Checklist Lines, tubes and foreign bodies Endotracheal tubes 1 - PDF document

10/13/2016 Chest Radiology Case #1 Checklist: Tips, Tricks and Things You Should Never Miss! Checklist  Lines, tubes and foreign bodies Endotracheal tubes 1

10/13/2016 Airway landmarks 3-7 cm What is the ideal location? 2

10/13/2016 Tip position with changes in head Esophageal intubation Esophageal intubation 3

10/13/2016 When is the tube post-pyloric? Enteric tubes GE junction 1 st duodenum Ligament of Treitz 2 nd duodenum 4 th duodenum 3 rd duodenum 4

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10/13/2016 Tension PTX s/p feeding tube removal 6

10/13/2016 Central lines Venous IJ IJ anatomy SCV SCV RBCV SVC LBCV AzV The Elusive Cavoatrial Junction Venous landmarks 7

10/13/2016 Variation with expiration ? location Right posterior oblique 8

10/13/2016 IJ IJ SCV SCV RBCV SVC LBCV AzV 9

10/13/2016 Left SVC Duplicated SVC Duplicated SVC 10

10/13/2016 Pacemaker in left SVC PICC in internal mammary vein PICC line in aorta RIJ line in aorta 11

10/13/2016 Arterial line Venous line Central line free in mediastinum 12

10/13/2016 Pulmonary artery catheters Infarct from a PA line Pulmonary artery pseudoaneurysm 13

10/13/2016 Retained surgical sponge Retained catheter fragment Pneumothorax Checklist  Lines, tubes and foreign bodies 14

10/13/2016 Checklist Pneumothorax vs. skin fold  Lines, tubes and foreign bodies • Pleural line, NOT edge  Pneumothorax • No vessels lateral to line • Line doesn ’ t go outside chest wall or across midline Pleural Line Edge Pleural Line Edge Air in Air in pleura pleura Air in Air in lung lung 15

10/13/2016 Skin fold Not a PTX! Where is the PTX? Pre ‐ IJ line removal Post ‐ IJ line removal 16

10/13/2016 Deep Sulcus Sign ARDS with pneumothorax Pneumothorax (subpulmonic) ? PTX 17

10/13/2016 Tension pneumothorax Case #3 Checklist  Lines, tubes and foreign bodies  Pneumothorax 18

10/13/2016 Normal mediastinal interfaces Checklist Right  Lines, tubes and foreign bodies Aorta paratracheal stripe Aorticopulmonary window  Pneumothorax Left pulmonary artery  Mediastinal abnormalities Azygoesophageal recess Metastatic disease (unknown primary) Tuberculosis 19

10/13/2016 Lung Cancer Esophageal cancer Case #4 Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities 20

10/13/2016 Subtle cancer #1 Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities  Tough spots in the lungs Subtle cancer #2 Subtle cancer #3 21

10/13/2016 ? pneumonia ? pneumonia Normal LLL Pneumonia Normal Pleural effusion 22

10/13/2016 Normal Nodule Normal Pott’s disease Don’t forget about the bones Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal abnormalities  Tough spots in the lungs 23

10/13/2016 A simple approach to lung opacities… Checklist  Lines, tubes and foreign bodies  Pneumothorax  Mediastinal lymphadenopathy  Lung nodules  Bones Alveolar Interstitial 24

10/13/2016 Airways Not applicable Alveolar What produces alveolar opacities? • Fluid • Blood • Features of alveolar disease • Pus – 1. Confluent opacities • Cells – 2. Air bronchograms – 3. Fluffy at the periphery 25

10/13/2016 ARDS Pulmonary edema Hemorrhage PCP Pneumonia 26

10/13/2016 Which compartment of lung is affected Interstitial Interstitial Alveolar Miliary TB 27

10/13/2016 Miliary TB What diseases cause small nodules? • Infections (fungus and tuberculosis) • Malignancy • Sarcoidosis Miliary fungal Sarcoidosis 28

10/13/2016 Interstitial Metastatses: lung cancer Pulmonary edema What diseases cause lines? • Pulmonary edema • Malignancy • Interstitial lung disease (e.g. IPF) 29

10/13/2016 Edema Idiopathic pulmonary fibrosis Airways disease • Circular • Tubular Which compartment of lung is affected? 30

10/13/2016 Cystic fibrosis 31