Introduction to Chest X-Ray Interpretation
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This document provides guidance on interpreting chest radiographs from Kristopher Maday, a physician assistant. It lists steps for reading chest x-rays, recognizes common pathologies, and focuses the assessment based on history and physical exam rather than trying to interpret like a radiologist. Examples are then provided of chest x-ray findings from patient cases with relevant history, physical exam findings, and radiographic impressions. Resources for further radiograph interpretation education are included at the end.
Introduction to Chest X-Ray Interpretation
- 1. Kristopher R. Maday, MS, PA-C, CNSC University of Alabama at Birmingham Physician Assistant Program Pegasus Emergency Group @PA_Maday #FNPintensive
- 2. • List the(my) steps to reading chest radiographs • Recognize common pathologies seen on chest radiographs • Focus your assessment of reading radiographs based off of history and physical exam • Not turn you into a radiologist!!! 4th Year Medical Student Medic al Degre e After 4 years of Radiology Residency
- 4. Airspaces Bones Cardiac Diaphragms Examination Technique Fluid Gastric Bubble Hilum Instrumentatio n
- 5. • 72yo female with 3 day history of fever and cough • Medications • Simvastatin 40mg, ASA 81, Clopidogrel 75mg, Metformin 500mg BID • Past Medical/Surgical History • Hyperlipidemia, DMII • CVA – 1995 – no residual deficits • Vital Signs • BP-131/82, HR-92, RR-21, O2-95%, temp-101.2o
- 6. Review of Systems • Productive cough? • Yes, “green” • Dyspnea? • Yes, worse with activity • Malaise or fatigue? • Yes • Nausea or vomiting? • No • Chest pain? • Mild, worse with cough • Fever/chills/rigors? • Yes • Smoking history? • Never • Sick contacts? • My grandbaby had strep throat last week • Dizziness/lightheadednes s? • Just when I get to coughing
- 7. Cardiac RRR without M/G/R Pulmonary Diminished BS in right Increased tactile fremitus on right Dullness to percussion on right Neuro A&O x 3, answers questions appropriately Abdomen S/NT/ND, (+) BS Vascular 2+ pulses throughout No edema
- 9. • 22yo male presents to emergency department with a 2 hour history of acute onset of shortness of breath • Medications • None • Past Medical/Surgical History • None • Vital Signs • BP-120/80, HR-115, RR-25, O2-95%, temp-98.9o
- 10. Review of Systems • Trauma? • No • Chest pain? • 4/10, dull, left side • Hemoptysis? • No • Any risk factors for DVT? • No • History of DVT? • No • Nausea/Vomiting? • No • History of anything like this before? • Yes, 3 years ago, went away on its own • Syncope/dizziness? • No
- 11. Cardiac Tachycardia, no M/G/R Pulmonary Diminished BS on left Tympanic percussion on left Decreased tactile fremitus on left Neuro A&O x 3, answers questions appropriately Abdomen S/NT/ND, (+) BS Vascular 2+ pulses throughout No edema General Tall, thin male in moderate distress
- 12. 3.5cm
- 13. • 62yo male presents to PCP with 2 week h/o worsening cough • Medications • HZCT 50mg daily, Metoprolol 25mg daily, ASA 81mg, Simvastatin 40mg • Past Medical/Surgical History • HTN, CAD, HLD • 2001 – AMI • 2001 – Coronary stenting x 3 • Vital Signs • BP-146/95, HR-75, RR-19, O2-93%, temp-99.0o
- 14. Review of Systems • Productive cough? • No • Fever? • No • Dyspnea? • Yes, worse with exertion • New or change in medications? • No • Fatigue? • I cant walk as far as I used to • Orthopnea? • I need to sleep on 2 pillows • PND? • No • Leg swelling? • Yes, a little • Smoking history? • Quit 20 years ago • Chest pain? • Not really
- 15. Cardiac RRR with murmur Displaced PMI laterally Pulmonary Diminished BS throughout Dullness to percussion in bases Neuro A&O x 3, answers questions appropriately Abdomen S/NT/ND, (+) BS Vascular 2+ pulses throughout 1+ pitting edema Neck (+) JVD
- 17. • 22yo male with 3 week history of cough and malaise • Medications • None • Past Medical/Surgical History • Tonsillectomy at 8yo • Vital Signs • BP-120/72, HR-81, RR-16, O2-98%, temp-100.8o
- 18. Review of Systems • Fever/Chills/Rigors? • Occasionally • Night sweats? • No • Weakness or fatigue? • Tired “all the time” • Recent illnesses? • No • Productive cough? • No, it is dry • Hemoptysis? • No • Smoking history? • Yes, 1ppd since 13 • Dyspnea? • Just with exertion • Chest pain? • Occasionally • Abdominal pain? • No • N/V/D? • No • Weight loss? • Not that I noticed • Rashes? • No • Swelling? • I did notice a “knot” in my groin
