Postoperative chest x-ray May Mats Beckman Emergency Radiology. Shutter use!
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1 Postoperative chest x-ray May 2009 Mats Beckman Emergency Radiology Shutter use! 2Postoperative chest x-ray May 2009
2 Exposure/ window settings Quick resorption of infiltrations= water logged lung 3Postoperative chest x-ray May 2009 Fluid?? 4Postoperative chest x-ray May 2009
3 Ultrasound! 5Postoperative chest x-ray May 2009 Fluid? Meniscus Obliteration of sinus Grey gradient Interlobar fissure AP Chest ca 60% sensitivity in fluid detection 6Postoperative chest x-ray May 2009
4 Before and after percutaneous pigtail drain 7Postoperative chest x-ray May 2009 Before and after percutaneous pigtail drain 8Postoperative chest x-ray May 2009
5 DAD = Diffuse alveolar disease. RDS 9Postoperative chest x-ray May 2009 Causes of Acute Respiratory Distress Syndrome Aspiration Burns Cardiopulmonary bypass surgery Chest injury Inflammation of the pancreas (pancreatitis) Inhalation of large amounts of smoke Inhalation of other toxic gas Injury to the lungs from inhaling high concentrations of oxygen Massive blood transfusions Near drowning Overdose of a drug, such as heroin, methadone, propoxyphene, and aspirin Pneumonia Prolonged or severe low blood pressure (shock) Pulmonary embolism Severe, widespread infection (sepsis) 10Postoperative chest x-ray May 2009
6 AP Chest Tension pneumothorax Hemothorax Diaphragm Mediastinum LEFT VS RIGHT? 11Postoperative chest x-ray May 2009 Normal chest AP view 12Postoperative chest x-ray May 2009
7 Oblique view- NOT right tension 13Postoperative chest x-ray May 2009 Normal Chest x-ray can hide 14Postoperative chest x-ray May 2009
8 Hemothorax +? SC emfysema 15Postoperative chest x-ray May 2009 Tension pneumothorax Action? 16Postoperative chest x-ray May 2009
9 Acute drainage!! 17Postoperative chest x-ray May 2009 For those with tame surgons 18Postoperative chest x-ray May 2009 Trauma.org
10 Metro accident 19Postoperative chest x-ray May 2009 Spineboard! 20Postoperative chest x-ray May 2009 With and without Spineboard
11 Spineboard 21Postoperative chest x-ray May 2009 B- Breathing A young female falls 3m. Initially unconcious and intubated on the spot. On arrival to the hospital sat 96% with 40% oxygen. Clinical examination reveals tympanistic percussionsound on the right thorax, decreased breathing sounds on the left. Immediate management? 22Postoperative chest x-ray May 2009
12 B-Breathing Chest X-ray reveals right bronchial intubation, a common finding in trauma patients intubated under stress. 23Postoperative chest x-ray May 2009 Postop left upper lobe resection Bülau- drainage Gotthard Bülau was the son of the physician Gustav Bülau ( ). From 1854 he studied in Heidelberg and Göttingen, where he obtained his doctorate in Postoperative chest x-ray May 2009
13 ETT and Central line 25Postoperative chest x-ray May 2009 Lung resection Preop 26Postoperative chest x-ray May 2009
14 Lung resection Postop 27Postoperative chest x-ray May 2009 Lung resection Postop 3d 28Postoperative chest x-ray May 2009
15 Lung resection Postop 5d 29Postoperative chest x-ray May 2009 CDK Central Dialysis Katheter Tip at right atrium inlet 30Postoperative chest x-ray May 2009
16 Process parameters 31Postoperative chest x-ray May 2009 Process parameters adjusted for lines 32Postoperative chest x-ray May 2009
17 Infection lobar pneumonia S-value? 33Postoperative chest x-ray May 2009 PA Katheter Pulmonary Artery 34Postoperative chest x-ray May 2009
18 PA Catheter Pulmonary Artery 35Postoperative chest x-ray May 2009 PA Catheter Location relative truncus pulmonalis Central or peripheral Wedge to assess pressure in left atrium Used to monitor iv fluid 36Postoperative chest x-ray May 2009
19 Wedge to assess pressure in left atrium 37Postoperative chest x-ray May 2009 Introducer ETT Pigtail CVK Pigtail 38Postoperative chest x-ray May 2009
20 The immunocompromised patient 39Postoperative chest x-ray May 2009 Infiltrations or fluid?? 40Postoperative chest x-ray May 2009
21 Cardiac failure Stas Aggravated by renal failure. Aortic valve. 41Postoperative chest x-ray May 2009 TEE trans esophageal echocariography 42Postoperative chest x-ray May 2009
22 Advice Shutters Patient close to film Adequate exposure Same exp as last time Do not manipulate the picture at QA station Reprocsss if lines are placed. INHALE, cooperate with ICU staff! 43Postoperative chest x-ray May 2009 Diagnostic Difficulties? DO CT! Low dose chest CT for ICU? 44Postoperative chest x-ray May 2009
23 DLP ca 500 DLP 34 45Postoperative chest x-ray May 2009 Thank You! 46Postoperative chest x-ray May 2009
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