TB: Recognizing It on a Chest X-Ray
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X-Ray Interpretation
Objectives Describe a systematic method for interpretation of chest and abdomen x-rays List findings to accurately identify common X-ray Interpretation pathology in chest & abdomen x-rays Describe a systematic method to approach the Denise Ramponi, DNP, FNP-C, ENP-BC, FAANP, FAEN important components in interpretation of upper & lower extremity x-rays Chest X-ray: Standard Views Lateral Film Postero-anterior (PA): (LAT) view can determine th On inspiration – diaphragm descends to 10 rib the anterior-posterior posteriorly structures along the axis of the body Normal LAT film Counting Ribs AP View - Portable http://www.lumen.luc.edu/lumen/MedEd/medicine/pulmonar/cxr/cxr_f.htm When the patient is unable to tolerate routine views with pts sitting or supine No participation from the patient Film is against the patient's back (supine) 1 Consolidation, Atelectasis, Chest radiograph Interstitial involvement Consolidation - any pathologic process that fills the alveoli with Left and right heart fluid, pus, blood, cells or other borders well defined substances Interstitial - involvement of the Both hemidiaphragms supporting tissue of the lung visible to midline parenchyma resulting in fine or coarse reticular opacities Right - higher Atelectasis - collapse of a part of Heart less than 50% of the lung due to a decrease in the amount of air resulting in volume diameter of the chest loss and increased density. Infiltrate, Consolidation vs. Congestive Heart Failure Atelectasis Fluid leaking into interstitium Kerley B 2 Kerley B lines Prominent interstitial markings Kerley lines Magnified CXR Cardiomyopathy & interstitial pulmonary edema Short 1-2 cm white lines at lung periphery horizontal to pleural surface Distended interlobular septa - secondary to interstitial edema. -
Chest and Abdominal Radiograph 101
Chest and Abdominal Radiograph 101 Ketsia Pierre MD, MSCI July 16, 2010 Objectives • Chest radiograph – Approach to interpreting chest films – Lines/tubes – Pneumothorax/pneumomediastinum/pneumopericar dium – Pleural effusion – Pulmonary edema • Abdominal radiograph – Tubes – Bowel gas pattern • Ileus • Bowel obstruction – Pneumoperitoneum First things first • Turn off stray lights, optimize room lighting • Patient Data – Correct patient – Patient history – Look at old films • Routine Technique: AP/PA, exposure, rotation, supine or erect Approach to Reading a Chest Film • Identify tubes and lines • Airway: trachea midline or deviated, caliber change, bronchial cut off • Cardiac silhouette: Normal/enlarged • Mediastinum • Lungs: volumes, abnormal opacity or lucency • Pulmonary vessels • Hila: masses, lymphadenopathy • Pleura: effusion, thickening, calcification • Bones/soft tissues (four corners) Anatomy of a PA Chest Film TUBES Endotracheal Tubes Ideal location for ETT Is 5 +/‐ 2 cm from carina ‐Normal ETT excursion with flexion and extension of neck 2 cm. ETT at carina Right mainstem Intubation ‐Right mainstem intubation with left basilar atelectasis. ETT too high Other tubes to consider DHT down right mainstem DHT down left mainstem NGT with tip at GE junction CENTRAL LINES Central Venous Line Ideal location for tip of central venous line is within superior vena cava. ‐ Risk of thrombosis decreased in central veins. ‐ Catheter position within atrium increases risk of perforation Acceptable central line positions • Zone A –distal SVC/superior atriocaval junction. • Zone B – proximal SVC • Zone C –left brachiocephalic vein. Right subclavian central venous catheter directed cephalad into IJ Where is this tip? Hemiazygous Or this one? Right vertebral artery Pulmonary Arterial Catheter Ideal location for tip of PA catheter within mediastinal shadow. -
Quick Review: Surgical Anatomy of Trachea Tracheal Ligament
