1 / 93

Differential Diagnosis of CXRs

Differential Diagnosis of CXRs. David Kirk. How to Learn. Personally look at every film every day. Examine every film the same way. Write down your opinion *before* you compare to the radiologist opinion. Re-examine the film *after* reading the radiology opinion.

bwoody
Télécharger la présentation

Differential Diagnosis of CXRs

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Differential Diagnosis of CXRs David Kirk

  2. How to Learn • Personally look at every film every day. • Examine every film the same way. • Write down your opinion *before* you compare to the radiologist opinion. • Re-examine the film *after* reading the radiology opinion. • Force your doc to read the film with you.

  3. My Pattern • Outside to Inside • Date / Patient • External / Hardware • ABCDE -- Airway, Bones (ribs/clavicles), Cardiac, diaphragm, everything else • Borders • Parenchyma

  4. http://cdn.lifeinthefastlane.com/wp-content/uploads/2012/08/CXR-AP.jpghttp://cdn.lifeinthefastlane.com/wp-content/uploads/2012/08/CXR-AP.jpg

  5. http://cdn.lifeinthefastlane.com/wp-content/uploads/2012/08/CXR-AP.jpghttp://cdn.lifeinthefastlane.com/wp-content/uploads/2012/08/CXR-AP.jpg

  6. http://www.wikiradiography.net/page/Lung+Anatomy

  7. http://www.wikiradiography.net/page/Lung+Anatomy

  8. Rules • Bunch of cases… thus we will move quickly • Guessing, shouting, participation required • Average computer monitor has 3 times less resolution than film. Projection decreases resolution even more…

  9. First Case • 51 year old male currently receiving treatment for hepatocellular carcinoma presents with several months of cough (+/- productive) and progressive DOE. • PFTs: • FVC is 94% predicted • FEV1 is 64% predicted • FEV1/FVC and FEF 25-75 percent are both markedly reduced

  10. What’s the Call? Based on the CXR findings including bilateral bullous changes in the bases, you make the diagnosis…

  11. Alpha-1-Antitrypsin • 3 hints that a patient’s obstructive disease is alpha-1-antitrypsin deficiency and not COPD. • Presents earlier (Median ages: 46 vs 52) • Bullous changes at bases instead of apex • Liver disease • Cirrhosis in 12 percent and hepatocellular carcinoma in 3 percent

  12. Everybody else… COPD CXRs

  13. Case 2 • 39 year old female with long history of sinusitis presents with SOB, DOE, and months of productive cough. • PMHx significant for congenital heart defect and recent pacemaker placement.

  14. Situs Inversus • What’s the syndrome? • Primary ciliary dyskinesia • What is Kartagener’s triad? • Chronic sinusitis • Bronchiectasis • Situs inversus • What percentage of PCD have situs inversus? • 50% • What percentage of situs inversus patients also have PCD? • 20-25%

  15. Case 3 • 65 year old WF presents to you with DOE/SOB, orthopnea, and diffuse muscle weakness. Worse when sleeping flat. • PMHx: Polio as a child requiring braces for ambulation. • You send the patient for inspiratory and expiratory CXRs.

  16. Inspiratory Muscle Weakness • What should the patient’s Aa gradient be? • Normal. (No impairment in diffusion…) • What’s the differential diagnosis of inspiratory muscle weakness? (12) • ALS • MS • Tetanus • Polio / Post-Polio Syndrome • Guillian Barre’ • Lyme Disease • Myasthenia Gravis • Botulism • Lambert-Eaton • Botulism • Muscular dystrophy • Polymyositis / Dermatomyositis

  17. Case 5 • 42 year old female presents with SOB, wt loss, joint tenderness, and chest pain. • Serial CXRs have shown diffuse, migratory infiltrates. • She has been treated in the ER for atypical pneumonia on several occasions.

  18. DDx of “Migratory” Infiltrates (10) • Asthma with mucus plugging • Allergic brochopulmonary aspergillosis • BOOP • Recurrent Aspiration • Allergic alveolitis • Pulmonary Edema • Eosinophilic infiltrates • Alveolar hemorrhage syndromes • Vasculitis • Collagen Vascular Diseases

  19. Pulmonary Hemorrhage • Bronchoscopy -> pulmonary hemorrhage • UA -> Active sediment with RBCs • Differential… (3) • Vasculitis (particularly Wegener's) • Usually C-ANCA/PR3-ANCA positive • Lupus • Goodpasture’s

  20. Case 6 • 28 year old F presents with encephalitis. As pt sits in the ER her MS continues to decline. Pt becomes hypoxic with increased WOB and is intubated. • Her initial CXR was normal. • Her current CXR is…

  21. Where’d that Lung go? • Differential Diagnosis (3) • Massive Effusion • Bronchial Occlusion -> atelectasis • Bronchial Torsion • How do you tell effusion vs atelectasis? • Effusions shift the heart away • Atelectasis shift the heart toward • Subsequent CXR post-bronchoscopy…

  22. Atelectasis vs Effusion

  23. Case 7 • 81 yo WM presents with URI and persistent cough for two weeks. His wife is in the hospital and the nurses on the floor convince him to go to the ED. • CXR obtained in the ED shows…

  24. What’s that big honkin’ thang? Thoracic Aorta Aneurysm

  25. Case 8 • 24 year old college student presents with inguinal discomfort, fatigue, and cough. • Palpation discovers an inguinal mass. Mild scrotal swelling is noticed. • CXR…

More Related