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E1802. Improving Portable Chest Radiographic Assessment and Reporting of Acute Parenchymal Disease and Cardiovascular Status in Acute Care Patients
Authors
  1. Michal Gabbai; University of Pennsylvania
  2. Rosita Shah; University of Pennsylvania
  3. Ana Kolansky; University of Pennsylvania
Background
The portable chest radiograph (pCXR) is unique amongst imaging studies in providing a low-cost and easily attained evaluation of the lung parenchyma in complex cardiopulmonary disease. Not only can initial pCXR findings corroborate the common clinically suspected diagnoses of pneumonia and pulmonary edema, but sequential imaging can provide valuable information regarding dynamic physiologic changes. These include documentation of therapeutic response and detection of concurrent fluid overload, lung injury or other complications that may directly impact patient management. Directed reporting that includes conclusions based on this assessment will optimize the radiologists’ contribution to critical care patient management.

Educational Goals / Teaching Points
Emphasis will be placed on 1.understanding the pathophysiology associated with findings of early parenchymal or vasculo-centric diseases that alter the normal broncho-vascular pattern, 2. establishing hydrostatic pulmonary edema as the primary or concurrent disease process when associated with widening of the vascular pedicle, and 3. recognizing evolving changes in lung injury. Based upon established literature in pCXR interpretation, this exhibit details assessment of the lung parenchyma and cardiovascular status, aimed at optimizing detection and reporting of subtle abnormalities in acute pneumonia and dynamic trends in aeration, lung density and fluid status. The focus will be on recognition of normal and abnormal broncho-vascular markings and their significance relative to vascular pedicle width. Pertinent signs and pitfalls in diagnosis will be discussed, including technical and patient factors that may lead to incorrect interpretation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Radiographic literature has previously demonstrated the diagnostic value of the pCXR in evaluating physiologic parameters including circulatory blood volume, systemic venous pressure, pulmonary blood volume and capillary wedge pressures. An understanding of the pathophysiology of these parameters and their relevance is key to correctly interpreting the pCXR. When combined with a focused assessment of the lung parenchyma that includes recognizing changes in normal broncho-vascular pattern of the lungs, the radiologist can provide important information regarding patient fluid status or new parenchymal disease.

Conclusion
Despite the perceived limitations of pCXR in assessing nonspecific parenchymal opacities, a targeted systematic approach to lung findings in the critical care patient can improve the accuracy and clinical value of the corresponding radiographic report. It is the goal of this exhibit to review physiologic parameters indicative of cardiovascular status that are detectable on pCXRs and to improve recognition of normal and abnormal broncho-vascular markings in order to increase the accuracy of pCXR interpretation and reporting.