Simple question. What do these two chest x-rays have in common. No info I’m afraid.
They are both x-rays of the same patient.
He had fallen through a roof and fractured his left humerus but was clinically quite well. The first x-ray was supine. After c-spine clearance and observation he remained very well and despite the official report of CXR 1 suggesting to get a CT thorax, we sat him up and got CXR 2 and left things be.
This illustrates the impact of projection and position on CXR findings. We would all agree that the first x-ray as a massive and concerning mediastinum and the second looks fine.
It would be wise to get a CT on these people if the clinical situation demands it, which is a slippery (but still accurate) way of saying that lots of info goes into deciding when to go looking for a mediastinal haematoma or aortic dissection.
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Andy
There was a talk at ACEP I heard yesterday on Joe Lex FEMT where they covered this.
The panscan or selective imaging debate in the US seems to be a bit over the top! The reading of supine AP cxr as “wide mediastinum ” prompts a lot of unnecessary radiation it seems.
Personally I only order panscans on lawyers and their families
Casey
agreed -- it’s the unconscious guys who you can’t get a history (or even have a conversation with) and have a big mechanism that i worry about more. An apparently isolated injury (like a limb) can usually be distinguished as just that if they’re awake and cooperative and don’t need the panscan