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Outline:
First things first
Normal Anatomy
Vascular Patterns
Chamber Enlargement
Cases
Normal Anatomy:
http://radresidents.ccf.org/omar/Anatomicguide/Mainpagecxr.htm
Normal Anatomy:
http://radresidents.ccf.org/omar/Anatomicguide/Mainpagecxr.htm
Normal Anatomy:
http://radresidents.ccf.org/omar/Anatomicguide/Mainpagecxr.htm
Normal Anatomy:
http://radresidents.ccf.org/omar/Anatomicguide/Mainpagecxr.htm
Normal Anatomy:
http://radresidents.ccf.org/omar/Anatomicguide/Mainpagecxr.htm
Normal:
No LR shunting:
Pulmonary artery or vein obstruction
(PA SysP: 30 mm Hg)
Aorta or Aortic Valve obstruction
w/o LV dysfunction or MV disease
PCWP < 13 mm Hg
LR shunting:
Qp:Qs < 1.5:1.0
Question #1:
What is the abnormality?
1) CXR is backward
2) Right aortic arch
3) Free air under left diaphragm
4) None the CXR is normal
Decreased:
CHD:
RL or complex shunting
TOF, PA, Severe PS (+ASD),
Ebsteins (+ASD), TA (+ASD+PS),
ccTGV (+VSD+PS),
admixture lesions (+VSD+PS), etc.
Acquired:
RV dysfunction: e.g., ARVD
Increased:
Pulmonary Venous Hypertension:
Stage I: Redistribution
WP: Acute 13-18 mm Hg; Chronic 18-22 mm Hg
12-18 mmHg
Interstitial Edema
18-25 mmHg
Alveolar Edema
> 25 mmHg
NL (MS)
PVH 1 (MS)
PVH 2
Cardiac
Increased
NL or
Reversed
NL or
Not common
Common
Not common
Even
Common
Renal
Increased
Increased
Balanced
Increased
Not common
Common
Not common
Central
Common
Injury
Normal
NL or
NL or Bal.
Normal
absent
Not common
Common
Peripheral
Not common
PVH 3
(Acute MI)
Pulmonary
hemorrhage
Pneumonia
35-50 mm Hg
50-75 mm Hg
> 75 mm Hg
Constrictive (Hyperkinetic)
Hypoxia, Shunts
PAH
1o PAH
PAH - Chronic PE
Pressure overload
Typically valvular stenosis
mitral stenosis
mitral regurgitation
MS
MR
Mitral regurgitation
PVH much less frequently
LAE out of proportion to PVH
LA appendage enlargement = ? rheumatic
aortic stenosis
aortic regurgitation
tricuspid regurgitation
Ebstein anomaly
Question #2:
What is the abnormality?
1) Pneumothorax
2) Pneumomediastinum
3) Pneumopericardium
4) None the CXR is normal
Pearls:
Pneumomediastinum
Air in mediastinum
Air around heart
Pneumopericardium
Cannot diagnose on CXR without
seeing air on undersurface of heart
Question #3:
What is the diagnosis?
1) Pneumomediastinum
2) Pneumothorax
3) Tension pneumothorax
4) Selective intubation of the LMB
Pearls:
Pneumothorax
Hyperlucency
Deep lateral sulcus
Tension Pneumothorax
Shift of heart and mediastinum
Hyperexpansion
Clinical, not x-ray diagnosis
Question #4:
What is the diagnosis?
1) Aortic dissection
2) Pneumonia
3) Pneumothorax
4) Pulmonary embolism
Pearls:
Pulmonary Embolism
Most common CXR: Normal
Question #5:
What is the diagnosis?
1) Type A dissection
2) Type B dissection
3) Type II dissection
4) Motion artifact in non-gated scan
Aortic Dissection:
A
II
III
Classifications:
Stanford
Type A, B
Debakey
Type I, II, III
Pearls:
Aortic Dissection
CXR may be:
Normal
Widened mediastinum
Pleural effusion
Pericardial effusion
Pearls:
Aortic Dissection
CT scan must be ECG-gated