Urgent findings on portable chest radiography: what the radiologist should know--review
| Autor: | Matthew D. Gilman, Rathachai Kaewlai, Subba R. Digumarthy, Ashwin Asrani, Jo-Anne O. Shepard |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Pulmonary Atelectasis Point-of-Care Systems Pulmonary Edema Diagnosis Differential Postoperative Complications Aortic valve replacement medicine.artery medicine Mediastinal Diseases Humans Radiology Nuclear Medicine and imaging Pneumomediastinum Aged Aged 80 and over medicine.diagnostic_test business.industry Mediastinum Pneumothorax General Medicine Pneumonia Middle Aged medicine.disease Hemothorax Surgery Pleural Effusion medicine.anatomical_structure Aortic valve stenosis Right coronary artery Acute Disease Female Radiography Thoracic Radiology Emergencies Chest radiograph business Pulmonary Embolism Tomography X-Ray Computed |
| Zdroj: | AJR. American journal of roentgenology. 196 |
| ISSN: | 1546-3141 |
| Popis: | Objective Portable chest radiographs account for the majority of in-patient radiographs. Portable studies are usually obtained of acutely ill patients who may have urgent findings necessitating prompt detection and treatment. Urgent findings are defined as significant and unexpected findings requiring immediate corrective action. The purpose of this article is to illustrate common examples of urgent findings on portable chest radiographs and to provide useful tips for the radiologist. Clinical scenarios are included to orient the learner to the evaluation of urgent findings on portable chest radiography. The examples in this article are selected from various ICUs including medical, cardiac, neurology, cardiothoracic surgery, general surgery, orthopedic, and burn services. Conclusion Portable chest radiographs are obtained of acutely ill patients who cannot stand up for a standard two-view chest radiographic study. Although portable radiographs may be technically limited, they still provide valuable information. Acutely ill patients often have multiple support devices and rapidly evolving findings. Knowledge of the clinical setting provides a clue to the urgent findings that might be expected. Scenario I Clinical History A 71-year-old man presented with low cardiac output and elevated central venous pressure 2 weeks after cardiac surgery. He had undergone coronary artery bypass grafting with the left internal mammary artery to the left anterior descending coronary artery and the saphenous vein from the ascending aorta to the posterior descending branch of the right coronary artery. Aortic valve replacement with an ascending aortic tube graft and hemiarch replacement were also performed. Chest tube drainage showed a small amount of blood. Of note, he had undergone mediastinal exploration for evacuation of a hematoma on postoperative day 1 because of leakage from the ascending aortic graft. Serial chest radiographs were obtained daily after cardiac surgery. Figures 1A and 1B are supine chest radiographs obtained on the second and third postoperative days, respectively. The patient underwent subsequent contrast-enhanced chest CT (Fig. 1C). Description of Images The initial chest radiograph showed slight widening of the mediastinum (arrows, Fig. 1A). A subsequent chest radiograph (Fig. 1B) showed progressive widening of the mediastinum, worsening interstitial edema, and increased pleural effusions. Chest CT (Fig. 1C) revealed a high-attenuation collection in the mediastinum located to the right of the ascending aortic graft. Conclusion Magnification on anteroposterior supine radiographs, low-volume respiration, and lordotic positioning can produce an apparent widening of the mediastinum that is difficult to confidently distinguish from true abnormalities. This is especially true in critically ill or postoperative chest patients who cannot voluntarily take a deep breath. Additionally, crowding of normal vascular structures can be caused by the splinting effect of the chest. In this setting, serial chest radiographs are often helpful in identifying a change in cardiothoracic status in addition to repeated clinical and laboratory testing. Because the second radiograph was obtained using a similar technique and there were equal lung volumes compared with the baseline radiograph, an interval increase in mediastinal widening is likely to be a true finding. An aortic aneurysm is often a result of atherosclerotic disease and occurs frequently in elderly patients. Aortic root dilatation can occur in patients with severe hypertension and aortic valve stenosis. Dissection may complicate a. |
| Databáze: | OpenAIRE |
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