonary artery catheters Infarct from a PA line

Pulmonary artery pseudoaneurysm

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Retained surgical sponge Retained catheter fragment

Checklist

 Lines, tubes and foreign bodies

Pneumothorax

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Checklist

 Lines, tubes and foreign bodies  Pneumothorax

Pneumothorax vs. skin fold

• Pleural line, NOT edge
• No vessels lateral to line
• Line doesn’t go outside chest wall or across

midline

Pleural Line Air in pleura Edge Air in lung Pleural Line Air in pleura Edge Air in lung

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Skin fold Where is the PTX? Not a PTX!

Pre‐IJ line removal Post‐IJ line removal

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Deep Sulcus Sign

ARDS with pneumothorax

Pneumothorax (subpulmonic)

? PTX

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Tension pneumothorax

Checklist

 Lines, tubes and foreign bodies  Pneumothorax

Case #3

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Checklist

 Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities

Normal mediastinal interfaces

Right paratracheal stripe Aorta Left pulmonary artery Aorticopulmonary window Azygoesophageal recess

Tuberculosis Metastatic disease (unknown primary)

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Lung Cancer

Esophageal cancer Checklist

 Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities

Case #4

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Checklist

 Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities  Tough spots in the lungs

Subtle cancer #1 Subtle cancer #2

Subtle cancer #3

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? pneumonia ? pneumonia Normal LLL Pneumonia Normal Pleural effusion

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Normal Nodule Normal Pott’s disease

Checklist

 Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities  Tough spots in the lungs

Don’t forget about the bones

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Checklist

 Lines, tubes and foreign bodies  Pneumothorax  Mediastinal lymphadenopathy  Lung nodules  Bones

A simple approach to lung opacities…

Alveolar Interstitial

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Airways

Not applicable Alveolar

• Features of alveolar disease

– 1. Confluent opacities – 2. Air bronchograms – 3. Fluffy at the periphery

What produces alveolar opacities?

• Fluid
• Blood
• Pus
• Cells

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ARDS Pulmonary edema PCP Pneumonia Hemorrhage

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Which compartment of lung is affected Interstitial Interstitial Alveolar Miliary TB

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What diseases cause small nodules?

• Infections (fungus and tuberculosis)
• Malignancy
• Sarcoidosis

Miliary TB Miliary fungal Sarcoidosis

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Metastatses: lung cancer

Interstitial What diseases cause lines?

• Pulmonary edema
• Malignancy
• Interstitial lung disease (e.g. IPF)

Pulmonary edema

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Edema Idiopathic pulmonary fibrosis

Which compartment of lung is affected?

Airways disease

• Circular
• Tubular

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Cystic fibrosis