1. Chest Xrays Christopher A. Klipstein

2. Chest Xrays Christopher A. Klipstein Approach vs Classic Examples

3. See anything abnormal?

4. How do CXRs work ? Send xrays at film – pass though, absorbed to various degrees, scatter Five basic radiologic densities: – Air, fat, soft tissue (fluids/muscle), calcium (bone), metal Film is a map of xray attenuation

5. Five basic radiologic densities

6. Film: map of xray attenuation

7. How do CXRs work ? Send xrays at film – pass though, absorbed to various degrees, scatter Five basic radiologic densities: – Air, fat, soft tissue (fluids/muscle), calcium (bone), metal Film is a map of xray attenuation

8. How do CXRs work ? Send xrays at film – pass though, absorbed to various degrees, scatter Five basic radiologic densities: – Air, fat, soft tissue (fluids/muscle), calcium (bone), metal Film is a map of xray attenuation See borders between different densities Do not see borders when density is the same

9. See borders between different densities

10. Do not see borders when density is the same

11. Do not see borders when density is the same AND in direct contact

12. Silhouette sign

13. Do not see borders when density is the same AND in direct contact

14. Important to know borders

15. And anatomy

17. Can localize findings

19. Where is the infiltrate?

20. How do CXRs work ? Send xrays at film – pass though, absorbed to various degrees, scatter Five basic radiologic densities: – Air, fat, soft tissue (fluids/muscle), calcium (bone), metal Film is a map of xray attenuation See borders between different densities Do not see borders when density is the same AND in direct contact

21. Classic Examples Infiltrates (alveolar and interstitial) Pleural effusion Pneumothorax COPD CHF Mass/nodule

22. Alveolar infiltrate

24. Pus (pneumonia) Water (edema) Cells (blood)

25. Interstitial infiltrate

26. Sarcoidosis Hypersensitivity pneumonitis Idiopathic pulmonary fibrosis TB or tumor Fungal Asbestosis Collagen vascular diseases Eosinophilic granulomatosis Drugs

27. Alveolar infiltrate

33. Interstitial infiltrates Sarcoid

34. IPF

35. Miliary TB

38. PCP

40. Air bronchograms

41. = Alveolar

43. Alveolar Interstitial Acute Localized Silhouette sign Air bronchograms Chronic Diffuse Lines, nodules

46. Pleural Effusion

51. Pneumothorax

54. COPD

57. CHF

62. Cephalization

63. Peri-Bronchial Cuffing

64. Interstitial Edema

65. Kerley B lines

66. Interstitial Edema

67. Alveolar Edema

69. Mass (>3cm)

70. Nodule

71. Is Your Brain Full ?

72. How do CXRs work ? Send xrays at film – pass though, absorbed to various degrees, scatter Five basic radiologic densities: – Air, fat, soft tissue (fluids/muscle), calcium (bone), metal Film is a map of xray attenuation See borders between different densities Do not see borders when density is the same AND in direct contact (Silhouette sign)

73. Classic Examples Infiltrates (alveolar and interstitial) Pleural effusion Pneumothorax COPD CHF Mass/nodule

74. Quiz

82. Interstitial, hypersensitivity

84. Great Job Last xray