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
Introduction to ICU Series
Introduction to ICU Series Landing Page
DAY TO DAY ICU: FASTHUG, ICU Ward Round, Clinical Examination, Communication in a Crisis, Documenting the ward round in ICU, Human Factors
AIRWAY: Bag Valve Mask Ventilation, Oropharyngeal Airway, Nasopharyngeal Airway, Endotracheal Tube (ETT), Tracheostomy Tubes
BREATHING: Positive End Expiratory Pressure (PEEP), High Flow Nasal Prongs (HFNP), Intubation and Mechanical Ventilation, Mechanical Ventilation Overview, Non-invasive Ventilation (NIV)
CIRCULATION: Arrhythmias, Atrial Fibrillation, ICU after Cardiac Surgery, Pacing Modes, ECMO, Shock
CNS: Brain Death, Delirium in the ICU, Examination of the Unconscious Patient, External-ventricular Drain (EVD), Sedation in the ICU
GASTROINTESTINAL: Enteral Nutrition vs Parenteral Nutrition, Intolerance to EN, Prokinetics, Stress Ulcer Prophylaxis (SUP), Ileus
GENITOURINARY: Acute Kidney Injury (AKI), CRRT Indications
HAEMATOLOGICAL: Anaemia, Blood Products, Massive Transfusion Protocol (MTP)
INFECTIOUS DISEASE: Antimicrobial Stewardship, Antimicrobial Quick Reference, Central Line Associated Bacterial Infection (CLABSI), Handwashing in ICU, Neutropenic Sepsis, Nosocomial Infections, Sepsis Overview
SPECIAL GROUPS IN ICU: Early Management of the Critically Ill Child, Paediatric Formulas, Paediatric Vital Signs, Pregnancy and ICU, Obesity, Elderly
FLUIDS AND ELECTROLYTES: Albumin vs 0.9% Saline, Assessing Fluid Status, Electrolyte Abnormalities, Hypertonic Saline
PHARMACOLOGY: Drug Infusion Doses, Summary of Vasopressors, Prokinetics, Steroid Conversion, GI Drug Absorption in Critical Illness
PROCEDURES: Arterial line, CVC, Intercostal Catheter (ICC), Intraosseous Needle, Underwater seal drain, Naso- and Orogastric Tubes (NGT/OGT), Rapid Infusion Catheter (RIC)
INVESTIGATIONS: ABG Interpretation, Echo in ICU, CXR in ICU, Routine daily CXR, FBC, TEG/ROTEM, US in Critical Care
ICU MONITORING: NIBP vs Arterial line, Arterial Line Pressure Transduction, Cardiac Output, Central Venous Pressure (CVP), CO2 / Capnography, Pulmonary Artery Catheter (PAC / Swan-Ganz), Pulse Oximeter
- Labelled normal Chest X-ray
- DRSABCDE of CXR Interpretation
- ABC of CXR Interpretation
- Top 150 CXR Quiz
- Chest X-ray for the OSCE
- Dr Eric Strong Vodcast series on CXR Interpretation
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
