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: Pleural Effusion, Dilated Cardiomyopathy, Septic Pulmonary emboli, Tracheal Laceration, LifeVest Defibrillator, Aspirated Tooth, Pulmonary Nodule, Rib Fractures, Fail Chest, Metastatic Melanoma.

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
Interim Vice President of Research
Atrium Health
Chest X-Ray Mastery Project
April 22nd 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 providing cases and these slides are shared with all contributors.
 Contributors from many CMC departments, and soon… Tanzania and Brazil.
 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.

4. It’s All About The Anatomy!

5. Airway
Bones
Cardiac
Diaphragm
Effusion
Foreign body
Gastric
Hilum

6. 60 Year Old With Advanced Cirrhosis And Encephalopathy

7. 60 Year Old With Advanced Cirrhosis And Encephalopathy
Right Pleural Effusion

8. 72 Year Old With Metastatic Breast Cancer

9. 72 Year Old With Metastatic Breast Cancer
Malignant Right Pleural Effusion

10. 43 Year Old With Metastatic Breast Cancer

11. 43 Year Old With Metastatic Breast Cancer
Bilateral Malignant Pleural Effusions

12. 35 Year Old With
A Long History Of
Alcohol Abuse
Presents With
Dyspnea

13. 35 Year Old With
A Long History Of
Alcohol Abuse
Presents With
Dyspnea
Dilated Cardiomyopathy

14. 25 Year Old With
A History Of
Intravenous Drug
Abuse Presents
With Fever And
Dyspnea

15. 25 Year Old With
A History Of
Intravenous Drug
Abuse Presents
With Fever And
Dyspnea
Endocarditis & Septic Pulmonary Emboli

16. 55 Year Old
With A Large
Tracheal
Laceration On
ECMO

17. 55 Year Old
With A Large
Tracheal
Laceration On
ECMO
Massive Subcutaneous Emphysema

20. LifeVest Defibrillator®

21. LifeVest Defibrillator®

22. Intubated
Trauma Patient
Head Injury +
Right Humeral
Neck Fracture
CXR Findings Can Be Subtle!

23. Intubated
Trauma Patient
Head Injury +
Right Humeral
Neck Fracture
Aspirated Tooth
CXR Findings Can Be Subtle!

24. Aspirated Tooth
Intubated
Trauma Patient
Head Injury +
Right Humeral
Neck Fracture

25. CXR Findings Can Be Subtle!

26. Aspirated Tooth
Right Mainstem
Bronchus
RLL Collapse
CXR Findings Can Be Subtle!

27. CXR Finding Can Be Subtle!
Routine
Preoperative CXR

28. CXR Finding Can Be Subtle!
Routine
Preoperative CXR
Pulmonary
Nodule

29. Pulmonary Nodule
Routine
Preoperative CXR

30. High Speed MVC
And Left-Sided
Chest Pain
Multiple Rib Fractures With A Clinical Flail Segment

31. Flail Chest
 Inspiration increases [-] thoracic pressure.
 Leads to paradoxical motion of the flail segment.

32. 70 Year-Old With
Uncontrolled
HPTN As Well As
ESRD Presents
With Dyspnea
Initial Oxygen
Saturations 65%
Acute Pulmonary Edema

33. 75 Year Old With Metastatic Melanoma – CXR One Year Ago

34. 75 Year Old With Metastatic Melanoma – CXR Today

35. 75 Year Old With Metastatic Melanoma – CXR Today
Multiple New Metastases

36. Summary Of Diagnoses This Week
• Pleural effusion
• Dilated cardiomyopathy
• Septic pulmonary emboli
• Tracheal laceration - ECMO + massive subcutaneous emphysema
• LifeVest Defibrillator®
• Aspirated tooth
• Pulmonary nodule
• Rib fractures with a clinical flail segment
• Metastatic melanoma

37. See You Next Week!