- 19. Cardiac RRR without M/G/RPulmonary CTA bilaterally HEENT B TM clear, OP clear Abdomen S/NT/ND, (+) BS Vascular 2+ pulses throughout Neck No LAD Skin Dry without lesions, rashes, purpura Lymphatic Non-tender right femoral LAD
- 22. • 2yo male brought in by mother for 4 day h/o cough and fever • Medications • OTC Tylenol Cough and Cold • Past Medical History • Prenatal – uncomplicated pregnancy • Born at 39w via NSVD without complications • Vital Signs • BP-116/75, HR-104, RR-28, O2-95%, Temp-99.9o
- 23. Review of Systems • Ear pain/Sore throat? • No • Vomiting? • No • Decreased PO intake? • A little due to the coughing • Decreased wet/dirty diapers? • Not really • Decreased activity? • Yes • Diarrhea? • No • Productive cough? • No • Rashes? • No • Nasal drainage? • “A ton” • Immunization status? • Up to date
- 24. Cardiac RRR without M/G/RPulmonary Diminished BS throughout General NAD, non-toxic appearance Abdomen S/NT/ND, (+) BS Vascular 2+ pulses throughout HEENT B TM clear, mild OP erythema and petechiae Neck No meningismus No LAD Skin Dry without lesions or rashes
- 26. • 66yo male presents to PCP with increasing dyspnea and cough • Medications • Albuterol MDI PRN, Ipratropium Nebulizer TID, Formoterol/Budesonide BID • Metformin 500mg BID • Home O2 • Past Medical/Surgical History • COPD, DMII • Vital Signs • BP-138/85, HR-87, RR-22, O2-93% on 2L NC, temp-99.8o
- 27. Review of Systems • Productive cough? • No • Fever? • Yes • Dyspnea? • Yes, worse than normal • Increase in O2 use? • Yes, up to 3L from 2L • Chest pain? • No • Malaise or fatigue? • Yes • Nausea/Vomiting? • No • Recent illnesses? • Had a cold last week
- 28. Cardiac RRR without M/G/R Pulmonary Diminished BS throughout Increased resonance to percussion HEENT Breathing through pursed lips Abdomen S/NT/ND, (+) BS Vascular 2+ pulses throughout Neck Accessory muscle use General Thin, speaking in broken sentences
- 30. • 52yo female presents to PCP for follow up after a 2 week history of pneumonia • Medications • Prednisone 20mg daily, Hydroxychloroquine 400mg daily, Lasix 40mg BID • Past Medical/Surgical History • SLE, Stage II Renal Disease • Vital Signs • BP-153/85, HR-79, RR-19, O2-98%, temp-99.8o
- 31. Review of Systems • Cough? • Still just a little, but not bad • Fever/Chills/Rigors? • Not really • Dyspnea? • Improving • Malaise or fatigue? • No • Leg swelling? • No • Decreased urine output? • Slightly • Increased proteinuria? • No more than normal • Chest pain? • No
- 32. Cardiac RRR with M/G/R Pulmonary Slightly diminished in bases CTA bilaterally Neuro A&O x 3, answers questions appropriately Abdomen S/NT/ND, (+) BS Vascular 2+ pulses throughout
- 34. • 27yo male presents to PCP with a 2 month history of “not feeling well”. Just released from prison and needs to establish care • Medications • None • Past Medical/Surgical History • None • Vital Signs • BP-132/84, HR-74, RR-16, O2-100%, temp-100.2o
- 35. Review of Systems • Fever/Chills/Rigors? • Yes • Night sweats? • Yes, occasionally • Malaise or fatigue? • Yes • Recent illnesses? • No • Cough? • No • Hemoptysis? • No • Dyspnea? • No • Chest pain? • No • Abdominal pain? • Not really, but feels “full” • N/V/D? • No • Weight loss? • Not that I noticed • Rashes? • No
- 36. Cardiac RRR without M/G/RPulmonary CTA bilaterally HEENT B TM clear, OP clear Abdomen S/NT/ND, (+) BS Palpable spleen Vascular 2+ pulses throughout Neck Posterior cervical LAD bilaterally Skin Dry without lesions, rashes, purpura
- 37. 7.5cm
- 38. • Radiology Masterclass • http://radiologymasterclass.co.uk/tutorials/tutorials.html • Eric’s Medical Lectures – Interpreting CXR (9 part series) • https://www.youtube.com/playlist?list=PLYojB5NEEakU6vTUAoUeVh gRzQgaoSnFi • Radiology Assistant • http://www.radiologyassistant.nl/en/p497b2a265d96d/chest-x-ray- basic-interpretation.html • Life in the Fast Lane • http://lifeinthefastlane.com/drsabcde-of-cxr-interpretation/ • Virginia Medical School – Department of Radiology • http://www.med-ed.virginia.edu/courses/rad/cxr/Index.html • RadAnatomy – University of Kansas • http://classes.kumc.edu/som/radanatomy/search.asp
- 39. Kristopher R. Maday, MS, PA-C, CNSC Assistant Professor, Academic Coordinator Physician Assistant Program Email: maday@uab.edu Twitter: @PA_Maday