CORE CASE 4 WORKSHOP

Petra Lewis MDProfessor of Radiology and OBGYN

Geisel School of Medicine at Dartmouth

Learning objectives Be able to identify some of the most common radigraphic

findings in emphysema and COPD Know what the imaging alternatives are for patients with

suspected aortic dissection Understand how aortic dissection can look on CT scans Know some methods for decreasing renal toxicity from

contrast Know the CXR findings in mild and more severe pulmonary

edema Know the imaging options for patients with suspected PEs See examples of PE on CT and VQ scans Understand the significance of VQ scan reports

COPD and emphysema

What are some of the CXR signs of COPD/emphysema

What might we see on a CT?

Patient 1 Patient 2

Aortic dissection

What patients are at risk for aortic dissection?

How might they present?

What are our imaging options?

What do we look for on a contrast enhanced chest CT in patients at risk of aortic dissection

How do we classify aortic dissections? What is the significance of the classifications

How can we decrease renal toxicity from iodinated contrast?

Which patients are at risk?

Pulmonary edema

What are some of causes of pulmonary edema?

How might we distinguish between the causes?

When might the heart not be enlarged, yet the cause be cardiogenic?

What are some of the earliest CXR signs of pulmonary edema?

Interstitial Pulmonary Edema

What are the radiographic signs of severe pulmonary edema?

Why do we sometimes see effusions in patients with CHF but no pulmonary edema?

Sev

erity

Time

Pulmonary emboli

What are our diagnostic options in patients with suspected PE?

What guides our choice?

Put the following CT scans in order of how soon after injection that we acquire them.

CTPA for PE

Abdominal CT for R/O mets

CTA for dissection

What do we look for on a CTPA for PE? How good is this test?

Patient 1 Patient 2

Patient 1

Patient 2

What do you see here that might suggest that the patient is at cardiovascular risk from her PE?

How are VQ scans reported?

What do the probabilities mean?What is the risk of PE? Normal = Very low = Low = Intermediate = High =

What do we look for on a VQ scan?

Appendix

Recognize the typical changes of emphysema and COPD on chest radiographs. Recognize the classic findings of aortic dissection on CT scans. Understand how aortic dissections are classified based on imaging Have a basic concept of complications of aortic dissections and how dissections can be treated Know the different imaging options used to diagnose pulmonary embolism. Understand the basic principles of nuclear medicine V/Q scan imaging Understand the significance of V/Q scan interpretations: normal, low, intermediate and high

probability. Know options to decrease renal toxicity from IV contrast in a patient with impaired renal function Know when a D-dimer should be measured and the significance of a raised or normal value Know the typical appearance of pulmonary emboli on CT pulmonary angiograms Understand the use of IVC filters. Recognize cardiomegaly on chest radiographic and provide a differential diagnosis. Know the imaging findings of pulmonary edema. Understand the difference between in the terms “CHF” and pulmonary edema. Recognize Kerley B lines (and what they mean). Know where the heart chambers are on a chest radiograph and how the chest radiographs will

change with chamber enlargement. Know the approximate positioning of heart valves on chest radiographs.