ABCDE approach for CXR Interpretation

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Using ABCDE approach in CXR interpretation

Dr Issam Abdulwahab Seyala

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Learning Outcomes

By the end of this session you should be able to: 1. Demonstrate methodical and thorough interpretation of the chest X-ray. 2. Recognise common abnormalities observed in chest radiography. 3. Apply a well-structured communication for handover the important CXR findings.

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• You will navigate a total of 8 cases to work through.

• Every page contains helpful tools to assist you as you progress through the tutorial:

Using this Educational Media

• Take your time to absorb the information and engage with the interactive components to maximize your understanding.

• Expect to spend around 30 to 40 minutes completing this tool.

• Get ready for a quiz to test your understanding and reinforce key concepts.

Finally, Enjoy!

Using This Educational Media

Can you remember the normal anatomical structure observed in the Chest x ray?

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Back to Anatomy

Name DOB

PA

1. Check identity (Highlighted in white) 2. Assess quality, using mnemonic PIER: - Position (P): i. Supine (AP or PA). ii. Lateral. - Inspiration (I): Count posterior ribs should be 10 to 11 ribs. Please click on - Exposure (E): Showed full lung details. - Rotation (R): The distance between the medial clavicle and the adjacent vertebral margin should approximately match (please note the dotted line).

Before starting interpretation, Please remember to:

ABCDE approach is a benefecial systematic method for CXR intrpretation.A: Airway. B: Breathing. C: Circulation. D: Disability. E: Everything else.

ABCDE approach

A : airways. B: breathing. C: circulation. D: disability. E: everything else.

ABCDE Approach

Please click on each icon in turn for systematic ABCDE approach.

Case 1

55 year old male usually fit and well presented with 3 days history of fever, shortness of breath and productive cough with green sputum. On examination: he was clinically unwell, tachycardic, BP 120/70 mmHg and temperature 38 and SPO2: 95% on 2 litres of Oxygen. Chest auscultation revealed reduced air entry in the right side with right basal crackles. ED doctor requested CXR which showed:

QUIZ 1

- Follow ABCDE approach as per icons in page 6.

Correct answer is: Community Acquired Pneumonia

- There is a right basal opacity as indicated by the arrow. - Consolidation may result from any condition that displaces alveolar air, such as pneumonia, where inflammatory exudate replaces the air within the alveoli.

You are asked to review 60 year old female who arrived at the emergency department with a sudden onset of breathlessness. The symptoms started approximately 2 days ago and have been getting worse On examination: she is tachypnic with oxygen saturation of 95% on 2L of oxygen. Chest auscultation: reduced air entry right base with reduced tactile vocal fremitus. CXR showed:

Case 2

QUIZ 2

- Follow ABCDE approach as per icons in page 6. - There is a right sided basal effusion as indicated by the arrow. - It is important to acknowledge that in a standard upright chest X-ray, a significant amount of fluid, ranging from 250 to 600 mls, may be needed before pleural effusion becomes visually apparent.

Correct answer is: Pleural effusion

A 65-year-old COPD patient presents at the emergency department with sudden onset of dyspnoea and left-sided chest discomfort. Denies fever, chills, or changes in sputum. Vital signs: BP 136/92 mmHg, HR 110 bpm, RR 24 breaths/min. Examination reveals decreased chest movement, left-sided hyperinflation, hyper-resonance on percussion, and diminished breath sounds bilaterally, more pronounced on the left. Please review the next slide for the CXR requested

Case 3

QUIZ 3

- Follow ABCDE approach as per icons in page 6. - There is a left sided pneumothorax as indicated by the arrow. - There are no clear lung markings in the left side. - Do not forget to look for mediastinum shift (Tension pneumothorax).

Correct answer is: Pneumothorax

Case 4

A 73-year-old female with a history of MI presents to the emergency department experiencing breathlessness. Examination reveals central cyanosis, cool extremities, tachycardia (110 bpm), and barely recordable systolic blood pressure (80 mmHg). Jugular venous pressure is elevated, with a gallop rhythm and a displaced cardiac apex beat. Chest examination reveals widespread crackles and wheezes. Urgent CXR requested and showed:

QUIZ 4

Cardio-Thorasic ratio > 0.5

- Follow ABCDE approach as per icons in page 6. - This patient presented with acute pulmonary oedema secondary to decompensated heart failure. - CXR findings include: Cardiomegally, dilated upper lobe vesseles and alveolar oedema. -

Correct answer is: Pulmonary Oedema

35 year old female presented with sudden onset severe epigastric and left sided abdominal pain. She has background of rheumatoid arthritis and take regular analgesics. She is tachycardic with abdominal examination revealed severe tenderness in epigastric and left hypochondrial area. CXR showed:

Case 5

QUIZ 5

- Follow ABCDE approach as per icons in page 6. - There is a rim of air below the left hemi-diaphragm as indicated by the arrow. - This finding indicates the presence of gas within the peritoneal cavity and is frequently indicative of a severe medical condition, commonly associated with the perforation of a hollow organ.

Correct answer is: Pneumoperitonium

A 65-year-old male presents to the emergency department with a few days history of shortness of breath . He initially felt faint but did not lose consciousness. He experiences right-sided chest pain aggravated by deep breaths. Past medical history was unremarkable. He recently underwent left hip replacement and noticed swelling in his left calf. His current vital signs are: heart rate of 112 bpm, blood pressure of 95/65 mmHg, and oxygen saturation of 91% on room air.

Case 6

QUIZ 6

- Follow ABCDE approach as per icons in page 6. - This chest x ray showed no abnormalities. - Typical history of pleuritic chest pain, recent major surgery, leg swelling (probably DVT), tachycardia and hypoxia. All are highly suggestive of diagnosis of PE. - CXR is usually normal and used to exclude other diagnosis.

Correct answer: Normal CXR

A 65-year-old male reported a dry, persistent cough over the last 2 months and an unintentional weight loss of 8 kg over the same duration. He denies fevers, difficulty breathing, sore throat, runny nose, chest pain, or haemoptysis. His medical history includes chronic obstructive pulmonary disease (COPD) and hypertension. He quit smoking 5 years ago after 40 years of a one-pack-per-day smoking. Physical examination reveals no palpable lymph nodes and reduced air entry left side. You have been asked by the nurse to review his chest x ray.

Case 7

QUIZ 7

- Follow ABCDE approach as per icons in page 6. - There is a left sided round mass in the left upper lobe (indicated by the icon). - History of significant non-intentional weight loss on background of smoking are highly suggestive of lung cancer. Further imaging like CT chest, abdomen and pelvis is required to confirm the diagnosis and for staging.

Correct answer is: Lung cancer

45 year old female come to A&E with few weeks history of palpitation, progressively worsening neck swelling, hot intolerance, mood changes and amenorrhoea. Over the last week she noticed worsening shortness of breath. As part of routine investigations in the emergency department, she had Chest x ray done which showed:

Case 8

- Follow ABCDE approach as per icons in page 6. - There is a significant tracheal narrowing secondary to pressure effect from goitre (indicated by the icon). - Symptoms of palpitation, hot intolerance, neck swelling, amenorrhoea and mood changes are features of hyperthyroidism.

Correct answer is: Airway

To enhance retension and transferring of what you just learnt, you need simply to:

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References