Patients goes to his doctor with
complaints of chest pain and
fever.
1
Diagnosis:__Rt. Middle lobe pneumonia
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confirm the diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal structures .
1
Lt clavicle
Lt. pulmonary
artery
RADIOLOGY EXAM: PA & Lateral Chest X-ray
Opacified Rt .
middle lung
Lt. Lung
CLINICAL INDICATION: Chest pain & cough
REPORT: Blurred right heart border in the area
of the right middle lobe(Silhouette sign)
Wedged shaped density in the right middle lobe
seen on the lateral view.
CONCLUSION: Right Middle lobe pneumonia
1
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
1-Blurred right heart border indicative of loss of
normal volume of right middle lobe.
2-Wedge shaped density in the right middle lobe
indicative of pneumonia.
3- Patient will likely need antibiotic therapy.
2
56 year old female goes to ED
with cough and fever.
Diagnosis:
Rt. Upper lobe
Pneumonia
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confirm the diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal structures.
2
Lt clavicle
Lung
RADIOLOGY EXAM: Frontal & Lateral chest
x-ray
CLINICAL INDICATION: 56 yoF with a cough
and fever.
Abnormal density in
upper Rt. lung
Lt. ventricular
border
REPORT: Chest radiograph shows abnormal
density in the upper lobe of the right lung.
CONCLUSION: Soft tissue density in the
upper lobe most typical for segmental
pneumonia.
2
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
Pneumonia is an infection of the lungs that
causes the alveoli to become inflamed and fill
with fluid. It can be bacterial, viral or fungal,
and symptoms can vary from mild to severe.
It is most serious in the very young and very
old.
Pneumonia can be diagnosed via chest x-ray
(seen as abnormal densities in the lungs),
physical exam (abnormal lung sounds, such as
rales and ronchi, and/or blood and mucus
testing. (white blood cell count or testing for
specific pathogens).
3
4 week old infant taken to the ED
because of a cough x 2 weeks
Diagnosis: Normal Chest
Normal Thymus
3
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diagnosis and /or other abnormalities.
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RADIOLOGY EXAM: AP Chest
Clavicle
Thymus
Snap on Shirt
CLINICAL INDICATION: Cough x 2 weeks
REPORT: Large wing shaped soft tissue
structure that appears to be located anterior
to the Upper lobe of the Rt. lung. The lungs
overall appear normal. The cardiac size and
shape are as expected.
CONCLUSION: Normal pediatric chest-normal
Thymus.
Liver
3
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
The Thymus gland varies greatly during
infancy and early childhood. Enlarged but
normal for this stage in life.
During infancy, the thymus makes up the
greatest proportion of overall body weight
compared to any other time of life.
4
Patient in Doctor’s office with peripheral edema.
Diagnosis: Cardiomegaly
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diagnosis and /or other abnormalities. Use
blue arrows to identify 3 normal structures.
4
RADIOLOGY EXAM: Frontal Chest x-ray
Lt. Lung
CLINICAL INDICATION: Peripheral
edema
REPORT: The heart is enlarged and
causes a widened mediastinum.
5th Rib
CONCLUSION: Cardiomegaly .
Hemi diaphragm
4
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less
•Cardiomegaly is defined as a cardiothoracic
ratio of more than .50.
•Cardiomegaly can be the result of Left or
Right ventricular hypertrophy.
•It is the result of low cardiac output with
dilation of the ventricle as compensation.
Patient in the ICU with decreased 02 saturation over 12 hours.
Diagnosis :Congestive edema
Alveolar edema
5
5
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diagnosis and /or other abnormalities.
Use blue arrows to indicate 3 normal
structures.
RADIOLOGY EXAM: Supine Chest x-ray
Lt. Clavicle
Cardiac electrode
Alveolar
edema
Rt. lobe of the liver
CLINICAL INDICATION: Decreased O2 sat.
REPORT: Vascular engorgement
indicating pulmonary venous
hypertension .
Bilateral opacity of the lungs indicating
alveolar edema
CONCLUSION: Alveolar Edema/
Congestive Edema
5
Three bullet points about pathology identified
OR
Management of the identified process
(50 words or less)
Left ventricular failure leads to pulmonary
venous congestion in the lungs. With
increasing failure interstitial edema and
subsequently alveolar edema develop.
6
CHEST CASE #6
35 YEAR OLD MALE PRESENTS TO THE ED WITH SOB
Diagnosis: Pneumothorax
tension component
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diagnosis and /or other abnormalities. Use
blue arrows to indicate 3 normal structures.
Trachea
Aorta
Your report here
RADIOLOGY EXAM:Frontal Chest
X-Ray
CLINICAL INDICATION: SOB
REPORT: 35 yo male reports to ED
with SOB. Auscultation of right lung
revealed decreased breath sounds.
Tension Pneumothorax is suspected
Pneumothorax
Collapsed
Lung
Left Ventricle
REPORT: Chest X-ray revealed
mediastinal shift to left, collapsed
right lung, and an accumulation of
air under pressure in the right pleural
space.
