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CORE Case 2 Workshop

Petra Lewis MD Professor of Radiology and OBGYN Geisel School of Medicine at Dartmouth. CORE Case 2 Workshop. Learning objectives. Understand who should get a pre-op CXR Know what features affect how we manage SPNs Know some of the ways that we can manage SPNs in patients

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CORE Case 2 Workshop

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  1. Petra Lewis MD Professor of Radiology and OBGYN Geisel School of Medicine at Dartmouth CORE Case 2 Workshop

  2. Learning objectives • Understand who should get a pre-op CXR • Know what features affect how we manage SPNs • Know some of the ways that we can manage SPNs in patients • Understand the radiographic signs of atelectasis • Be able to work out when atelectasis is present and what lobe is involved • Apply an algorithm to distinguishing the different causes for an opacifiedhemithorax • Recognize the features of a pneumothorax on different views • Recognize tension on a radiograph and how to treat it

  3. What questions/difficulties did you have arising from the case

  4. Who should get a pre-op CXR? • 37 year old man with no cardiorespiratory symptoms currently but a history of asthma pre-op ACL repair • 70 year old asymptomatic woman pre-op hip replacement • 45 year old diabetic man with no cardiorespiratory symptoms currently pre-op renal transplant

  5. Who should get a pre-op CXR? • Acute cardiopulmonary findings by history or physical • Chronic cardiopulmonary disease in the elderly (>age 70), previous chest radiograph within 6 months NOTE available. • Possibly: • Chronic cardiopulmonary disease in the elderly (>age 70), previous chest radiograph within 6 months available.

  6. Solitary Pulmonary Nodules

  7. What factors might affect whether we see a solitary pulmonary nodule?

  8. Where might we miss a nodule?

  9. What factors affect how we manage a lung nodule? • Patient factors • Radiographic factors

  10. How can we manage an SPN seen on a CXR? • Assess • Follow up

  11. Fleischner CriteriaMcMahon et al. 2005 Radiology, 237, 395-400.

  12. Atelectasis

  13. What are the characteristics of atelectasis?

  14. What are the causes of atelectasis

  15. What are the signs of volume loss?

  16. RUL atelectasis

  17. RUL atelectasis

  18. RUL atelectasis

  19. Pig Bronchus

  20. Day 1 Day 2

  21. LUL atelectasis

  22. Total lung atelectasis

  23. Total lung atelectasis

  24. DDx of unilateral hemithorax opacification • Causes

  25. Pneumothorax

  26. What are the signs of a pneumothorax

  27. What can we do to see pneumothoraces better?

  28. So you find a pneumothorax…What is your next question ALWAYS?

  29. What are the signs of tension? • Clinical • Radiographic

  30. You think your patient has a tension pneumothorax? What will you do?

  31. www.brooksidepress.org

  32. Note, this should be a clinical diagnosis! Don’t wait for the CXR http://handbook.muh.ie

  33. Appendix

  34. Learning Objectives • Know the current recommendations for preoperative chest radiographs in people who are healthy and in those with underlying chest and cardiac diseases • Understand some of the challenges in detecting small nodules on chest radiographs. • Have a concept of the different appearances of pulmonary nodules and their prognostic significance • Understand the current status of low dose CT imaging for lung cancer screening. • Understand some of the management issues related to pulmonary nodules (including the Fleischner Society recommendations). • Have a basic understanding of the use of FDG PET imaging in the management of nodules and lung malignancies. • Have reviewed the methods available for nodule biopsy • Will understand indications for needle biopsy, how the procedure is done, and the possible complications. • Be able to recognize a pneumothorax and understand the meaning and consequences of a tension pneumothorax. • Know the options for treating a pneumothorax. • Understand the purpose of TNM tumor staging and implications for long term survival • Recognize the common appearances of lobar atelectasis on chest radiographs. • Recognize the common appearances of linear and subsegmental atelectasis on chest radiographs. • Know the different etiologies that may cause complete opacification of a hemithorax • Know the expected postoperative appearance of the chest after pneumonectomy.

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