Chest Imaging in Emergency and Acute Care
Source: Pain Management presentation by Daniel Stone, MD
Chest Imaging: A Practical Approach for Emergency and Acute Care Providers
Chest imaging is one of the most frequently used diagnostic tools in emergency and acute care settings. When used thoughtfully, it can rapidly narrow a differential diagnosis, guide urgent decision-making, and identify life-threatening pathology. When used indiscriminately, it can also create false reassurance or lead to unnecessary downstream testing.
This session focuses on a practical, clinically grounded approach to chest imaging with an emphasis on how and when to use chest X-ray, ultrasound, and CT effectively.
When Chest Imaging Matters Most
Chest imaging is most valuable in high-risk clinical scenarios such as hypoxia, respiratory distress, trauma, suspected infection, chest pain with concerning features, and shock. Understanding which clinical presentations require immediate imaging and which can be evaluated conservatively is a critical skill for frontline clinicians.
Understanding Chest X-Ray Limitations
While chest X-ray is often the first imaging modality obtained, it has important limitations. Vascular pathology such as pulmonary embolism, aortic dissection, or myocardial infarction may not be visible on plain radiographs. Recognizing what chest X-ray can and cannot show helps prevent missed diagnoses.
The session reviews:
AP vs PA radiographs and why positioning matters
When single-view imaging is appropriate
Common pitfalls that lead to false reassurance
Systematic Image Interpretation
A structured approach to reading chest imaging reduces error. This presentation emphasizes consistent interpretation methods, including evaluating the mediastinum, heart, lungs, diaphragm, pleura, chest wall, and soft tissues in a reproducible sequence.
The Role of Ultrasound and CT
Point-of-care ultrasound adds dynamic, bedside diagnostic capability for conditions such as pneumothorax, pulmonary edema, pleural effusion, and pneumonia. CT imaging, particularly CT angiography, remains the gold standard for evaluating vascular pathology and complex disease processes.
Understanding when to escalate from X-ray to ultrasound or CT is a central theme of this training.