thanks again for the case...I think everyone will get benefited from this series of teachings
Again my 2 cents worth
the PA chest radiograph (as evidenced by the scapulae retracted bilaterally, there's no soft tissue and bone involvment, the costophrenic angles are sharp and no meniscus sign is seen which is suggestive for pleural effusion), well I can see there's some crowding of ribs,on the right hemithorax as comopared to the left, this is the feature to suggest lung volume loss , hila and cardiothoracic ratio are normal, no mediastinum shift and trachea looks central.. and sometimes upper triangle sign can b presented in right lower lobe collapse, in this case, i don see any significant superior anterior mediastinal shift to the right (quite useful sign i think), not the golden S sign for upper lobe collapse..
since you already the hint there, so I will just go for the elephant there's a well defined triangle radio-opaque density sit right beside the right heart border which is suggestive of RLL collapse (plus the evidence of lung volume loss) the right hemidiaphargm is completely obscured by the opacity, any way to tell which diapharm is higher? the famous 6 P's is always the mnemonic (in this case is passive pulled upwards)
And I see well-defined round radio-opaque density near the right beside the triangle opacity..not sure about that, is this the elephant causing the damage?
I'm not at good eyes at seeing whether there's displacement of horizontal fissures...
from the lateral chest radiograph, there's definitey more black sign as you can see the lower thoracic vertebrae appear denser as it goes down.. and only one hemidiaphragm is visible..well i'm not good at seeing this but I doubt there's oblique fissue and hila pulled towards infero-posteriorly (as well as horizontal fissure)
(1) “Perforation” Diaphragmatic Rupture with herniation of bowels into thorax (2) “Pulled” Upwards Active :Fibrosis of the lung pulling up the Diaphragm Passive: Lung Diseases Causing volume loss: Atelectasis lower lobes & Pneumonectomy (3) Pushed Upwards Hepatomegaly, Abscess, Ascites.Pancreatitis, Pregnancy (4) Paralysis of the Phrenic Nerve (5) “Pseudodiaphragm” Subpulmonic Effusion (more horizontal medially and peak more laterally)
thanks again for the case...I think everyone will get benefited from this series of teachings
ReplyDeleteAgain my 2 cents worth
the PA chest radiograph (as evidenced by the scapulae retracted bilaterally, there's no soft tissue and bone involvment, the costophrenic angles are sharp and no meniscus sign is seen which is suggestive for pleural effusion), well I can see there's some crowding of ribs,on the right hemithorax as comopared to the left, this is the feature to suggest lung volume loss , hila and cardiothoracic ratio are normal, no mediastinum shift and trachea looks central..
and sometimes upper triangle sign can b presented in right lower lobe collapse, in this case, i don see any significant superior anterior mediastinal shift to the right (quite useful sign i think), not the golden S sign for upper lobe collapse..
since you already the hint there, so I will just go for the elephant there's a well defined triangle radio-opaque density sit right beside the right heart border which is suggestive of RLL collapse (plus the evidence of lung volume loss) the right hemidiaphargm is completely obscured by the opacity, any way to tell which diapharm is higher? the famous 6 P's is always the mnemonic (in this case is passive pulled upwards)
And I see well-defined round radio-opaque density near the right beside the triangle opacity..not sure about that, is this the elephant causing the damage?
I'm not at good eyes at seeing whether there's displacement of horizontal fissures...
from the lateral chest radiograph, there's definitey more black sign as you can see the lower thoracic vertebrae appear denser as it goes down.. and only one hemidiaphragm is visible..well i'm not good at seeing this but I doubt there's oblique fissue and hila pulled towards infero-posteriorly (as well as horizontal fissure)
6Ps? Kindly enlighten :)
ReplyDelete5Ps sry
ReplyDeletecourtesy: Dr Ng for elevated diaphargm
5 Ps for elevated diaphargm
(1) “Perforation”
Diaphragmatic Rupture with herniation of bowels into thorax
(2) “Pulled” Upwards
Active :Fibrosis of the lung pulling up the Diaphragm
Passive: Lung Diseases
Causing volume loss: Atelectasis lower lobes & Pneumonectomy
(3) Pushed Upwards
Hepatomegaly, Abscess, Ascites.Pancreatitis, Pregnancy
(4) Paralysis of the Phrenic Nerve
(5) “Pseudodiaphragm” Subpulmonic Effusion (more horizontal medially and peak more laterally)
well, i'm thinking abt round opaque stuff beside the triangle opacity looks like locaulated effusion/pseudotumour..any answer for that?
ReplyDeleteNot sure what this is probably an artifact
ReplyDeleteDanny i think i have found the answer to the round opaque stuff u have been asking me about
ReplyDeleteok tell me
ReplyDeleteSee the answer to this case
ReplyDeleteI have edited the post