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M-1 CHEST RADIOLOGY

M-1 CHEST RADIOLOGY. Francis H. Neuffer, MD USC-SOM. OBJECTIVES. Chest x-ray as a organizing concept for anatomy of the chest Correlate pathology with anatomic changes on the chest x-ray Correlate CT imaging with the chest x-ray.

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M-1 CHEST RADIOLOGY

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  1. M-1 CHEST RADIOLOGY Francis H. Neuffer, MD USC-SOM

  2. OBJECTIVES • Chest x-ray as a organizing concept for anatomy of the chest • Correlate pathology with anatomic changes on the chest x-ray • Correlate CT imaging with the chest x-ray

  3. LEFT 4TH RIBPOSTERIOR AND ANTERIOR PORTIONS POSTERIOR 4th ANTERIOR 4TH BREAST SHADOW

  4. MAMMOGRAPHY OBLIQUE VIEW LATERAL CHEST X-RAY

  5. SCREENING MAMMOGRAPHY VIEWS CC MLO FATTY TISSUE MUSCLE GLANDULAR AND FIBROUS TISSUE CC VIEW CRANIO - CAUDAL MLO VIEW MEDIO-LATERAL OBLIQUE

  6. NORMAL CHEST X-RAY LATERAL PA

  7. NORMAL HEART BORDERS

  8. NORMAL HEART

  9. UPPER EXTREMITY VENOUS DRAINAGE INT. JUG. VEIN BRACHIOCEPHALIC VEINS SUBCLAVIAN VEIN SVC ELECTRODES (NOTE CATHETERS)

  10. PULMONARY ARTERY CATHETER SWAN CATHETER INT. JUG. VEIN SVC PA RT. PUL .ART. RA RV

  11. PACEMAKER WITH RT. ATRIAL AND RT. VENTRICULAR LEADS RA RV

  12. MR CONTRAST ARTERIOGRAM

  13. TRICUSPID AND MITRAL VALVE REPLACEMENT ARROWS SHOW DIRECTION OF BLOOD FLOW THROUGH VALVES FROM ATRIA TO VENTRICLES T M T M Right to left Posterior to anterior

  14. Pulmonic Aortic

  15. Pulmonic Aortic

  16. The patient has a diastolic murmur on physical exam and the ultrasound is limited by size but shows a dilated chamber. The left main bronchus is reported elevated on chest x-ray. What valve disease do you suspect? • Aortic stenosis • Aortic regurgitation • Mitral stenosis • Mitral regurgitation

  17. The patient has a diastolic murmur on physical exam and the ultrasound is limited by size but shows a dilated chamber. The left main bronchus is reported elevated on chest x-ray. What valve disease do you suspect? • Aortic stenosis • Aortic regurgitation • Mitral stenosis • Mitral regurgitation

  18. ELEVATED MAIN STEM BRONCHUS

  19. CORONARY ARTERY ANATOMY

  20. CORONARY ARTERIES RT. LT. LAD CIRCUMFLEX

  21. The pathologist report states the autopsy showed infarcted tissue around the SA node which contributed to fatal arrhythmia. What blood vessel do you think was the involved? Left main Left anterior descending Circumflex Right coronary

  22. The pathologist report states the autopsy showed infarcted tissue around the SA node which contributed to fatal arrhythmia. What blood vessel do you think was the involved? Left main Left anterior descending Circumflex Right coronary

  23. CORONARY ARTERY STENTS

  24. FISSURES DIVIDE LUNGS INTO LOBES RIGHT lung has: UPPER MIDDLE lobes LOWER LEFT lung has: UPPER lobes LOWER HORIZONTAL FISSURE separates the Rt. upper lobe and Rt. middle lobe.

  25. PNEUMONIA IN THE RIGHT UPPER LOBE.

  26. NORMAL CHESTANATOMY LATERAL CHEST XRAY Hemidiaphragm-AP view AORTIC ARCH LT. TRACHEA RT. LT. HORIZONTAL FISSURE Hemidiaphragm- Lateral view OBLIQUE FISSURE LT. RT. LT. COLON GAS

  27. RT. MIDDLE LOBE PNEUMONIA

  28. AIR SPACE DISEASE RT LOWER LOBE PNEUMONIA

  29. BRONCHOGRAM—CONTRAST OUTLINING AIRWAY TRACHEA LT. MAIN BRONCHUS RT. MAIN BRONCHUS CARINA

  30. TRACHEA AND ET TUBE POSITION TIP OF ET TUBE

  31. The patient had an endotrachael tube placed to improve oxygenation. Immediately afterwards the patient’s oxygenation worsened. The tube is likely extending into the: RUL RML RLL LUL LLL

  32. The patient had an endotrachael tube placed to improve oxygenation. Immediately afterwards the patient’s oxygenation worsened. The tube is likely extending into the: RUL RML RLL LUL LLL

  33. ATELECTASIS DISTAL ET TUBE IN RT. BRONCHUS

  34. PULMONARY ARTERIES SEE NOTE CATHETER RT. PULMONARY ARTERY RT. UPPER LOBE VESSELS LT. UPPER LOBE VESSELS LT. PULMONARY ARTERY RT. MIDDLE LOBE VESSELS MAIN PULMONARY ARTERY LT. LOWER LOBE VESSELS RT. LOWER LOBE VESSELS

  35. NUCLEAR MEDICINE LUNG SCANS Lt

  36. NUCLEAR MEDICINE PERFUSION SCAN PERFUSION VENTILATION

  37. NORMAL PULMONARY EMBOLI

  38. BARIUM FILLED ESOPHAGUS AORTIC IMPRESSION

  39. The patient reported their child swallowed a coin and is now drooling and coughing. Where do you think the coin is stuck in the Esophagus?

  40. WHERE IS IT ?

  41. CT THORACIC ANATOMY LOOK AT AN X-RAY AS IF THE PATIENT IS LOOKING AT YOU. LOOK AT A CT SCAN AS IF THE PATIENT IS LYING ON THEIR BACK AND YOU ARE LOOKING FROM THEIR FEET TO THEIR HEAD. Anterior projection

  42. RT SCAN LEVELS GREAT VESSELS AORTIC ARCH CARINA PULMONARY ARTERIES ATRIA VENTRICLES CT CHEST ANATOMY

  43. RT BRACHIOCEPHALIC ARTERY LT. COMMON CAROTID ART. SVC LT. SUBCLAVIAN ART. TRACHEA GREAT VESSELS

  44. CHEST -- CT INTERNAL MAMMARY (THORACIC) ARTERY AND VEIN SVC AORTIC ARCH ESOPHAGUS SCAPULA AORTIC ARCH

  45. CHEST -- CT STERNUM ASCENDING AORTA LT. PULMONARY ARTERY CARINA DESCENDING AORTA PULMONARY & CARINA

  46. MAIN PULMONARY ARTERY RT.. PULMONARY ARTERY LT. PULMONARY ARTERY PULMONARY ARTERIES

  47. CT AXIAL ARROWS INDICATE CLOT IN THE PULMONARY ARTERIES Normal

  48. ASCENDING AORTA RT. ATRIUM LT. ATRIUM DESCENDING AORTA ATRIA

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