Chest Radiology Highlights: Tips, Tricks and Things You Should - - PDF document

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Chest Radiology Highlights: Tips, Tricks and Things You Should - - PDF document

Dec 23, 2023 33 likes •679 views

10/28/2015 Chest Radiology Highlights: Tips, Tricks and Things You Should Never Miss! Case #1 1 10/28/2015 Checklist Lines, tubes and foreign bodies Endotracheal tubes 2 10/28/2015 Airway landmarks 3 10/28/2015 3-7 cm What is

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

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Checklist

 Lines, tubes and foreign bodies

Endotracheal tubes

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Airway landmarks

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10/28/2015 4 3-7 cm

What is the ideal location?

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Tip position with changes in head Esophageal intubation

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Esophageal intubation Enteric tubes

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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 Central lines

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10/28/2015 14 AzV SCV SCV IJ IJ RBCV LBCV SVC

Venous landmarks

The Elusive Cavoatrial Junction

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The Elusive Cavoatrial Junction

  • 1. Junction of inferior bronchus intermedius

with lateral heart border

  • 2. Two vertebral bodies below carina
  • 3. 1-2 cm below right atrial/SVC junction

Venous landmarks

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Variation with expiration ? location

Right posterior oblique

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10/28/2015 19 AzV SCV SCV IJ IJ RBCV LBCV SVC

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Left SVC

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Duplicated SVC

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Duplicated SVC Pacemaker in left SVC

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PICC in internal mammary vein

PICC in superior intercostal vein

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Central line free in mediastinum

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Pulmonary artery catheters

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Retained surgical sponge

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Retained catheter fragment Retained guidewire

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Checklist

 Lines, tubes and foreign bodies

Pneumothorax

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 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

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10/28/2015 32 Pleural Line Air in pleura Edge Air in lung Pleural Line Air in pleura Edge Air in lung

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Pneumothorax Where is the PTX?

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Skin fold Skin fold

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Overlying sheet Deep Sulcus Sign

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Pneumothorax (subpulmonic) ? Medial PTX

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Tension pneumothorax

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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

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Tuberculosis Metastatic disease (unknown primary)

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Lung Cancer

Esophageal cancer

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

Case #4

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

Subtle cancer #1

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Subtle cancer #2

Subtle cancer #3

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? pneumonia ? pneumonia

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Normal LLL Pneumonia Normal Pleural effusion

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Normal Nodule Normal Pott’s disease

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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

Which compartment of lung is affected?

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Alveolar Interstitial

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Airways

Not applicable

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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

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PCP Pneumonia Hemorrhage

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Which compartment of lung is affected Interstitial

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Interstitial Alveolar Miliary TB

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What diseases cause small nodules?

  • Infections (fungus and tuberculosis)
  • Malignancy
  • Sarcoidosis

Miliary TB

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Miliary fungal Sarcoidosis

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Metastatses: lung cancer

Interstitial

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What diseases cause linear or reticular opacities?

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

Lymphangitic spread of tumor

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Edema Idiopathic pulmonary fibrosis

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Which compartment of lung is affected?

Airways disease

  • Circular
  • Tubular
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Cystic fibrosis