Quick Review: Surgical Anatomy of Trachea tracheal ligament. This attachment makes the larynx move up and down along with the larynx during respiration and swallowing. The length of trachea can be correctly gauzed by measuring the exact distance between lower border of cricoid cartilage and apex of the bifurcation angle (Perelman 1972). It varies with age (Allen, M S 2003). Langova (1946) measured the length of the trachea in 390 cadavers ranging in age from six months of intra-uterine life to twenty years and found that it was 3.1 cm on an average in the newborn, 6 cm in a five year old child, 7 cm at the age of ten and 8.5 cm at the age of 15 years. In adults the length of trachea varies widely from 8.5 to 15 cm. Tehmina Begum et al (2009) measured the length of trachea in adult males in the age range of 20 to 58 years. The mean lengths of the "Larynx, Trachea, and the Bronchi. (Front view.) A, epiglottis; B, thyroid cartilage; C, cricothyroid membrane, trachea were 8.73 ± 0.21 cm in 20-29 years age connecting with the cricoid cartilage below, all forming the Group, 9.53 ±0.46 cm in 30-39 years age larynx; D, rings of the trachea." — Blaisedell, 1904. Source: Group, 9.63 ± 0.23 cm in 40 - 49 years age http://etc.usf.edu/clipart/15400/15499/trachea_15499_lg.gif group & 9.79 ± 0.39 cm in 50-59 years age group. On an average the length of trachea in an The trachea connects the larynx with main adult male is 11 cm and 10 cm in female. -
Medical Term for Throat
Medical Term For Throat Quintin splined aerially. Tobias griddles unfashionably. Unfuelled and ordinate Thorvald undervalues her spurges disroots or sneck acrobatically. Contact Us WebsiteEmail Terms any Use Medical Advice Disclaimer Privacy. The medical term for this disguise is called formication and it been quite common. How Much sun an Uvulectomy in office Cost on Me MDsave. The medical term for eardrum is tympanic membrane The direct ear is. Your throat includes your esophagus windpipe trachea voice box larynx tonsils and epiglottis. Burning mouth syndrome is the medical term for a sequence-lastingand sometimes very severeburning sensation in throat tongue lips gums palate or source over the. Globus sensation can sometimes called globus pharyngeus pharyngeus refers to the sock in medical terms It used to be called globus. Other medical afflictions associated with the pharynx include tonsillitis cancer. Neil Van Leeuwen Layton ENT Doctor Tanner Clinic. When we offer a throat medical conditions that this inflammation and cutlery, alcohol consumption for air that? Medical Terminology Anatomy and Physiology. Empiric treatment of the lining of the larynx and ask and throat cancer that can cause nasal cavity cancer risk of the term throat muscles. MEDICAL TERMINOLOGY. Throat then Head wrap neck cancers Cancer Research UK. Long term monitoring this exercise include regular examinations and. Long-term a frequent exposure to smoke damage cause persistent pharyngitis. Pharynx Greek throat cone-shaped passageway leading from another oral and. WHAT people EXPECT ON anything LONG-TERM BASIS AFTER A LARYNGECTOMY. Sensation and in one of causes to write the term for throat medical knowledge. The throat pharynx and larynx is white ring-like muscular tube that acts as the passageway for special food and prohibit It is located behind my nose close mouth and connects the form oral tongue and silk to the breathing passages trachea windpipe and lungs and the esophagus eating tube. -
Cholinergic Chemosensory Cells in the Trachea Regulate Breathing
Cholinergic chemosensory cells in the trachea regulate breathing Gabriela Krastevaa,1, Brendan J. Canningb, Petra Hartmanna, Tibor Z. Veresc, Tamara Papadakisa, Christian Mühlfelda, Kirstin Schlieckera, Yvonne N. Tallinid, Armin Braunc, Holger Hacksteine, Nelli Baale, Eberhard Weihef, Burkhard Schützf, Michael Kotlikoffd, Ines Ibanez-Tallong, and Wolfgang Kummera aInstitute of Anatomy and Cell Biology and eInstitute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen D-35385, Germany; bJohns Hopkins Asthma and Allergy Center, Baltimore, MD 21224; cFraunhofer Institute for Toxicology and Experimental Medicine, Hannover D-30625, Germany; dDepartment of Biomedical Sciences, College of Veterinary Medicine, Ithaca, NY 14853; fInstitute for Anatomy and Cell Biology, Philipps-University Marburg, D-35037 Marburg, Germany; and gMax-Delbrück-Centre for Molecular Medicine, Berlin D-13092, Germany Edited* by Ewald R. Weibel, University of Bern, Bern, Switzerland, and approved May 2, 2011 (received for review December 23, 2010) In the epithelium of the lower airways, a cell type of unknown two independently generated mouse strains with knockin of eGFP function has been termed “brush cell” because of a distinctive ul- within a BAC spanning the ChAT locus (10, 11). The average trastructural feature, an apical tuft of microvilli. Morphologically number of these cells in a mouse trachea was 6242 ± 989 with similar cells in the nose have been identified as solitary chemosen- approximately twice as many cells located above noncartilagenous sory cells responding to taste stimuli and triggering trigeminal regions (4,065 ± 640 cells) than in epithelial stretches overlaying reflexes. Here we show that brush cells of the mouse trachea ex- cartilage rings (2,177 ± 550 cells) (Fig. -
