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

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 the ideal location? 4

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10/28/2015 Tip position with changes in head Esophageal intubation 6

10/28/2015 Esophageal intubation Enteric tubes 7

10/28/2015 When is the tube post-pyloric? GE junction 1 st duodenum Ligament of Treitz 2 nd duodenum 4 th duodenum 3 rd duodenum 8

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10/28/2015 Tension PTX s/p feeding tube removal Central lines 13

10/28/2015 IJ IJ Venous landmarks SCV SCV RBCV SVC LBCV AzV The Elusive Cavoatrial Junction 14

10/28/2015 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 15

10/28/2015 Variation with expiration ? location Right posterior oblique 16

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

10/28/2015 Left SVC 20

10/28/2015 Duplicated SVC 21

10/28/2015 Duplicated SVC Pacemaker in left SVC 22

10/28/2015 PICC in internal mammary vein PICC in superior intercostal vein 23

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10/28/2015 Central line free in mediastinum 25

10/28/2015 Pulmonary artery catheters 26

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10/28/2015 Retained surgical sponge 28

10/28/2015 Retained catheter fragment Retained guidewire 29

10/28/2015 Checklist  Lines, tubes and foreign bodies Pneumothorax 30

10/28/2015 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 31

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

10/28/2015 Pneumothorax Where is the PTX? 33

10/28/2015 Skin fold Skin fold 34

10/28/2015 Overlying sheet Deep Sulcus Sign 35

10/28/2015 Pneumothorax (subpulmonic) ? Medial PTX 36

10/28/2015 Tension pneumothorax 37

10/28/2015 Checklist  Lines, tubes and foreign bodies  Pneumothorax Case #3 38

10/28/2015 Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities Normal mediastinal interfaces Right Aorta paratracheal stripe Aorticopulmonary window Left pulmonary artery Azygoesophageal recess 39

10/28/2015 Tuberculosis Metastatic disease (unknown primary) 40

10/28/2015 Lung Cancer Esophageal cancer 41

10/28/2015 Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities Case #4 42

10/28/2015 Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities  Tough spots in the lungs Subtle cancer #1 43

10/28/2015 Subtle cancer #2 Subtle cancer #3 44

10/28/2015 ? pneumonia ? pneumonia 45

10/28/2015 Normal LLL Pneumonia Normal Pleural effusion 46

10/28/2015 Normal Nodule Normal Pott’s disease 47

10/28/2015 Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities  Tough spots in the lungs Don’t forget about the bones 48

10/28/2015 Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal lymphadenopathy  Lung nodules  Bones Which compartment of lung is affected? 49

10/28/2015 Alveolar Interstitial 50

10/28/2015 Airways Not applicable 51

10/28/2015 Alveolar • Features of alveolar disease – 1. Confluent opacities – 2. Air bronchograms – 3. Fluffy at the periphery What produces alveolar opacities? • Fluid • Blood • Pus • Cells 52

10/28/2015 ARDS Pulmonary edema 53

10/28/2015 PCP Pneumonia Hemorrhage 54

10/28/2015 Which compartment of lung is affected Interstitial 55

10/28/2015 Interstitial Alveolar Miliary TB 56

10/28/2015 What diseases cause small nodules? • Infections (fungus and tuberculosis) • Malignancy • Sarcoidosis Miliary TB 57

10/28/2015 Miliary fungal Sarcoidosis 58

10/28/2015 Metastatses: lung cancer Interstitial 59

10/28/2015 What diseases cause linear or reticular opacities? • Pulmonary edema • Malignancy • Interstitial lung disease (e.g. IPF) Lymphangitic spread of tumor 60

10/28/2015 Edema Idiopathic pulmonary fibrosis 61

10/28/2015 Which compartment of lung is affected? Airways disease • Circular • Tubular 62

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10/28/2015 Cystic fibrosis 64