Friday, March 22, 2013

Chest radiograph of different conditions

Pink Puffer
– Pa02 70 – 75 
– Mild C02 retention 40 – 50 torr

Blue Bloater

– Pa02 < 70 
– Mod – Severe C02 retention
– Polycythemia



Bronchiectasis:
  • Permanent dilatation of bronchi.
  • Cough, copious purulent sputum.
  • Lower lobes common
  • Complications; 
  • Pneumonia, empyema, septicemia, meningitis.
  • Types:
  • Cylindrical, Saccular, Fusiform (no significance)


Cardiomegaly

Causes
Numerous causes such as hypertension, renal failure, valvular lesions, cardiomyopathy,
severe anemia, thyroid disorders, hemochromatosis, and amyloidosis.

CXR Findings
Measure from the most lateral borders of the heart and compare this width to the inner border of the widest part of the inner rib; if this ratio exceeds 50%, the diagnosis can be made.


Heart size and shape

A normal Heart shadow in CXR PA view

Left atrial enlargement

Rheumatic mitral stenosis. This frontal film shows marked
enlargement of the left atrial appendage (arrow).

Penetrated chest film in the same patient double right heart border and splaying of the carina is seen

Right atrial enlargement

Right atrial enlargement. Right atrial enlargement is often difficult to detect with only subtle enlargement of the right heart border present on the PA view.

Left ventricular enlargement

Selective left ventricular enlargement in aortic incompetence. (A) Frontal view shows that the left ventricle has enlarged along its long axis, taking the apex of the heart to the left and downward (white arrow).


(B) Lateral view shows the left ventricle extending behind the line of the barium-filled oesophagus (arrow).

Congestive Heart Failure (CHF)

STAGE I CHF (PROGRESSIVE CEPHALIZATION) (Can only use this sign on an upright chest x-ray, not supine, since blood flow will redistribute.)
CAUSE
Increased mean capillary wedge pressure 10–20 mm Hg
CHEST X-RAY FINDINGS
Progressive cephalization, which means increased blood fl ow toward the top of the lung


CXR showing cardiomegaly with cephalization in a patient with pulmonary venous hypertension.

STAGE 2 CHF  (INTERSTITIAL EDEMA)
CAUSE
Increased mean capillary wedge pressure 20–25 mm Hg
CHEST X-RAY FINDINGS
Thin white lines due to interstitial edema, known as Kerley B lines (Horizontal white lines at the lung bases extending from the periphery of the lung). 

Kerley-B lines

STAGE 3 CHF (ALVEOLAR EDEMA)
CAUSE
Wedge pressure greater than 25 mm Hg
CHEST X-RAY FINDINGS
Increased opacity around the hilum in a butterfly pattern referred to as “bat wings” appearance. 
STAGE 4 CHF (CHRONIC PULMONARY VENOUS HYPERTENSION) 
CAUSE
Increased wedge pressure greater than 30 mm Hg
CHEST X-RAY FINDINGS
Bilateral interstitial infi ltrates and bilateral pleural effusions.

Note- If the patient doesn’t have cardiomegaly, consider noncardiogenic causes of CHF such as head injury or drug overdose.

CXR depicting cardiomegaly with bilateral interstitial infiltrates and bilateral pleural effusions, consistent with advanced CHF.
Enlargement of the ascending aorta can be found with Marfan's disease, aortic insufficiency, post-stenotic dilation and aortic aneurysms. 
The prominence of central pulmonary artery caused by pulmonary hypertension.

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