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, Flail Chest, Metastatic Melanoma

1. Chest X-Rays Of The Month
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
Adult Chest X-Ray Mastery Project
May 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 Carolinas Medical Center departments, and now…
Brazil, Chile and Tanzania.
 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. 65 Year Old
With Dyspnea

7. 65 Year Old
With Dyspnea
Hazy Left Hemithorax – Pleural Effusion
Mediastinal
Shift With
Tracheal
Deviation

8. ED Bedside Ultrasound Confirms The Effusion

9. ED Bedside Ultrasound Confirms The Effusion
Left Pleural
Effusion

10. Healthy 20 Year
Old Struck By A
Car
On Arrival

11. Healthy 20 Year
Old Struck By A
Car
Severe Pulmonary Contusion
On Arrival

12. Healthy 20 Year
Old Struck By A
Car
Severe Pulmonary Contusion
16 Hours Later

13. Cases Studies From
Our Emergency
Medicine Partners In
Tanzania
CXR Last Week CXR Today

14. Cases Studies From
Our Emergency
Medicine Partners In
Tanzania
25 Year-Old Presents With “Wheezing.” CXR One Week Ago Reveals
Aortic Dilatation And The Patient Refused Hospital Admission Then.
Imaging Now Reveals “Impending Aortic Rupture!”
CXR Last Week CXR Today

15. 56 Year Old
With Traumatic
Paraplegia Now
Presents In
Respiratory
Failure

16. 56 Year Old
With Traumatic
Paraplegia Now
Presents In
Respiratory
Failure
Right Lower Lobe Collapse

17. 75 Year Old Has A Pre-Operative Chest X-Ray

18. 75 Year Old Has A Pre-Operative Chest X-Ray
Thoracic Endovascular Aortic Repair [TEVAR]

19. 60 Year Old With Advanced Cirrhosis And Encephalopathy

20. 60 Year Old With Advanced Cirrhosis And Encephalopathy
Right Pleural Effusion

21. 60 Year Old With Advanced Cirrhosis And Encephalopathy
Right Pleural Effusion

22. 72 Year Old With Metastatic Breast Cancer

23. 72 Year Old With Metastatic Breast Cancer
Malignant Right Pleural Effusion

24. 72 Year Old With Metastatic Breast Cancer
Malignant Right Pleural Effusion

25. 43 Year Old With Metastatic Breast Cancer

26. 43 Year Old With Metastatic Breast Cancer
Bilateral Malignant Pleural Effusions

27. 35 Year Old With
A Long History Of
Alcohol Abuse
Presents With
Dyspnea

28. 35 Year Old With
A Long History Of
Alcohol Abuse
Presents With
Dyspnea
Dilated Cardiomyopathy

29. 25 Year Old With
A History Of
Intravenous Drug
Abuse Presents
With Fever And
Dyspnea

30. 25 Year Old With
A History Of
Intravenous Drug
Abuse Presents
With Fever And
Dyspnea
Endocarditis & Septic Pulmonary Emboli

31. 55 Year Old
With A Large
Tracheal
Laceration On
ECMO

32. 55 Year Old
With A Large
Tracheal
Laceration On
ECMO
Massive Subcutaneous Emphysema

35. LifeVest Defibrillator®

36. LifeVest Defibrillator®

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

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

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

40. RLL Collapse
CXR Findings Can Be Subtle!

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

42. CXR Finding Can Be Subtle!
Routine
Preoperative CXR

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

44. Pulmonary Nodule
Routine
Preoperative CXR

45. Pulmonary Nodule
Routine
Preoperative CXR

46. High Speed MVC
And Left-Sided
Chest Pain

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

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

49. 70 Year-Old With
Uncontrolled
HPTN As Well As
ESRD Presents
With Dyspnea
Initial Oxygen
Saturations 65%

50. 70 Year-Old With
Uncontrolled
HPTN As Well As
ESRD Presents
With Dyspnea
Initial Oxygen
Saturations 65%
Acute Pulmonary Edema

51. 75 Year Old With Metastatic Melanoma – CXR One Year Ago

52. 75 Year Old With Metastatic Melanoma – CXR Today

53. 75 Year Old With Metastatic Melanoma – CXR Today
Multiple New Metastases

54. 75 Year Old With Metastatic Melanoma – CXR Today
Multiple New Metastases

55. Summary Of Diagnoses This Month
• 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

56. See You Next Month!