醫(yī)學(xué)的學(xué)習(xí)資料第1頁(yè)/共60頁(yè)Howdoyoulookatachestx-ray?Avoidtunnelvision!or第2頁(yè)/共60頁(yè)Haveasystem第3頁(yè)/共60頁(yè)Chestwall,bonesandabdomen第4頁(yè)/共60頁(yè)Mediastinum,heartandhila第5頁(yè)/共60頁(yè)Lungs第6頁(yè)/共60頁(yè)TheLateralChestFilm

FindabnormalitieshiddenonthefrontalfilmConfirmabnormalitiessuspectedfromfrontalfilmDon’tbeafraidtolookatit!Ourbestfriend!第7頁(yè)/共60頁(yè)LookingatthelateralCXR第8頁(yè)/共60頁(yè)Hilarstructuresonthelateralfilm第9頁(yè)/共60頁(yè)第10頁(yè)/共60頁(yè)“Ringaroundthebronchus”第11頁(yè)/共60頁(yè)TechnicalFactorsPositioningstraightvsoblique(Howwe’lltrytofoolyou)第12頁(yè)/共60頁(yè)Effectofobliquityonheartsize第13頁(yè)/共60頁(yè)TechnicalFactorsPositioningstraightvsobliquePAvsAP第14頁(yè)/共60頁(yè)TechnicalFactorsPositioningstraightvsobliquePAvsAPerectvssupineerectsupine第15頁(yè)/共60頁(yè)TechnicalFactorsPositioningstraightvsobliquePAvsAPerectvssupinelordoticvskyphoticlordotickyphotic第16頁(yè)/共60頁(yè)TechnicalFactorsPositioningstraightvsobliquePAvsAPerectvssupinelordoticvskyphoticEffectonmediastinalcontour第17頁(yè)/共60頁(yè)TechnicalFactorsDepthofinspirationVisualizationofpathologydependsoncontrastprovidedbyairinthelungsCountribs!10第18頁(yè)/共60頁(yè)8ShortofbreathOneminutelater8第19頁(yè)/共60頁(yè)TechnicalFactorsBodyhabitusRadiographictechnique:Isitreallydifferent?Changingtechniquecanmakediseaselookbetterorworse.第20頁(yè)/共60頁(yè)Istheheartlarge?Isthemediastinumwide?Samepatient,4filmswithinonemonth第21頁(yè)/共60頁(yè)RecognizingairspacediseaseAlveolarspacesfilledwith…something.Radiologist'sreport:“consolidation”“airspaceopacity”“fluffydensity”“infiltrate”Nonspecific:Atelectasis,pneumonia,bleeding,edema,tumor第22頁(yè)/共60頁(yè)TheSilhouetteSignIndicatesairspacedisease.Obscurationofanormallyseenborder,e.g.diaphragmorheart.Opacitywithsharpedgealongafissure.第23頁(yè)/共60頁(yè)LocalizingdiseasefromthesilhouettesignRLLRMLLLLLingulaLLL第24頁(yè)/共60頁(yè)LocalizingdiseasefromthesilhouettesignRULRMLULLLRMLorlingula第25頁(yè)/共60頁(yè)16hourslaterWhathappenedhere?第26頁(yè)/共60頁(yè)LobarAtelectasisBestsign–shiftofafissureRapiddevelopmentandclearanceAirbronchogramsifnon-obstructiveSecondarysigns:MediastinalshiftElevateddiaphragmRibsclosertogetherVagueincreaseddensity第27頁(yè)/共60頁(yè)LLLAtxNextday第28頁(yè)/共60頁(yè)RULAtx第29頁(yè)/共60頁(yè)RMLAtx第30頁(yè)/共60頁(yè)LULAtx第31頁(yè)/共60頁(yè)P(yáng)neumoniaSigns:AirbronchogramSilhouette-“positive”or“negative”Densehilum“Spine”signAllaresignsofanyairspaceprocessDxofpneumoniadependsonappropriateclinicalscenario.第32頁(yè)/共60頁(yè)AirbronchogramsignPseudomonaspneumoniaLungcancer第33頁(yè)/共60頁(yè)Airbronchograms—CT

PneumoniaLungcancer第34頁(yè)/共60頁(yè)Rightmiddlelobe第35頁(yè)/共60頁(yè)Rightupperlobe第36頁(yè)/共60頁(yè)RightlowerlobePosteriordiaphragmsilhouetted第37頁(yè)/共60頁(yè)Densehilum,spinesign第38頁(yè)/共60頁(yè)Densehilum,spinesignagain第39頁(yè)/共60頁(yè)Fourdayslater第40頁(yè)/共60頁(yè)FinalExam第41頁(yè)/共60頁(yè)21y.o.withfeverandcough第42頁(yè)/共60頁(yè)第43頁(yè)/共60頁(yè)Hyperlucenthemithorax:why?第44頁(yè)/共60頁(yè)Didyounoticethemass?第45頁(yè)/共60頁(yè)Lymphoma

第46頁(yè)/共60頁(yè)Takehomemessage#1It’sachestx-ray,notalungx-ray.第47頁(yè)/共60頁(yè)6cmlungmassmissed.How?2yearsago第48頁(yè)/共60頁(yè)Takehomemessage#2Oldfilmsareyourfriend!第49頁(yè)/共60頁(yè)Elderlymanwithhypotension第50頁(yè)/共60頁(yè)Suddenlyseptic第51頁(yè)/共60頁(yè)P(yáng)neumatosisofsmallbowel第52頁(yè)/共60頁(yè)Takehomemessage#3Thepatientpaysfor

thewholefilm!第53頁(yè)/共60頁(yè)ReviewQuestions第54頁(yè)/共60頁(yè)Allarekindsofairspacediseaseexcept:HemorrhagePneumoniaTumorSarcoidosisAtelectasis第55頁(yè)/共60頁(yè)Themostspecificsignofatelectasisis:ObscurationofadiaphragmShiftofafissureAirbronchogramsDensityoverthespineMediastinalshift第56頁(yè)/共60頁(yè)Thiscanmaketheheartlooklargerthanitis:LordoticpositioningAPpositioningExpiratoryfilmSupinepositioningAlloftheabove第57頁(yè)/共60頁(yè)AdditionalReadingChestRoentgenologyFelson,BW.B.SaundersCo,Philadelphia1973Chapter2:LocalizationofIntrathoracicDisease.pp22-70.PareJAPandFraserRGSynopsisofDiseasesoftheChest