PowerPoint Presentation

Chest X-Ray InterpretationKristopher R. Maday, MS, PA-C, CNSCUniversity of Alabama at BirminghamPhysician Assistant ProgramPegasus Emergency Group

@PA_Maday#FNPintensive

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What we will accomplish todayList the(my) steps to reading chest radiographsRecognize common pathologies seen on chest radiographsFocus your assessment of reading radiographs based off of history and physical examNot turn you into a radiologist!!!

4th Year Medical StudentMedical DegreeAfter 4 years of Radiology Residency

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Radiologist Selfie

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Airspaces

Bones

Cardiac

Diaphragms

ExaminationTechnique

Fluid

Gastric Bubble

Hilum

Instrumentation

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Patient #172yo female with 3 day history of fever and coughMedicationsSimvastatin 40mg, ASA 81, Clopidogrel 75mg, Metformin 500mg BIDPast Medical/Surgical HistoryHyperlipidemia, DMIICVA 1995 no residual deficitsVital SignsBP-131/82, HR-92, RR-21, O2-95%, temp-101.2o

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Patient #1Review of SystemsProductive cough?Yes, greenDyspnea?Yes, worse with activityMalaise or fatigue?YesNausea or vomiting?NoChest pain?Mild, worse with cough

Fever/chills/rigors?YesSmoking history?NeverSick contacts?My grandbaby had strep throat last weekDizziness/lightheadedness?Just when I get to coughing

CardiacRRR without M/G/RPulmonaryDiminished BS in rightIncreased tactile fremitus on rightDullness to percussion on right

NeuroA&O x 3, answers questions appropriatelyAbdomenS/NT/ND, (+) BSVascular2+ pulses throughoutNo edema

Patient #222yo male presents to emergency department with a 2 hour history of acute onset of shortness of breathMedicationsNonePast Medical/Surgical HistoryNoneVital SignsBP-120/80, HR-115, RR-25, O2-95%, temp-98.9o

Patient #2Review of SystemsTrauma?NoChest pain?4/10, dull, left sideHemoptysis?NoAny risk factors for DVT?NoHistory of DVT?NoNausea/Vomiting?NoHistory of anything like this before?Yes, 3 years ago, went away on its ownSyncope/dizziness?No

CardiacTachycardia, no M/G/RPulmonaryDiminished BS on leftTympanic percussion on leftDecreased tactile fremitus on leftNeuroA&O x 3, answers questions appropriatelyAbdomenS/NT/ND, (+) BSVascular2+ pulses throughoutNo edemaGeneralTall, thin male in moderate distress

3.5cm

Left PTX12

Patient #362yo male presents to PCP with 2 week h/o worsening coughMedicationsHZCT 50mg daily, Metoprolol 25mg daily, ASA 81mg, Simvastatin 40mgPast Medical/Surgical HistoryHTN, CAD, HLD2001 AMI2001 Coronary stenting x 3Vital SignsBP-146/95, HR-75, RR-19, O2-93%, temp-99.0o

Patient #3Review of SystemsProductive cough?No Fever?NoDyspnea?Yes, worse with exertionNew or change in medications?NoFatigue?I cant walk as far as I used toOrthopnea?I need to sleep on 2 pillowsPND?No Leg swelling?Yes, a littleSmoking history?Quit 20 years agoChest pain?Not really

CardiacRRR with murmurDisplaced PMI laterallyPulmonaryDiminished BS throughoutDullness to percussion in basesNeuroA&O x 3, answers questions appropriatelyAbdomenS/NT/ND, (+) BSVascular2+ pulses throughout1+ pitting edemaNeck(+) JVD

Patient #422yo male with 3 week history of cough and malaiseMedicationsNonePast Medical/Surgical HistoryTonsillectomy at 8yoVital SignsBP-120/72, HR-81, RR-16, O2-98%, temp-100.8o

Patient #4Review of SystemsFever/Chills/Rigors?OccasionallyNight sweats?NoWeakness or fatigue?Tired all the timeRecent illnesses?NoProductive cough?No, it is dryHemoptysis?NoSmoking history?Yes, 1ppd since 13

Dyspnea?Just with exertionChest pain?OccasionallyAbdominal pain?NoN/V/D?NoWeight loss?Not that I noticedRashes?NoSwelling?I did notice a knot in my groin

CardiacRRR without M/G/RPulmonaryCTA bilaterallyHEENTB TM clear, OP clearAbdomenS/NT/ND, (+) BSVascular2+ pulses throughoutNeckNo LADSkinDry without lesions, rashes, purpuraLymphaticNon-tender right femoral LAD

