Imaging in the ICU

Imaging in the ICU

ModalitiesX-RayCT scansMRIUltrasound examinationsAngiographyFlouroscopy

X-RayMost commonAP viewCentering difficultExposure equalization difficultX-Rays other than chest difficult

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Case 170 year old diabetic reverend admitted to the ICU for Urosepsis. Intubated for poor sensorium and labored breathing. On treatment gradually getting better. On day 5, being weaned from ventilation when he desaturates with no hemodynamic instability. On examination has decreased breath sounds on right side and crackles bilaterally

876308A

876308A

918121C

CollapseHumidificationSuctionChest physiotherapyPositionPEEPBronchoscopy

Case 230 yr old man with AML on chemotherapy develops bilateral fungal pneumonia. He is intubated for persistent hypoxia in spite of CPAP. His lung infiltrates worsen on Amphotericin and antibiotics and he requires high peep, low tidal volumes and prone position ventilation to maintain saturations of 88-92%. He is also on high inotropes. On Day 15, he develops a sudden deterioration of oxygenation and hemodynamics.

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864620C

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864620C

898326C20 yr old primi with scrub typhus

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898326C

PneumothoraxDeep sulcus sign

Hemodynamic compromiseSuspected tensionHemodynamically stableNeedle aspiration and chest tube placementFiO2 100%Reduce PEEP to 3FiO2 100%Reduce PEEP to 3Chest X-RayClinically suspected pneumothoraxChest X-RayMechanical ventilationSymptomaticSelf ventilatingasymptomaticChest tube/pigtailConservative management

Case 3Patient with Multiple Myeloma on mechanical ventilation for respiratory failure due to bilateral pneumonia.FiO2 100%, PEEP 15cm H2O, TV 360ml Rate 35/min.

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BA16 year old girl with ITP,autoimmune thyroiditis and medium vessel vasculitis on mechanical ventilation with high PEEP for ARDS due to viral pneumonia

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Causes of pneumomediastinum in mechanical ventilationHigh tidal volumesHigh PEEPfighting the ventilatorAuto PEEP

Case 435 yr old lady with SLE and lupus nephritis and mild CRF on steroids is intubated for severe hypoxia when she presents to the emergency department with breathlessness. Examination reveals bilateral crackles. She is started on cover for bacterial, fungal and PCP etiologies.

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Ely, E. W. et al. Chest 2002;121:942-950The VPW is measured by (1) dropping a perpendicular line from the point at which the left subclavian artery exits the aortic arch and (2) measuring across to the point at which the superior vena cava crosses the right mainstem bronchus

Vascular Pedicle Width

890403C

278680A

832720C-malaria

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Patients with a VPW > 70mm coupled with a cardiothoracic ratio >0.55 are more than three times likely to have a Pulmonary Artery Occlusion Pressure > 18mm Hg compared to those without these findings.

Wayward Lines

ReviewCollapseDeep sulcus sign for pneumothoraxPneumomediastinumFluid overload-VPWPleural effusionWayward lines

Patient with Multiple Myeloma on mechanical ventilation for respiratory failure due to bilateral pneumonia. Arrows show edge of pneumomediastinum along the left lateral border of the heart.Apoorba barmanPatient with Idiopathic Thrombocytopenic purpura ,autoimmune thyroiditis and medium vessel vasculitis on mechanical ventilation with high PEEP for ARDS due to viral pneumonia.Arrows show continuous diaphragam sign .A shows the site of subcutaneous emphysema in the left infraclavicular area.Sugunamma 16 year old girl with ITP,autoimmune thyroiditis and medium vessel vasculitis on mechanical ventilation with high PEEP for ARDS due to viral pneumonia . Arrow A shows the pneumomediastinum around the heart border.This has extended down to the retroperitoneum to outline the left kidney B.Sugunamma ,16 year old girl, with ITP,autoimmune thyroiditis and medium vessel vasculitis on mechanical ventilation with high PEEP for ARDS due to viral pneumonia . Arrow A shows the pneumomediastinum around the right heart border.This has extended down to the retroperitoneum to outline the left kidney B.