Chest X-ray

OVERVIEW

System:

  • Lines/Hardware
  • Lungs
  • Heart
  • Mediastinum
  • Bones
  • Soft tissue

Key points and tips:

  • always interpret in clinical context
  • compare sides – divide lung fields into upper, middle and lower thirds
  • start presentation with ‘this frontal CXR shows’
  • you can’t diagnose Aortic Dissection of CXR -> if the question is asked -> CT
  • opacification -> look for shift in mediastinum (towards lesion = collapse, away = mass effect)
  • fluid in pleural space = exudate, transudate, blood, pus, chyle
  • pulmonary oedema – is either cardiogenic (big heart) or non-cardiogenic (small heart)
  • hidden places on CXR = suprasternal above clavicles, paratracheal, behind the heart, below the diaphragm, soft tissue and bones
  • miliary pattern = tb, metastatic malignancy, fungal pneumonia
  • diffuse airspace opacification – PCP, CMV
  • pleural based irregular lesions – breast carcinoma mets, mesothelioma
  • melanoma goes every where
  • don’t miss pneumopericardium
  • don’t miss pneumomediastinum
  • tentorial millary lesions = Tb meningitis
  • remember the importance of the aorto-pulmonary contour (window) -> if it disappears then there is major pathology and you need to work out why
  • septic emboli – discrete lesion that go where blood flows (lower zones of lungs)

ALVEOLAR INFILTRATE

Cardiogenic

  • LVF
  • MS
  • AR

Non-cardiogenic

  • ARDS
  • ALI
  • aspiration
  • fluid overload
  • infection
  • anaphylaxis
  • SAH

BILATERAL PERIPHERAL CONSOLIDATION

  • cryptogenic organizing pneumonia
  • chronic eosinophilic pneumonia
  • atypical pulmonary oedema
  • Churg-Strauss syndrome
  • drug reactions
  • pulmonary contusion
  • pulmonary infarction
  • sarcoidosis

References and Links


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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