Patient #52yo male brought in by mother for 4 day h/o cough and feverMedicationsOTC Tylenol Cough and ColdPast Medical HistoryPrenatal uncomplicated pregnancyBorn at 39w via NSVD without complicationsVital SignsBP-116/75, HR-104, RR-28, O2-95%, Temp-99.9o

Patient #5Review of SystemsEar pain/Sore throat?NoVomiting?NoDecreased PO intake?A little due to the coughingDecreased wet/dirty diapers?Not reallyDecreased activity?Yes Diarrhea?NoProductive cough?NoRashes?NoNasal drainage?A tonImmunization status?Up to date

CardiacRRR without M/G/RPulmonaryDiminished BS throughoutGeneralNAD, non-toxic appearanceAbdomenS/NT/ND, (+) BSVascular2+ pulses throughoutHEENTB TM clear, mild OP erythema and petechiaeNeckNo meningismusNo LAD

SkinDry without lesions or rashes

Patient #666yo male presents to PCP with increasing dyspnea and coughMedicationsAlbuterol MDI PRN, Ipratropium Nebulizer TID, Formoterol/Budesonide BIDMetformin 500mg BIDHome O2Past Medical/Surgical HistoryCOPD, DMIIVital SignsBP-138/85, HR-87, RR-22, O2-93% on 2L NC, temp-99.8o

Patient #6Review of SystemsProductive cough?No Fever?YesDyspnea?Yes, worse than normalIncrease in O2 use?Yes, up to 3L from 2L

Chest pain?NoMalaise or fatigue?YesNausea/Vomiting?NoRecent illnesses?Had a cold last week

CardiacRRR without M/G/RPulmonaryDiminished BS throughoutIncreased resonance to percussionHEENTBreathing through pursed lipsAbdomenS/NT/ND, (+) BSVascular2+ pulses throughout

NeckAccessory muscle useGeneralThin, speaking in broken sentences

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Patient #752yo female presents to PCP for follow up after a 2 week history of pneumoniaMedicationsPrednisone 20mg daily, Hydroxychloroquine 400mg daily, Lasix 40mg BIDPast Medical/Surgical HistorySLE, Stage II Renal DiseaseVital SignsBP-153/85, HR-79, RR-19, O2-98%, temp-99.8o

Patient #7Review of SystemsCough?Still just a little, but not badFever/Chills/Rigors?Not reallyDyspnea?ImprovingMalaise or fatigue?No

Leg swelling?No Decreased urine output?SlightlyIncreased proteinuria?No more than normal Chest pain?No

CardiacRRR with M/G/RPulmonarySlightly diminished in basesCTA bilaterallyNeuroA&O x 3, answers questions appropriatelyAbdomenS/NT/ND, (+) BSVascular2+ pulses throughout

Patient #827yo male presents to PCP with a 2 month history of not feeling well. Just released from prison and needs to establish careMedicationsNone Past Medical/Surgical HistoryNone Vital SignsBP-132/84, HR-74, RR-16, O2-100%, temp-100.2o

Patient #8Review of SystemsFever/Chills/Rigors?YesNight sweats?Yes, occasionallyMalaise or fatigue?Yes Recent illnesses?NoCough?NoHemoptysis?No

Dyspnea?NoChest pain?NoAbdominal pain?Not really, but feels fullN/V/D?NoWeight loss?Not that I noticedRashes?No

CardiacRRR without M/G/RPulmonaryCTA bilaterallyHEENTB TM clear, OP clearAbdomenS/NT/ND, (+) BSPalpable spleenVascular2+ pulses throughoutNeckPosterior cervical LAD bilaterallySkinDry without lesions, rashes, purpura

7.5cm

Widened mediastinum = measured at aortic knob of > 6cm PA or > 8cm supine37

Websites to BookmarkRadiology Masterclasshttp://radiologymasterclass.co.uk/tutorials/tutorials.htmlErics Medical Lectures Interpreting CXR (9 part series)https://www.youtube.com/playlist?list=PLYojB5NEEakU6vTUAoUeVhgRzQgaoSnFiRadiology Assistanthttp://www.radiologyassistant.nl/en/p497b2a265d96d/chest-x-ray-basic-interpretation.htmlLife in the Fast Lanehttp://lifeinthefastlane.com/drsabcde-of-cxr-interpretation/Virginia Medical School Department of Radiologyhttp://www.med-ed.virginia.edu/courses/rad/cxr/Index.htmlRadAnatomy University of Kansashttp://classes.kumc.edu/som/radanatomy/search.asp

Thank You For Your TimeKristopher R. Maday, MS, PA-C, CNSCAssistant Professor, Academic CoordinatorPhysician Assistant ProgramEmail: maday@uab.eduTwitter: @PA_Maday

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