Rupture of the Trachea and Bronchi by Closed Injury
Thorax: first published as 10.1136/thx.21.1.21 on 1 January 1966. Downloaded from Thorax (1966), 21, 21. Rupture of the trachea and bronchi by closed injury J. T. CHESTERMAN AND P. N. SATSANGI From the Thoracic Surgical Unit, City General Hospital, Sheffield This paper has three objects: (1) A brief clinical TABLE Il review of the subject; (2) an attempt to assess ASSOCIATED INJURIES (PATIENTS REACHING HOSPITAL the functional results of conservative surgery; ALIVE) and (3) a discussion on the mechanism of rupture. None .. .. .. .. .. .. 50% It is based on some 200 cases which have been Fractures Chest wall .... 33% reported in Western European languages, but so Pelvis and long bones 12% Head injury. 5% many records are incomplete that precise statistics Spinal, oesophageal, abdominal Rare Pulmonary vascular injury...Doubtful if it occurs are difficult to obtain. Bronchial vascular injury.25% (probable cause ofhaemoptysis and haemo- thorax) BRIEF CLINICAL REVIEW Rupture of lung Rare Tables I to V give an overall picture of the present position. patients and possibly to the poor quality of many copyright. radiographs. Fracture of one or more of the first COMMENTS ON TABLE I three ribs in a patient over 30 is very suggestive 1. There is a preponderance of males under 40 of the possibility of rupture of the air passages, affected. and if rupture is present with fracture of the ribs 2. The injury practically always involves diffuse then one or more of the first five ribs are involved. http://thorax.bmj.com/ antero-posterior compression of the chest. 3. Rupture of the lung is rare since it is pro- 3. -
Chest X-Ray Made Ridiculously Plain, Basic, Or Uncomplicated in Form, Nature, Or Design; Without Much Decoration Or Ornamentation
Chest X-Ray Made ridiculously plain, basic, or uncomplicated in form, nature, or design; without much decoration or ornamentation Steve Cohen, MD, PA-C Associate Professor, Dept. of Surgery & Director of PA Clinical Education Florida International University Really Simple Step 3 The END, Bye-Bye Thanks for Coming! Posterior Anterior (PA) Workhorse PA Films Properties • X-ray is a “NEGATIVE” – Light is dark (ex. Air) – Less x-ray get through = shows white (eg. bone) • Beam is divergent – Posterior elements magnified – Dense posterior elements may hide anterior structures What can you see on CXR? 4 3 2 5 5 1 3 6 What are we looking at? Quickie Anatomy What are we looking at? Quickie Anatomy Airway • Film “Position” – Patients left on your right • Trachea – Midline (mostly) – Open • Mostly equal from wall to wall Ribs • Rib count – Extent quality • Bony integrity – Fracture, dislocation • Left first rib – Posterior at top • Beam hits first – Anterior at bottom Ribs • Use 1st rib to count • Posterior ribs usually most visible – beam hits first • Seen here = 8 ribs • Clavicles – Integrity (fx, displacement) – Assessing midline • Same distance from trachea Diaphragm – Stomach Bubble • Right higher than left diaphragm – Liver • Costophrenic angles – Fluid “haziness” • Air under diaphragm • Stomach bubble – variable Left Vessels and Heart • Subclavian Artery • Coming off arch • Aortic Arch • Pulmonary Artery • Returning to heart • Left Atrium • Left Ventricle Right Vessels and Heart • Ascending Aorta • Leaving heart • Superior Vena Cava • Entering -
CHEST RADIOLOGY: Goals and Objectives
