Chest X-ray a (1)
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1Diagnosis
Can you tell why this patient is short of breath?
Tension pneumothorax
Complete right-sided
pneumothorax
Lung is compressed
against mediastinum
Shift of heart and trachea to
left
Tension pneumothorax
Pneumothorax
Post
Ant
With person lying on their back, air in
pleural space rises to top and displaces
normal lung
2Diagnosis
This person developed chest pain after vomiting
Pneumomediastinum
Streaky, linear densities due
to air in the mediastinumStreaky, linear
densities due to air in the mediastinum
Pneumomediastinum – CT scan
Air surrounding esophagus in mediastinum
Extraluminal contrast from
perforation along left
lateral wall of distal
esophagus
3Diagnosis
Why does this patient have abdominal pain?
Pneumoperitoneum
Air outlines under surface of left hemidiaphragm
Air outlines under surface of
right hemidiaphragm
Pneumoperitoneum
Air outlines both sides of the wall of the stomach-a sign of free air in
the peritoneal cavity
Pneumoperitoneum - CT
CT scans on 2 different people show a small and large amount of free air in the peritoneal cavity which rises to the highest point (anterior abdomen with the
person lying on their back) and is not contained within bowel
Free airFree air
4Diagnosis
57 year-old female with shortness of breath
Pleural Effusions
Meniscus-shaped density at left base from a pleural effusion
Meniscus-shaped density
at right base from a pleural
effusion
Pleural Effusions
Meniscus-shaped density
at right base from a pleural
effusion Meniscus-shaped density at left base from a pleural effusion
Effect of Position - Layering
Supine Erect
In the supine position, the fluid layers out posteriorly and produces a haziness, especially near the bases (since the patient is actually semi-
recumbent). In the erect position, the fluid falls even more to the bases.
5Diagnosis
This patient has atrial fibrillation and a heart murmur
Pulmonary Venous Hypertension from Mitral Stenosis
Size (not number) of vessels at the apex exceeds size of vessels at the base in this upright person. This is called “cephalization.” Normally the vessels at the base exceed the size of the vessels at the apex
Pulmonary Interstitial Edema
Pulmonary interstitial edema produced by Kerly A and C lines
Pulmonary Alveolar Edema
Bilateral, diffuse airspace disease more marked centrally than at the periphery of the lung (“bat-wing appearance”)
6Diagnosis
63 year-old man with chest pain
Aortic Dissection
Linear lucency in the contrast-filled descending aorta is the intimal flap of an aortic dissection
Aortic Dissection
• Widened mediastinum
• Left pleural effusion
• Chest pain
Should make you think of an aortic dissection
Classification of Dissecting Aneurysms
Stanford classification
• Widened mediastinum
• Left pleural effusion
• Chest pain
7Diagnosis
Why did this 85 year-old have abrupt onset of abdominal pain?
Aortic rupture
Red arrows point to active extravasation of contrast from the aorta into the retroperitoneum
Thrombus inside the lumen of the aorta
Red arrows point to active extravasation of contrast from the aorta into the retroperitoneum
AortaAorta
Ruptured Aortic Aneurysm
Enlargement of abdominal aorta > 3cm Usually 2 to atherosclerosis Below renals, above iliacs
About 20-25% rupture <4cm~10%; >10 cm~60% Retroperitoneal, usually on left Into GI tract: massive hemorrhage Into IVC: rapid cardiac decompensation
8Diagnosis
Newborn with tachypnea
Diaphragmatic Rupture
Left hemithorax contains multiple lucencies--air in the lumen of bowel, now located in the chest
Heart and trachea are
displaced to right by bowel in
opposite hemithorax
Diaphragmatic RuptureGeneral
5% of all diaphragmatic hernias Most (90%) are left-sided
Central and posterior >10cm in length Contain stomach, colon, small bowel,
omentum, spleen
Half have no initial abnormal radiographic findings
Half are missed clinically
Diaphragmatic Rupture General
Associated with Fx ribs Pneumoperitoneum Ruptured spleen
Delayed diagnosis = higher mortality MRI most useful in showing site of tear
The End