chest x-ray interpretation
TRANSCRIPT
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Chest X-ray Interpretation
Joseph S. Alpert, MD, FACC
Professor of Medicine, Department of Medicine
The University of Arizona College of Medicine;
Editor in Chief, The American Journal of Medicine
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Disclosure
Joseph S. Alpert, MD, FACC
Consultant Fees/Honoraria
Bayer HealthCare; Boehringer Ingelheim; Daiichi Sankyo, Inc.; Johnson and Johnson; MedIQ; Roche; sanofi-aventis U.S. Inc.; Servier Pharmaceuticals, ZS pharmaceuticals, Roche.
Data Safety Monitoring Board
Bayer HealthCare; Duke Clinical Research Institute; Janssen Pharmaceuticals, Inc.; TIMI Clinical Research Group, Novo Nordisk.
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The Chest X-Ray: Principles of
Reading
1. The bones
2. The lungs
3. The heart
4. The vessels
5. Miscellaneous such as pacemakers,
catheters, etc.
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Normalchestxray
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Is this lateralchest x-rayfrom the same patient as the last film—the PA film?
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1. Yes, it is the same patient
2. No, it is not the same patient
3. Yes, it is the same patient but a
different view
4. No, it is not the same patient; this
patient is a female.
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normal
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1. Is theAorticknob enlarged?
2. Is theheartenlarged?
3. Are thelungs congested
?
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A. Is the aortic knob enlarged?
1. yes 2. No
B. Is the heart enlarged?
1. Yes 2. No
C. Are the lungs congested?
1. Yes 2. No
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Marked cardiomegaly: Whichheart disease could causethe enlarged heart?
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A. Ischemic cardiomyopathy
B. Constrictive pericarditis
C. Aortic stenosis
D. Atrial septal defect
E. Atrial fibrillation
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PLEURAL EFFUSION
PERICARDIAL EFFUSION
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Right and left pleuraleffusion
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What is abnormalin this chestxray?
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This
patient
does not
have one
of the
following
diseases.
Which is
the wrong
one?
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1. Large pericardial effusion
2. Dilated cardiomyopathy
3. End stage aortic insufficiency
4. Ischemic cardiomyopathy with CHF
5. Athlete’s heart
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PNEUMONIA
LUNG ABCESS
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LLL infiltrate
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RML infiltrate
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Pneumonia and pleural
Effusion, right sided
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Pneumoniabilateral; ? of CHF as well.
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TB ??
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Lung abscess
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PULMONARY EDEMA
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CANCERS – LUNG AND
METASTATIC
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Lung cancer
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2012 2016
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COPD
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COPD
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PNEUMOTHORAX
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RIB NOTCHING – WHAT IS THE
DIAGNOSIS?
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Rib notching
What
is
the
diagnosis?
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1. Dissection of the aorta
2. Acute myocardial infarction
3. Coarctation of the aorta
4. Mitral stenosis
5. Constrictive pericarditis
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ANEURYSMS – DISSECTING AND
ATHEROSCLEROTIC
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Dissection of theAorta
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DEVICES
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What
is
this?
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??
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Case # 1: A 75 year old man with
dyspnea on exertion, a recent syncopal
episode, and a loud systolic murmur at
the right sternal border.
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DO YOU SEE ANYTHING
UNUSUAL IN THIS CHEST
XRAY
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Silicone
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Can the cardiac specialist learn
anything from the abdominal x-
ray?
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Case # 2: An 82 year old man is
admitted to the hospital for severe right
flank pain. Here is his abdominal x-ray
on admission.
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Case # 3: A 40 year old man comes to
the ER complaining of severe central
chest pain that is worse when he lies
down or takes a deep breath. He has
had nasal congestion, cough, and fever
for one week.
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