Dr. Michael Gibbs is a Professor of Emergency Medicine and interested in educating others. Radiology is a passion of his. Follow along with the EMGuideWire.com team as they post Dr. Gibbs's weekly educational, self-guided radiology slides on: Parapneumonic Effusion, Traumatic Aortic Disruption, Right Upper Lobe Pneumonia, Pulmonary Metastatic Disease, Type A Aortic Dissection, Left Mainstem Bronchus Obstruction due to Mucous Plugging
Dr. Michael Gibbs's CMC X Ray Mastery Project - Week #8 Cases
1. Chest X-Rays Of The Week
Michael Gibbs, MD, FACEP, FAAEM
Professor And Chair
Department of Emergency Medicine
Carolinas Medical Center & Levine Children’s Hospital
Vice President of Research
Atrium Health
Chest X-Ray Mastery Project
April 1st 2019
2. Disclosures
This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
The goal is to promote widespread mastery of CXR interpretation.
There is no personal health information [PHI] within, and ages have been
changed to protect patient confidentiality.
3. Process
Many are contributing: Emergency Medicine, Fellows from the Center For
Advanced Practice, Trauma & Acute Care Surgery, SHVI, and Medical
Critical Care. Slides are shared with all contributors.
Cases submitted this week will be distributed next week.
When reviewing the presentation, the 1st image will show a chest X-ray
without identifiers and the 2nd image will reveal the diagnosis.
6. 13 Month Old
Being Treated For
Pneumonia In
The Setting Of
Recent Influenza
Now With More
Dyspnea
7. 13 Month Old
Being Treated For
Pneumonia In
The Setting Of
Recent Influenza
Now With More
Dyspnea
Parapneumonic Effusion With Shift
8. Parapneumonic Effusion With Shift
500 cc Of
Purulent
Chest Tube
Output
13 Month Old
Being Treated For
Pneumonia In
The Setting Of
Recent Influenza
Now With More
Dyspnea
9. 21 Year Old On A
Motorcycle That
Collided Head-On
With A Car
10. 21 Year Old On A
Motorcycle That
Collided Head-On
With A Car
Wide Mediastinum
And Loss Of The
Aortopulmonary
Window
Traumatic Aortic Disruption
11. 21 Year Old On A Motorcycle That Collided Head-On With A Car
Prior CXR Now
Traumatic Aortic Disruption
12. 21 Year Old On A Motorcycle That Collided Head-On With A Car
Traumatic Aortic Disruption
13. 21 Year Old On A Motorcycle That Collided Head-On With A Car
Traumatic Aortic Disruption
14. 21 Year Old On A Motorcycle That Collided Head-On With A Car
Traumatic Aortic Disruption
15. 21 Year Old On A Motorcycle That Collided Head-On With A Car
Traumatic Aortic Disruption
17. 55 Year Old
Pedestrian Struck
Wide Mediastinum
Tracheal Deviation
And Loss Of The
Aortopulmonary
Window
Traumatic Aortic Disruption & Multiple Rib Fractures
26. 2 Year Old With
Cough And Fever
Heart Rate 190
Temperature 105
27. 2 Year Old With
Cough And Fever
Heart Rate 190
Temperature 105
Right Upper Lobe Pneumonia
28. 70 Year Old With
Ovarian Cancer
Receiving
Chemotherapy
Presents With
Fever
29. 70 Year Old With
Ovarian Cancer
Receiving
Chemotherapy
Presents With
Fever
Diffuse Pulmonary Metastatic Disease
30. 70 Year Old With
Ovarian Cancer
Receiving
Chemotherapy
Presents With
Fever
Diffuse Pulmonary Metastatic Disease
31. 65 Year Old With
Hypertension
Presents To The
ED With Chest
Pain
32. 65 Year Old With
Hypertension
Presents To The
ED With Chest
Pain
Wide
Mediastinum
Type A Aortic Dissection
33. 65 Year Old With Hypertension Presents With Chest Pain
Type A Aortic Dissection
34. Comprehensive English language MEDLINE literature review from 1966 to 2000. Thirteen studies
permitted the analysis of 1337 chest X-rays.
90% of patient with aortic dissection had at least one CXR abnormal finding
The absence of a wide mediastinum had a [-] LR of 0.3 (95% CI: 0.2 – 0.4)
35.
36. The absence of a wide mediastinum on chest X-Ray had a
negative likelihood ratio ranging from 0.14 to 0.60, making
this a finding decreases the risk of aortic dissection
Evidence-based review of nine studies between 1986 and 2013, [n=2,400]. The prevalence or aortic
dissection ranged form 21% to 76%.
2018
41. Summary Of Diagnoses This Week
• Parapneumonic effusion
• Traumatic aortic disruption
• Right upper lobe pneumonia
• Diffuse pulmonary metastatic disease
• Type A aortic dissection
• Left mainstem bronchus obstruction due to a mucous plug