CONCLUSION: Right
Pneumothorax Tension Component
6
6
Three bullet points about pathology
identified
OR
Management of the identified process
(50 words or less)
Management:
• Place patient on oxygen
• Perform emergency needle
decompression of right pleural space
• After needle decompression, insert
thoracostomy tube and continue to monitor
and assess breathing.
7
Patient in the ICU becomes SOB
Diagnosis: Rt. Pleural effusion
7
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& captions that confirm the diagnosis
and /or other abnormalities. Use blue arrows to indicate 3
normal structures.
RADIOLOGY EXAM:
Clavicle
CLINICAL INDICATION:
Excess fluid
Spine of
scapula
Costophrenic angle
REPORT:
Excess fluid has accumulated between the
parietal and visceral pleura. Displacement
of the right lung medially is noted due to
fluid. Affected area spans the diaphragm
to clavicle.
CONCLUSION: Right pleural effusion
7
Three bullet points about pathology
identified
OR
Management of the identified process
(50 words or less)
•Occurs when the pleural space accumulates
an abnormal amount of fluid due to an
imbalence in production and resorbtion.
•Pleural space has key role in respiration
through strategic chest wall movement and
lung movement.
8
Diagnosis: Lt. Pleural effusion
8
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& captions that confirm the diagnosis
and /or other abnormalities. Use blue
arrows to indicate 3 normal structures.
RADIOLOGY EXAM: Frontal chest x-ray
CLINICAL INDICATION: Dyspnea
Clavicle
Fluid accumulation
in pleural cavity
REPORT: Large fluid density collection in the
Lt lung base typical of a large pleural effusion.
CONCLUSION: Large left effusion
Rt. Hemi diaphragm
Three bullet points about pathology identified
OR
Management of the identified process
(50 words or less)
To improve patient comfort and lung function
a thoracentesis is required. Fluid is analyzed
in the lab to determine the etiology and
respective treatment options of the effusion.
For example , if caused by CHF diuretics can
be used. In case of recurrent effusions,
pleurodesis, via thoracoscopic talc poudrage
placement has been shown to be safe an d
effective on preventing future effusions.
8
9
Diagnosis:
Et tube distally placed in
Rt. main stem bronchus
with atelectasis of the left lung.
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& captions that confirm the diagnosis
and /or other abnormalities. Use blue
arrows to indicate 3 normal structures.
9
RADIOLOGY EXAM: Frontal chest x-ray
CLINICAL INDICATION: Patient in ED s/p
MVA
Rt. clavicle
Scapula
ET tube in Rt. main
stem bronchus
CVP in SVC
Atelectatic
Lt. Lung
REPORT: An endotracheal tube has been
placed in the trachea and extends
inferolaterally down the Rt. main stem
bronchus. This is limiting the ventilation of
the lt. lung with secondary atelectasis
CONCLUSION: ET tube placed into the Rt.
main stem bronchus.
9
Three bullet points about pathology
identified
OR
Management of the identified process
(50 words or less)
ET tubes preferentially extend laterally
into the Rt. bronchus if positioned too far.
 Lt. hemithorax is opacified.
Typically opacified hemithorax is due to
atelectasis or large effusion.
10
33 year old male post 4-wheeler accident
Diagnosis: Fracture of the
Lt. 7th & 8th ribs
10
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& captions that confirm the diagnosis
and /or other abnormalities. Use blue
arrows to indicate 3 normal structures.
Aortic arch
RADIOLOGY EXAM: Chest X-Ray
CLINICAL INDICATION: Trauma to chest
REPORT: Patient is a 33 yr old male examined
post 4 wheeler accident. Fracture of the
lateral aspect of the 7th and 8th ribs is
demonstrated. The cardiac silhouette is
normal. No pneumothorax seen.
Atelectasis of the lt. lung base is noted.
Rt. pulmonary artery
Carina
Stomach
Rib fractures
CONCLUSION: Multiple rib fractures of the Lt.
inferolateral thoracic cage secondary to
trauma of the chest.
10
Three bullet points about pathology
identified
OR
Management of the identified process
(50 words or less)
•Fractured ribs normally take 1-2 months to
completely heal.
•Ribs 4-10 are the ribs mostly likely to be
broken.
•Complications from rib fractures include:
pneumothorax, internal bleeding damage to
major blood vessels and internal organs.
Mother brings child into the ED stating that
the child has swallowed something and is now
drooling extensively.
11
Diagnosis: Impacted coin in
the esophagus.
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& captions that confirm the diagnosis
and /or other abnormalities. Use blue
arrows to indicate 3 normal structures.
11
RADIOLOGY EXAM: PA & Lateral Cheat X-ray
CLINICAL INDICATION:Drooling due to
inability to swallow properly.
Coin in esophagus
REPORT: X-ray exam shows a coin in the
esophagus. There is normal ventilation of the
lungs.
Rt. atria
CONCLUSION:
The size of the coin leads us to believe that it
will not pass through the GI tract therefore it
needs to be extracted via endoscopic removal.
Sternum
Trachea
11
Three bullet points about pathology
identified
OR
Management of the identified process
(50 words or less)
•Coins are the most common esophageal
foreign body in children.
•Coins in esophagus do not generally
result in airway obstruction.
•In some cases, foreign bodies may pass
through the GI tract without difficulties:
however, they may need to be removed
via endoscopy.