The Medical Student's Guide to the Plain Chest Film.pdf

The

Medical Student's

Guide

to the

Plain Chest Film

Edwin F. Donnelly, M.D., Ph.D.

reproduced or distributed without the written permission of

either the publisher or the author.

ISBN 1-4116-9538-0

Published by Carchedon Publishing.

Distributed through Lulu Press.

Electronic Proof

Not For Distribution

www.carchedon.com

T able of C ontents

Introduction

Quick Flow Chart

iii

I Normal Anatomy

II Approach to the Film

III Life Support Devices

IV Physiology of the Chest

V Parenchymal Patterns

VI Nodules and Masses

VII Don’t-Miss Lesions

Introduction i

I ntroduction

here are no great textbooks out there for medical students (and,

for that matter, interns) who want to learn the basics of chest

film interpretation. Most chest radiologists balk at the thought

of trying to teach such a huge topic to a group that cannot devote a

significant amount of time to this one area. Of course, not everyone can

do a residency in Radiology and a fellowship in Thoracic Radiology. The

reality, though, is that as medical students and interns you will be caring

for a great number of patients on whom you will be ordering these

studies. While most films will ultimately be interpreted by a Radiologist,

you will nevertheless be expected to look at any film you order and you

should have some comfort in making general diagnoses off of these films

without having to wait the “official read.” In addition, many chest films

are obtained at night, both in the Emergency Department and in the

hospital. These films may have abnormalities that are immediately life-

threatening. You responsibility is to the patient, and the sooner you can

make the diagnosis, the better off the patient will be.

The true secret to understanding these films is that it is not

always as difficult as some would have you believe. Many of the more

difficult and confusing diagnoses can wait for the radiologists. You do

not need to worry about the subtle differences in findings between

different chronic interstitial diseases. These cases can wait for the

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