Harlem Hospital Center Department of Radiology Residency Training Program CHEST RADIOLOGY: Goals and Objectives ROTATION 1 (Radiology Years 1): Resident responsibilities: • ED chest CTs • Inpatient and outpatient plain films including the portable intensive care unit radiographs • Consultations with referring clinicians MEDICAL KNOWLEDGE: • Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognitive sciences and the application of this knowledge to patient care. At the end of the rotation, the resident should be able to: • Identify normal radiographic and CT anatomy of the chest • Identify and describe common variants of normal, including aging changes. • Demonstrate a basic knowledge of radiographic interpretation of atelectasis, pulmonary infection, congestive heart failure, pleural effusion and common neoplastic diseases of the chest • Identify the common radiologic manifestation of thoracic trauma, including widened mediastinum, signs of aortic laceration, pulmonary contusion/laceration, esophageal and diaphragmatic rupture. • Know the expected postoperative appearance in patients s/p thoracic surgery and the expected location of the life support and monitoring devices on chest radiographs of critically ill patients (intensive care radiology); be able to recognize malpositioned devices. • Identify cardiac enlargement and know the radiographic appearance of the dilated right vs. left atria and right vs. left ventricles, and pulmonary vascular congestion • Recognize common life-threatening -
THE 6 MAJOR BODY SYSTEMS and How They Interact with Each Other to Keep the “Body Machine” Alive and Working Well
THE 6 MAJOR BODY SYSTEMS And how they interact with each other to keep the “body machine” alive and working well. CIRCULATORY SYSTEM / CARDIOVASCULAR SYSTEM PRIMARY PURPOSE: transport blood throughout the body by circulating PRIMARY ORGANS/PARTS: Heart, blood vessels (arteries, veins, capillaries) (1) Transports/carries nutrients and oxygen through the blood to most parts of the body (2) Transports/carries waste in cells and carbon-dioxide (CO2) away from the parts: (a) Cell waste goes to the kidneys for filter and disposal (b) Carbon-dioxide (CO2) goes to the lungs to exhale (breathe out) Kidneys and Lungs have a close relationship with Cardiovascular system Kidneys: filter through blood to take out the waste and get it eventually out of the body Lungs: breathes in oxygen and gives it to the blood for Circulatory system to carry throughout the body; and takes unneeded carbon-dioxide (CO2) from the blood and breathes that out. Circulatory/Cardiovascular System through the blood to most parts of the body provides nutrients and oxygen which is needed for our bodies to have ENERGY! RESPIRATORY SYSTEM PRIMARY PURPOSE: Breathing - taking in Oxygen, pushing out Carbon-Dioxide (CO2) PRIMARY ORGANS: Lungs, trachea (tube going from lungs to nose/mouth) (1) Inhales (breathes in) Oxygen - good for the body - gives it to the Circulatory System to be transported throughout the body through the blood. (2) Exhales (breathes out) Carbon-Dioxide (CO2) - lungs get this gas from the blood (Circ. Sys.) and pushes it out of the body DIGESTIVE SYSTEM PRIMARY PURPOSE: take in food; break down food into nutrients (good) and waste (unneeded) PRIMARY ORGANS: Stomach, large and small intestines, esophagus (tube from stomach to mouth) (1) Digestive System gets nutrients (good) from food and hands it over to the blood and Circulatory System then carries those nutrients where they need to go. -
Redalyc.POSTERS EXPOSTOS
Revista Portuguesa de Pneumología ISSN: 0873-2159 [email protected] Sociedade Portuguesa de Pneumologia Portugal POSTERS EXPOSTOS Revista Portuguesa de Pneumología, vol. 23, núm. 3, noviembre, 2017 Sociedade Portuguesa de Pneumologia Lisboa, Portugal Disponível em: http://www.redalyc.org/articulo.oa?id=169753668003 Como citar este artigo Número completo Sistema de Informação Científica Mais artigos Rede de Revistas Científicas da América Latina, Caribe , Espanha e Portugal Home da revista no Redalyc Projeto acadêmico sem fins lucrativos desenvolvido no âmbito da iniciativa Acesso Aberto Document downloaded from http://www.elsevier.es, day 06/12/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. POSTERS EXPOSTOS PE 001 PE 002 A PLEASANT FINDING MALIGNANT CHEST PAIN A Pais, AI Coutinho, M Cardoso, A Pignatelli, C Bárbara A Pais, C Pereira, C Antunes, V Pereira, AI Coutinho, A Feliciano, Centro Hospitalar de Lisboa Norte C Quadros, A Ribeiro, L Carvalho, C Bárbara Centro Hospitalar de Lisboa Norte Key-words: mass, debridement, hamartoma Key-words: pain, S100, sarcoma 37-year-old male patient, salesman. Sporadic smoker. With a past history of allergic rhinitis and chronic gastritis. With no usual 26-year-old male patient, supermarket employee. Smoker of 10 medication. In January 2017, he was diagnosed with a respiratory pack-year. Past history of bronchial asthma in childhood. No rel - infection, having completed ten days of empirical antibiotic ther - evant family history. Without usual ambulatory medication. With apy with amoxicillin / clavulanic acid, with clinical improvement. a history of dry cough and chest pain in the posterior region of In May 2017, he underwent thoracic xray, which revealed homoge - the left hemithorax, for about two years, having had at that time, neous opacity of triangular morphology in the middle lobe of the chest X-ray without pathological findings, and the clinical picture right lung. -
