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CXRs & ECGs

CXRs & ECGs. What to look for. Patient data Technique (AP/PA, exposure, rotation, supine, erect) Trachea Lungs Pulmonary vessels Hila (masses, lymphadenopathy) Heart (width etc ) Mediastinal contour Pleura Bones Soft tissues Any other external devices (e.g. tubes, wires).

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CXRs & ECGs

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  1. CXRs & ECGs

  2. What to look for • Patient data • Technique (AP/PA, exposure, rotation, supine, erect) • Trachea • Lungs • Pulmonary vessels • Hila (masses, lymphadenopathy) • Heart (width etc) • Mediastinal contour • Pleura • Bones • Soft tissues • Any other external devices (e.g. tubes, wires)

  3. Incomplete inspiration Complete inspiration May lead to incorrect diagnosis (due to inability to notice normal anatomical structures)

  4. Underpenetrated Overpenetrated

  5. Clavicular head and spinous process alignment

  6. Skewed clavicles • Skin folds may be mistaken for a pneumothorax

  7. CT showing a mass this is likely pleural based (red arrow) • Pleural effusion posteriorly

  8. Congestive Heart Failure *After significant resolution

  9. Congestive Heart Failure with Kerley B lines

  10. Chronic TB Fibrosis, cavitation and calcification, particularly in RU lobe

  11. Pleural effusion in left hemithorax • RU lobe haemorrhage

  12. Bilateral pleural effusions • Blunting of both posterior costophrenic angles

  13. Right sided tension pneumothorax • Leftward mediastinal shift

  14. Interstitial Pulmonary Fibrosis • Hazy ‘ground glass’ opacification early

  15. Bilateral flattening of diaphragms • Significant hyperinflation • 11 posterior ribs visible Emphysema

  16. Posterior Mediastinal mass • Superomedial part of right lung is interrupted

  17. 55 yo male; 4hrs of ‘crushing’ chest pain • ST elevation in II, III, VF • Reciprocal ST depression in anterior leads • Acute inferior myocardial infarction

  18. 40 yo female; pleuriticcest pain, breathlessness • S1Q3T3 (prominent; present; inverted) • Sinus tachycardia • T wave inversion in V1-V3 • Right bundle branch block • Acute Pulmonary Embolus

  19. 75 yo female; loud S1, mid-diastolic murmur • Afib • No P waves present • Irregularly irregular • Right axis deviation and deep S waves in lateral leads • Mitral Stenosis

  20. 75 yo male; exercise intolerance • P waves show no relation to QRS • Ventricular escape rhythm • Complete Heart Block

  21. Complete Heart Block

  22. 53 yo male; IHD • Q wave in lead III wider than 1mm (1 small square) • Q wave in lead VF wider than 0.5mm • Q wave in lead II • Old Inferior MI

  23. Wide QRS • Changing R-R intervals • Torsade de Pointes

  24. 47 yo male; long history of palpitations, lately blackouts • Irregularly irregular, wide complex tachy • Wolf-Parkinson-White Syndrome with AFib

  25. Normal ECG

  26. Some good reference sites • http://www.ecglibrary.com/ • http://www.med-ed.virginia.edu/courses/rad/ • http://www.chestx-ray.com/Anatomy/Anatomy.html

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