STUDY OF X- RAYS IN ER

DR. AMITH KUMAR.

Points to remember
Label radiology request correctly , mention in breif
your clinical findings & diffrentials.

Correctly identify patients x-ray.

Make sure x-rays are not repeated- unnecessary
radiation exposure & expenditure.

Consider the possibility of pregnancy in females of
child bearing age group- teratogenicity.

Ask for chest AP- views in trauma & PA-views in
medical conditions.
Always have a systematic approach while reading x-
rays- look at all the structures from inside out or
vice versa.

Always comment on quality of x-rays- exposure,
rotation , inspiration & position.

Never miss to look for-

Trachea- pushed or pulled.
Mediastinum superior , posterior & cardiomegaly.
Hilum- lymphadenopathy, prominent pul.arteries &
bronchogenic carcinoma.
Diaphragm- elevated or depressed.
Never comment about cardiomegaly on a supine &
AP- view CXR.

Never comment on diaphragmatic position on a
supine CXR.

Describe lung pathalogy using appropriate
terminology- nodular, cystic, reticular &
homogenous/non-homogenous opacities.

Think 10 times before you ask for an AXR- 30 times
more radiation exposure than a CXR.

If in doubt ask for special views & seek senior help.

NORMAL CXR
35yr male who underwent splenectomy 4 days back c/o of
shortness of breath.
Left lateral view
A 55yr old male admitted in HDU with CVA on day 5
of hospitalization has a CXR for fever spikes.
45 yr old male on doxarubicin chemotherapy for long time
presents with acute onset SOB.
35 year male on long term nitrofurantoion for complicated UTI
presents with decreased exercise tolerance since last one
month.
35 yr male known IV drug abuser presents with sudden
onset collapse. ECG- sinus tachy, RBBB.
35 yr female presented with decreased exercise tolerance since
last one month. Labs-s. alpha-1- antitrypsin levels low.
30 yr female presents with red rash over legs & unwell
since last 3wks.
45yr male c/o decreased exercise tolerance & SOB since one
month. On further questioning revels multiple joint pains worse
on getting up from bed.
45yr male a chronic smoker presents with decreased exercise
tolerance since 2months & 2 episodes of massive heamoptysis.
65yr male presents with sudden onset right sided weakness.
You ask for CXR as part of routine stroke evaluation.
45yr female k/c/o rheumatoid arthritis & rheumatoid lung
disease presents with ac.onset SOB & collapse.
40yr male k/c/o COPD presented with sharp stabbing pain on
left side of chest.
45yr male chronic smoker presents with rt. upper limb
swelling & shortness of breath.
30yr male presents with dysphagia for a wk. on exmn you
find raynauds phenomenon in fingers with sclerodactyiy.
Barium swallow
30yr male presents with retrosternal chest discomfort &
aquaphobia. Past history- dog bite 3wks back.
45yr male on long term steroid treatment for rheumatoid
arthritis presents with severe abdominal pain & signs of
peritonism.
A neonate with respiratory distress.
A neonate with respiratory distress.
30yr male with vague abdominal discomfort &
constipation.
35yr male k/c/o IBS presents with abdominal distension ,pain
abdomen & bilious vomiting since a day.
55yr male with chronic constipation presents with crampy
lower abdominal & distension.
30yr male with chronic constipation now c/o abdominal
distension , vomiting & vague abdominal pain.
30yr male presents with severe abdominal pain & looks toxic .
Drug history- on Mesalazine for 2yrs.
60yr male with previous MI now presents with left upper
quadrant abd pain & passage of loose stools with blood.
30yr male was detained at airport terminal . On pre boarding
check found to have abdominal distension, drowsiness, pin
point pupil.
40yr male brought into ED with alleged consumption of
unknown medication. History of hematemesis, pain abdomen &
diarrhoea on arrival.
Thank you..