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Chest X-Rays Of The Week
Michael Gibbs, MD, FACEP, FAAEM
Professor And Chair
Department of Emergency Medicine
Carolinas Me...
Disclosures
 This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Prog...
Process
 Many are contributing: Emergency Medicine, Fellows from the Center For
Advanced Practice, Trauma & Acute Care Su...
It’s All About The Anatomy!
Airway
Bones
Cardiac
Diaphragm
Effusion
Foreign body
Gastric
Hilum
Fall Off Of A Roof
Flail Chest
 The result of severe blunt chest trauma.
 Multiple ribs fractured in ≥2 places.
Fall Off Of A Roof
Flail Chest
 Inspiration increases [-] thoracic pressure.
 Leads to paradoxical motion of the flail segment.
Flail Chest
 Frequently requires mechanical ventilation.
 Rib plating stabilizes the fail segment.
Pedestrian
Struck By An
SUV
Pedestrian
Struck By An
SUV
Traumatic Aortic Disruption [TAD]
 Typically a high mechanism of injury.
 MVC, pedestrian st...
Our Patient
Aortic
Laceration
TAD Chest X-Ray Findings
1. Wide mediastinum
2. Abnormal aortic contour
3. Lost of aortopulmonary window
4. Tracheal devia...
Loss Of The
Aortopulmonary
Window
Tracheal
Deviation
Loss Of The
Aortopulmonary
Window
Apical
CapTracheal
Deviation
Loss Of The
Aortopulmonary
Window
Apical
CapTracheal
Deviation
Loss Of The
Aortopulmonary
Window
MVC – Struck Chest On The Steering Wheel
MVC – Struck Chest On The Steering Wheel
Sternal Fracture
 Direct impact to the anterior chest.
 Overlying tenderness & ...
Sometimes The Foreign Body Is No So Easy To See!
Get A 2nd Views If You Suspect It And Your PA or AP Views Are “Negative.”...
Nail Gun
Injury
Sometimes The Foreign Body Is No So Easy To See!
Get A 2nd Views If You Suspect It And Your PA or AP Views...
Car Crash
Car Crash
Left Pneumothorax, Rib Fractures, SQ Emphysema.
*
*
*
Multiple Left
Sided Rib
Fractures
Stab Wound
To Left Chest
Left Hemothorax
Stab Wound
To Left Chest
Notice:
Early Tracheal Deviation
After Chest Tube Placed
Stab Wound
Left Chest
After Chest Tube Placed
Stab Wound
Left Chest
Notice:
Midline Trachea
72 Year-Old
Who Moved To
Charlotte From
Honduras
This Month
72 Year-Old
Who Moved To
Charlotte From
Honduras
This Month
Traumatic Aortic Aneurysm [TAA]
 Thoracic aorta >3.5 cm consi...
TAA: Anatomy Defined By CT Angiography
Thoracic Aortic Aneurysm
Endovascular Repair
TAA: Endograft
Thoracic Aortic Aneurysm
Thoracic Aortic Aneurysm
Thoracic Aortic Aneurysm
Summary Of Diagnoses This Week
• Flail chest
• Traumatic aortic disruption
• Foreign bodies that can be difficult to see
•...
See You Next Week!
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases
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Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases

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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: Traumatic Aortic Disruption, Foreign Bodies, Sternal Fracture, Rib Fractures, Chest Trauma, Pneumothorax, Hemothorax, and Thoracic Aortic Aneurysms.

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Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #1 Cases

  1. 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 CMC X-Ray Mastery Series February 11th 2019
  2. 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. 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 be distributed next week.  The 1st image will show a chest X-ray without identifiers and the 2nd image will reveal the diagnoses.
  4. 4. It’s All About The Anatomy!
  5. 5. Airway Bones Cardiac Diaphragm Effusion Foreign body Gastric Hilum
  6. 6. Fall Off Of A Roof
  7. 7. Flail Chest  The result of severe blunt chest trauma.  Multiple ribs fractured in ≥2 places. Fall Off Of A Roof
  8. 8. Flail Chest  Inspiration increases [-] thoracic pressure.  Leads to paradoxical motion of the flail segment.
  9. 9. Flail Chest  Frequently requires mechanical ventilation.  Rib plating stabilizes the fail segment.
  10. 10. Pedestrian Struck By An SUV
  11. 11. Pedestrian Struck By An SUV Traumatic Aortic Disruption [TAD]  Typically a high mechanism of injury.  MVC, pedestrian struck, fall from a height. Wide Mediastinum
  12. 12. Our Patient Aortic Laceration
  13. 13. TAD Chest X-Ray Findings 1. Wide mediastinum 2. Abnormal aortic contour 3. Lost of aortopulmonary window 4. Tracheal deviation 5. Depressed left mainstem 6. Apical cap 7. Deviated nasogastric tube 8. Widened paratracheal stripe
  14. 14. Loss Of The Aortopulmonary Window
  15. 15. Tracheal Deviation Loss Of The Aortopulmonary Window
  16. 16. Apical CapTracheal Deviation Loss Of The Aortopulmonary Window
  17. 17. Apical CapTracheal Deviation Loss Of The Aortopulmonary Window
  18. 18. MVC – Struck Chest On The Steering Wheel
  19. 19. MVC – Struck Chest On The Steering Wheel Sternal Fracture  Direct impact to the anterior chest.  Overlying tenderness & swelling.  Best seen on the lateral view.
  20. 20. Sometimes The Foreign Body Is No So Easy To See! Get A 2nd Views If You Suspect It And Your PA or AP Views Are “Negative.” Swallowed Coin
  21. 21. Nail Gun Injury Sometimes The Foreign Body Is No So Easy To See! Get A 2nd Views If You Suspect It And Your PA or AP Views Are “Negative.”
  22. 22. Car Crash
  23. 23. Car Crash Left Pneumothorax, Rib Fractures, SQ Emphysema. * * *
  24. 24. Multiple Left Sided Rib Fractures
  25. 25. Stab Wound To Left Chest
  26. 26. Left Hemothorax Stab Wound To Left Chest Notice: Early Tracheal Deviation
  27. 27. After Chest Tube Placed Stab Wound Left Chest
  28. 28. After Chest Tube Placed Stab Wound Left Chest Notice: Midline Trachea
  29. 29. 72 Year-Old Who Moved To Charlotte From Honduras This Month
  30. 30. 72 Year-Old Who Moved To Charlotte From Honduras This Month Traumatic Aortic Aneurysm [TAA]  Thoracic aorta >3.5 cm considered dilated.  Thoracic aorta >4.5 cm considered aneurysmal.
  31. 31. TAA: Anatomy Defined By CT Angiography
  32. 32. Thoracic Aortic Aneurysm Endovascular Repair
  33. 33. TAA: Endograft
  34. 34. Thoracic Aortic Aneurysm
  35. 35. Thoracic Aortic Aneurysm
  36. 36. Thoracic Aortic Aneurysm
  37. 37. Summary Of Diagnoses This Week • Flail chest • Traumatic aortic disruption • Foreign bodies that can be difficult to see • Sternal fracture • Chest trauma with assorted findings (e.g.: rib fracture, pneumothorax, hemothorax, subcutaneous emphysema) • Thoracic aortic aneurysm
  38. 38. See You Next Week!

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