Faculty Disclosure Nothing to disclose Educational Need/ Practice - PDF document

3/31/2011 Helpful Hints for Clinically Important Plain X-Ray Images I. chest/ airway I. chest/ airway [ II. abdomen – Dr Challa] Alan E. Oestreich, MD, FACR Professor, Radiology and Pediatrics University of Kentucky and Professor Emeritus, Radiology University of Cincinnati Faculty Disclosure •Nothing to disclose Educational Need/ Practice Gap •To raise awareness of the role of chest and airway f h d i radiograph interpretation in clinical care situations 1

3/31/2011 Objective •The attendee should be able to recognize and understand the upper airway conditions epiglottits, bacterial tracheitis, and l b l h d membranous croup; and signs of lung infiltrates and air trap phenomena in the thorax Expected Outcome •A greater awareness of the x ‐ ray patterns of epiglottitis , croup and membranous croup and membranous croup , “hidden” pneumonias , and free intrathoracic air 2

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3/31/2011 upper Alan respiratory tract Oestreich MD 4

3/31/2011 symmetric subglottic narrowing : croup , but over about 2 years old, consider bacterial tracheitis Note – many cases of epiglottitis also have symmetric subglottic narrowing asymmetric: consider membranous croup (or whooping cough) if acute; otherwise, such things as prior intubation, vascular malformations, … 5

3/31/2011 The most common round soft-tissue density in the lung of a child is air bronchogram sign 6

3/31/2011 from Albuquerque: #19 not just “cough and fever” (…. from #17 to #2) 7

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3/31/2011 silhouette sign 11

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3/31/2011 ] lucent waterwings sign; sharp edge sign; raised thymus sign ] pneumomediastinum 13

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3/31/2011 epiglottitis - croup -bacterial tracheitis – membranous croup pneumonia may be round –look behind the heart –look behind the diaphragm sharp edge sign pneumothorax – pneumomediastimum –pneumopericardium look at what you forget to look at look at what you forget to look at look everywhere else (except epiglottitis) 20