2.05 Remember the Structures of the Respiratory System 2.05 Remember the Structures of the Respiratory System
2.05 Remember the structures of the respiratory system 2.05 Remember the structures of the respiratory system Essential question What are the structures of the respiratory system? 2.05 Remember the structures of the respiratory system 2 Structures of the respiratory system Upper Respiratory System Nose Sinuses Pharynx Epiglottis Larynx Lower Respiratory System Trachea Lungs 2.05 Remember the structures of the respiratory system 3 Structures of the Upper Respiratory System Nose Nasal cavity – space behind the nose Vestibular region Olfactory region Respiratory region Nasal septum – cartilage that divides the nose into right and left sides Turbinates – scroll-like bones in the respiratory region Cilia – nose hairs 2.05 Remember the structures of the respiratory system 4 Structures of the Upper Respiratory System Sinuses - Cavities in the skull. Ducts connect sinuses to the nasal cavity Lined with mucous membrane to warm and moisten the air Provide resonance to the voice 2.05 Remember the structures of the respiratory system 5 Structures of the Upper Respiratory System Pharynx Throat Nasopharynx Oropharynx Laryngopharynx About 5” long 2.05 Remember the structures of the respiratory system 6 Structures of the Upper Respiratory System Epiglottis A flap or lid that closes over the opening to the larynx when food is swallowed 2.05 Remember the structures of the respiratory system 7 Structures of the Upper Respiratory System Larynx Voice Box Triangular chamber below pharynx Within the larynx are vocal cords, the glottis Also called the Adam’s Apple 2.05 Remember the structures of the respiratory system 8 Structures of the Lower Respiratory System Trachea Windpipe Approximately 4 ½” long The walls are composed of alternate bands of membrane and C-shaped rings of hyaline cartilage. -
H Exchangers in Human Airways Epithelium
JOP. J. Pancreas (Online) 2001; 2(4 Suppl):285-290. - - + + Detection of Cl -HCO3 and Na -H Exchangers in Human Airways Epithelium Faiq J Al-Bazzaz, Nael Hafez, Sangetta Tyagi, Cynthia A Gailey, Mark Toofanfard, Waddah A Alrefai, Talat M Nazir, Krishnamurthy Ramaswamy, Pradeep K Dudeja Department of Medicine, University of Illinois at Chicago and VA Chicago Health Care System. West Side Division. Chicago, Illinois (USA) Summary Immunohistochemical staining for AE2 protein demonstrated localization to the epithelial cells Molecular species of the Na+-H+ exchanger of human bronchial mucosa. (NHE) and anion exchanger (AE) gene families and their relative abundance in the human airway regions were assessed utilizing RT-PCR Introduction and the RNase protection assay, respectively. Organ donor lung epithelia from various The polarized epithelia of the mammalian bronchial regions (small, medium, and large tracheobronchial mucosa and of alveolar sacs bronchi and trachea) were harvested for RNA have various mechanisms involving extraction. Gene-specific primers for the human translocation of Na+ and Cl- across cell NHE and AE isoforms were utilized for RT- membranes. These include electrogenic PCR. Our results demonstrated that NHE1, processes, such as Na+ and Cl- channels [1, 2, 3, AE2, and brain AE3 isoforms were expressed 4, 5], and electroneutral processes, such as Na+- + - - in all regions of the human airway, whereas H exchange and Cl-HCO3 exchange [2, 3, 6, NHE2, NHE3, AE1, and cardiac AE3 were not 7, 8, 9, 10, 11, 12, 13, 14, 15]. These and other detected. RNase protection studies for NHE1 mechanisms, such as electrogenic anion and AE2, utilizing glyceraldehyde-3-phosphate exchangers [16, 17] play a vital role in the dehydrogenase as an internal standard, regulation of intracellular pH and volume, demonstrated that there were regional vectorial transport of these ions, and proton or - differences in the NHE1 mRNA levels in HCO3 secretion in various fluids, such as human airways.