chest film part 1

Radiology Review-Part 1

The chest film and cardiovasculardiagnoses

MDFPRJuly 29, 2009M. LaCombe

Why is this patient short of breath?

What is the valvular disease here?

Can this young woman play college soccer, doctor?

What is the likely organism?

Is this really a normal chest xrayas the radiologist reported it to be?

Does any of this matter?

No, not at all. Unless:

• You want to be a great doctor rather than merely ordinary

• You wish to avoid burn-out• You are interested in helping people rather

than collecting a paycheck• You wish to save lives

Major Segue:In defense of intellectual

curiosity -

• One can bother to know, or one can ask:• …a radiologist when you find one• …an astronomer when you have a chance• …a naturalist when you see one• …a botanist if you think of it• …a mycologist if there is one around

This is either a ‘blurry star”

Or the Andromeda Galaxy

…and this, a caterpillar, or the larval form of the Monarch butterfly

This is either a toadstool, or the velvet-footed pax, Paxillus atrotomentosus

…and this, a pretty wildflower, or a species of aquilegia

And finally, this is either “maybe a big heart” or the typical chest xray of a patient with an ASD

Back to our lecture, and a systematic approach to the chest

film:

This is just one system to use only until you become facile with chest xrays

Let’s start with a review of anatomy

Another patient, with mitral stenosis, showing this double density finding a bit better:

(What is truncus arteriosus, you ask?)

Truncus arteriosis is a complex defect where there is a single (normally there are two separate arteries) vessel arising from the heart that forms the aorta and pulmonary artery. Another congenital heart defect that occurs with truncus arteriosus is a ventricular septal defect (ventricular septum, or dividing wall between the two lower chambers of the heart known as the right and left ventricles).

...and tetralogy of Fallot?

Tetralogy of Fallot has four key features. A ventricular septal defect (a hole between the ventricles) and many levels of obstruction from the right ventricle to the lungs (pulmonary stenosis) are the most important. Also, the aorta (major artery from the heart to the body) lies directly over the ventricular septal defect, and the right ventricle develops thickened muscle.

...so how do you fix it?

Blalock and Taussig

But who is this?

In closing, which constellation is this?