Imaging

Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.

The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.

Rick Robbins, M.D. Rick Robbins, M.D.

Medical Image of the Week: Central Venous Access with Dextrocardia

Figure 1. Post CVC placement chest X-ray. Catheter traced with arrows.

An 88-year old man, with known dextrocardia, was admitted with a diagnosis of septic shock. A right sided internal jugular central venous catheter was placed uneventfully using ultrasound guidance. Chest X-ray obtained after the catheter placement is shown (Figure 1). Although the utility of a chest X-ray after every ultrasound guided central line placement is questionable, it continues to be “routine practice” in many centers. In dextrocardia, a right sided central line is expected to cross the midline as in this patient. When in doubt, the catheter may not be used unless venous placement is confirmed.

Venous placement of the catheter can be confirmed by:

  1. Transducing the catheter and confirming venous waveform;
  2. Blood gas analysis consistent with venous gas;
  3. Imaging X-ray or cross sectional (1).

Bhupinder Natt MD

Division of Pulmonary, Allergy, Critical Care and Sleep

Banner-University Medical Center, Tucson, AZ USA

Reference

  1. Morton PG. Arterial puncture during central venous catheter insertion. Crit Care Med. 1999 May;27(5):878-9. [CrossRef] [PubMed] 

Cite as: Natt B. Medical image of the week: central venous access with dextrocardia. Southwest J Pulm Crit Care. 2017;15(6):296. doi: https://doi.org/10.13175/swjpcc148-17 PDF 

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Rick Robbins, M.D. Rick Robbins, M.D.

Medical Image of the Week: ICU Chest X-Ray

Figure 1. ICU portable chest x-ray. A: cardioversion pads. B: oro-gastric tube. C: right internal jugular dialysis catheter. D: endotracheal tube. E: left internnal jugular central venous catheter, incidentally seen terminating within the azygous vein. F: external EKG lead. G: chest tubes. H: staples along the thoracotomy incision. I: left lower lobe atelectasis and small pleural effusion.

A chest x-ray is probably the most commonly obtained radiographic image in the intensive care unit (ICU). Although not supported by evidence and recommended against, daily chest x-rays, especially in the intubated patients, are done in many ICUs (1,2). Multiple hardware placed for the support of the patient need to be identified for placement, position and potential complications. These can make reading a radiograph challenging specially the mediastinum. The accompanied radiograph serves as an example of an “ICU chest x-ray” with multiple “tube and lines”.

Janet Campion MD and Bhupinder Natt MD

Division of Pulmonary, Allergy, Critical Care and Sleep

Banner-University Medical Center, Tucson (AZ)

References

  1. Oba Y, Zaza T. Abandoning daily routine chest radiography in the intensive care unit: meta-analysis. Radiology. 2010 May;255(2):386-95. [CrossRef] [PubMed]
  2. http://www.choosingwisely.org/wp-content/uploads/2015/02/SCCM-Choosing-Wisely-List.pdf 

Cite as: Campion J, Natt B. Medical image of the week: ICU chest x-ray. Southwest J Pulm Crit Care. 2017;14(1):39. doi: https://doi.org/10.13175/swjpcc007-17 PDF

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