SOB in a young lady

A young lady was presented with SOB with a Hx of RECURRENT PNEUMOTHORAX and pleural effiusion ( a big clue ). CXR was shown here?
What can u see?

CXR basic interpretation note

This is some of the notes i created using reference from Radiology Assistant
Note - please do not use this commercially as most of the things are referenced from the above mentioned website. Thanks

http://www.4shared.com/office/4YtfTQYKce/Chest_X_ray.html

Plasmodium life cycle

Always confuse with what zoite the plasmodium is in? Hopefully this table will help you

Pulmonary Embolism

In the right lower hemithorax ( near the costophrenic angle ), we can see a rounded opacity there. This is consolidation due to pulmonary infarction. Patient has positive D-dimer and CTPA reveals a saddle embolus 

Learning point: Consolidation can be due to 

1) Pus - pneumonia

2) Blood - infarction, hemorrhage, contusion

3) Fluid - pulmonary edema

Bonus point :

It will be useful to know acute vs chronic consolidation by the old film and the duration of patient's symptoms

As chronic consolidation will ONLY consists of a few ddx:

1) Main one is neoplasm ( adenocarcinoma in situ, lymphoma )

2) Chronic post infectious disease eg organizing pneumonia, chronic eosinophilic pneumonia )

3) Alveolar proteinosis

4) Sarcoidosis ( not exactly consolidation but numerous nodular opacities causing a consolidation like pattern )

Enjoy the weekend !!

Another mystery !!

Patient has SOB and pleuritic chest pain. A CXR is done

What is the diagnosis?

Right lower lobe atelectasis

Answer - right lower lobe atelectasis

This patient had fall and underwent orthopedic surgery. The right lower lobe atelectasis is presumably due to reluctance of the patient to breath due to pain

Notice -

- The right cardiac border is still preserved

- The right opacity has silhouetted the right hemidiaphragm ( this is the RLL atelectasis )

- There is some loculated pleural effusion posterolaterally ( possibly due to hemothorax after the fall )

Opacities in one hemithorax

1) Consolidation - no volume loss hence no tracheal deviation

2) Effusion - 'volume gain' so the fluid will push the trachea and mediastinum to the healthy part

3) Atelectasis - volume loss so the trachea and mediastinum will be 'pulled' to the affected part

Take home points

1) Learn this diagram

2) Learn three common causes of 'white out' hemithorax

Reference

Radiology Assistant - Chest

What lobe is collapsed?

Let's cut this short - patient has atelectasis - which lobe is collapsed?

What findings that are suggestive?