Dr. Michael Gibbs is a Professor of Emergency Medicine and interested in educating others. Radiology is a passion of his. Follow along with the EMGuideWire.com team as they post Dr. Gibbs's weekly educational, self-guided radiology slides on: RUL pneumonia, tension hemothorax, blunt bronchial injury, pneumomediastinum, Free air under the diaphragm, Lung Cancer and pleural effusion, Tension pneumothorax, cardiomegaly
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #4 Cases
1. Chest X-Rays Of The Week
Michael Gibbs, MD, FACEP, FAAEM
Professor And Chair
Department of Emergency Medicine
Carolinas Medical Center & Levine Children’s Hospital
Vice President of Research
Atrium Health
CMC X-Ray Mastery Series
March 4th 2019
2. Disclosures
This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
The goal is to promote widespread mastery of CXR interpretation.
There is no personal health information [PHI] within and ages have been
changed to protect patient confidentiality.
3. Process
Many are contributing: Emergency Medicine, Fellows from the Center For
Advanced Practice, Trauma & Acute Care Surgery, SHVI, and Medical
Critical Care. Slides are shared with all contributors.
Cases submitted this week be distributed next week.
The 1st image will show a chest X-ray without identifiers and the 2nd image
will reveal the diagnoses.
9. 42 Year-Old In A
High Speed Motor
Vehicle Crash.
Traumatic Right Tension Hemothorax
10. 31 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
11. 31 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
Right Chest
Tube
Multiple Rib Fractures And A Persistent Right
Pneumothorax Despite A Well Place Chest Tube
12. 42 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
1st Right
Chest Tube
2nd Right
Chest Tube
So, Why Does The Pneumothorax Persist After TWO Chest Tubes?
13. 42 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
1st Right
Chest Tube
2nd Right
Chest Tube
So, Why Does The Pneumothorax Persist After TWO Chest Tubes?
Our Patient Has A Large
Bronchial Laceration
That Leaks Air Into The
Pleural Space Faster
Than The Chest Tubes
Can Remove It.
14. 42 Year-Old In A
High Speed Motor
Vehicle Crash.
Ejected.
Our Patient Has A Large
Bronchial Laceration
That Leaks Air Into The
Pleural Space Faster
Than The Chest Tubes
Can Remove It.
The Next Step Is To Isolate & Occlude The Right Lung
Balloon Catheter
Occlusion Of The
Right Lung
16. Healthy 13 Year-Old With Throat And Upper Chest Pain
Pneumomediastinum & Pneumopericardium
17. Healthy 13 Year-Old With Throat And Upper Chest Pain
Pneumomediastinum & Pneumopericardium
18. Healthy 13 Year-Old With Throat And Upper Chest Pain
Pneumomediastinum & Pneumopericardium
19. 39 Year-Old With A Past History of Large Bowel Obstruction Presents With Severe Abdominal Pain
20. 39 Year-Old With A Past History of Large Bowel Obstruction Presents With Severe Abdominal Pain
Free Air Under The Diaphragm: Colonic Perforation
21. 48 Year-Old With Gallstone Pancreatitis Develops Acute Severe Peritonitis.
22. 48 Year-Old With Gallstone Pancreatitis Develops Acute Severe Peritonitis.
Free Air Under The Diaphragm: Duodenal Perforation
23. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath
24. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath
Prior CXR: Right Hilar Mass + RUL Density
RUL
Density
25. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath
26. 55 Year-Old With A Past History Lung Cancer Presents With Increasing Shortness Of Breath
Current CXR: New Malignant Right Pleural Effusion
New (Malignant)
Pleural Effusion
40. Summary Of Diagnoses This Week
• Right upper lobe pneumonia
• Traumatic tension hemothorax
• Blunt bronchial injury
• Pneumomediastinum
• Free air under the diaphragm
• Lung cancer + malignant pleural effusion
• Tension pneumothorax after central line placement
• Right lower lobe pneumonia
• Pleural effusion
• Cardiomegaly