How to see what you want to see on CXR แล้วตรวจร่างกายล่ะ แล้ว chest u/s ล่ะ

สิ่งที่เรามันจะอยากเห็นบน CXR มีอยู่หลักๆ 2 diagnoses คือ pneumonia และ pulmonary edema

Alveolar pattern - pneumonia

An acute reticular pattern is most frequently caused by interstitial edema due to cardiac heart failure. The other cause is interstitial pneumonia:

• Viral
• PCP
• Mycoplasma pneumonia.

Here suggests a 4-pattern approach:-

http://www.radiologyassistant.nl/en/p50d95b0ab4b90/chest-x-ray-lung-disease.html

ส่วน physical exam

• Consolidation --> Alveolar pattern in CXR --> late inspiratory crep, bronchial/bronchovesicular BS, bronchophony, egophony, whispered pectoriloquy, increase tactile fremitus
• Heart failure --> Reticular pattern in CXR --> late inspiratory crep, normal BS, normal transmitted sound+tactile fremitus

Findings

• Crepitations
• Quality
• Coarse - chronic bronchitis
• Medium - pneumonia, bronchiectasis
• Fine - CHF
• Timing
• Early inspiratory crep - chronic bronchitis
• Late inspiratory crep - early CHF
• Mid inspir/expiratory crep - bronchiectasis
• Wheezing
• Asthma/COPD/CHF
• Rhonchi
• Pleural rub

Source: Bate's Guide to Physical Examination; page:240-243; http://ponlagon.blogspot.com/2013/04/blog-post_9.html

Pathology and physical exam and ultrasound

• Consolidation: decreased echo, deeper penetration, air bronchogram/air bubble, hepatization, decreased A-line, +/- increased B-line
• Pulmonary edema: increased B-line -- interstitial edema, decreased A-line

Source: http://www.criticalecho.com/content/tutorial-9-lung-ultrasound