Radiology Case Presentation Final

8/16/2019 Radiology Case Presentation Final

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Radiology CasePresentation

A Case of DOB

PGI Jean CapulongPGI Gillian MarañaPGI Con Salazar

PGI Julien Torio


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Salient Features

M.C.85 years old

FemaleSingle


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Chief Complaint

Diful!y o" #rea!$ing


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History of PresentIllness

* 'ee+ prior !o onsul!) pa!ien!e%periened diculty of reathing#

dry cough and decreased appetite.S$e soug$! onsul! a! a pri,a!e $ospi!aland 'as gi,en o%ygen supplemen!a!ion.

Fe' $ours prior !o onsul!) pa!ien!e%periened diful!y o" #rea!$ing and'as #roug$! !o our ins!i!u!ion.


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Past $edical History

*-/s 0 1reas! Caner*--- 0 S2P Modi3ed 4adial

Mas!e!omy) #ila!eralS2P C$emo!$erapy


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Rele%ant P& 'ndings

&'a+e) no! in dis!ress) s!a#le ,i!alsigns

Symme!rial $es! e%pansion)dereased #rea!$ sounds on !$erig$!

Grade #ipedal edema


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Course in the &$D

Chest ()ray *+,-+,-. +/-0pm1

&n area de%oid of lung mar2ings on the

right hemithora!) amoun!ing !oappro%ima!ely 6*7

& homogenous density 'as li+e'ise no!ed on!$e right lo3er hemithora! o#suring !$e

rig$! $emidiap$ragm and rig$! os!op$renisulus

T$e $ear! size anno! #e properly assessed. &!$eroslerosis o" !$e !$orai aor!a is seen.

&en!ua!ion o" !$e pulmonary ,asulari!ies.


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Chest ()ray *+,-+,-.+/-0pm1

&n area de%oid of lungmar2ings on the right

hemithora!) amoun!ing!o appro%ima!ely 6*7

& homogenous density'as li+e'ise no!ed on!$e right lo3er

hemithora! o#suring!$e rig$! $emidiap$ragmand rig$! os!op$renisulus

ear! size anno! #e

properly assessed

&!$eroslerosis o" !$e!$orai aor!a is seen

&en!ua!ion o" !$e

pulmonary ,asulari!ies


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Impression/ydropneumo!$ora%) rig$!

&!$eroslerosis) !$orai aor!a1ila!eral pulmonary onges!ion


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Course in the &$D

4ltrasound)guided thoracentesisFree 9uid amoun!ing :*)///;*)*//

seen in !$e rig$! pleural a,i!y


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4ltrasound)guidedthoracentesis

Free 9uid amoun!ing :*)///;*)*// seen in !$e rig$! pleurala,i!y


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Course in the &$D

Follo3 up chest ()ray *+,-+,-. 5/-0pm1

& slight inter%al increase in theright sided pneumothora! no'amoun!ing !o 67.


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Follo3 up Chest(ray

*+,-+,-. 5/-0pm1

& slight inter%alincrease in theright sidedpneumothora! no'amoun!ing !o 67.


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Before and After thoracentesis


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Admitting Impression

Pleural &"usion) rig$!) S2P >T?;guided !$oraen!esis

Pleural @=usion) rig$!1reas! Caner) S!age A) S2P M4M)

#ila!eral


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6aoratory results

CBC 0 normalCB7# 4rea# Creatinine# 4ric acid#

S7P8# Serum 9a# :# Cl 0 normal8otal Protein 0 .* g2dB normalAlumin 0 6. g2dB lo'7loulin 0 A.A g2dB $ig$A,7 ration 0 /.(* lo'


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Course in the ;ard +)-+)-.

E6 ,ia nasal annula a! lpmD5


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Intraoperati%e 'ndings

Trans,erse inision done on !$e !$ ICS MCB) rig$!

Fr68 CTT inser!ed up !o 8m

5// o" s!ra';olored 9uid ameou! on pressure a"!er $es! !u#einser!ion


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Post C88 !)ray *+,-+,-. -0/th posterior ris.

Complete drainage o" !$e pre,iously no!edrig$! sided pleural e=usion) no' 'i!$ intactright costophrenic sulcus andhemidiaphragm.

1e!!er ,isualiza!ion o" !$e pneumo!$ora% in !$erig$! lo'er lung no' !o!ally amoun!ing !o a#ou!67 pre,iously 67.


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P t C88


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Post C88 !)ray *+,-+,-. -0/th

posterior ris.

Complete drainage o" !$epre,iously no!ed rig$! sided pleurale=usion) no' 'i!$ intact rightcostophrenic sulcus andhemidiaphragm.

1e!!er ,isualiza!ion o" !$epneumo!$ora% in !$e rig$! lo'erlung no' !o!ally amoun!ing !o a#ou!67 pre,iously 67.

4ig$! middle and lo'er lo#es are

a!ele!a!isear! size s!ill anno! #e properlyassessed

Pulmonary ,asulari!y remainsaen!ua!ed due !o #ila!eralpulmonary onges!ion

T$e res! o" !$e s!udy is s!a!ionaryand unremar+a#le.


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Chest (ray Follo3 4p *+,-5,-. 5/


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Chest (ray Follo3 4p*+,-5,-. 5/


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& "ollo' up $es! %ray 'as done on (2*-2*5


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DISC4SSIO9HD4EPMETE4&


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Hydropneumothora!

& !erm gi,en !o !$e onurren!presene o" a pneumo!$ora% and a

$ydro!$ora% in !$e pleural spaeMos! o"!en !$an no!) i! may arise due!o T$oraen!esis

T$orai Trauma

1ron$opleural Fis!ula

@sop$agopleural 3s!ula


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Causes

&ny in,asi,e proedure su$ as atransronchial iopsy# chest

tue placement or thoracentesismay #e omplia!ed #y a pos!;proedure $ydropneumo!$ora%

9eoplastic processes andtrauma an also !rigger$ydropneumo!$ora%


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Diagnosis

Can #e diagnosed using PA andlateral chest radiographs

CT san or less "reuen!ly 'i!$>l!rasound


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Hydropneumothora!

En plain 3lm radiograp$) i! an #eseen lassially as air ?uid le%el

3hen patient is upright

Pyopneumo!$ora% an #e adi=eren!ial diagnosis T$i+ening o" !$e pleural lining "a,ors

pyopneumo!$ora%


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Post)thoracentesis PA *a1 and lateral *1 chest radiographs sho3 ari ht)sided h dro neumothora!@ 9ote the air)?uid le%el arro3 and


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Pos!;proeduralla!eral $es!

radiograp$ s$o'san air)?uid le%el*arro31 posteriorto the drainagecatheter open

arro' 'i!$ apleural edge seenmore superiorlyarro'$ead)

onsis!en! 'i!$


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T$e P& $es!radiograp$demons!ra!es ameniscus along

!$e le"! $es! 'all)'i!$ #lun!ing o" !$ele"! os!op$reniangle ando#sura!ion o" !$ele"! $emidiap$ragm

T$e meniscus'nding supportslac2 of apneumothora! asin !$is ase.

8ypical featuresof a large pleurale"usion/•& menisus along!$e le"! $es! 'all

•Comple!eo#sura!ion o" !$e


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• 4ed #alloon lung• Kine glass $es! 'all• Mil+ pleural e=usionWhen free air is present above the

eusion (milk in the model) the airuid interface becomes clearl

HydroPneumothora! Simple Pleural &"usion

Milk is compressed along side of theinated balloon forming a meniscus-like edge.Meniscus sign is an important nding

that distinguishes a simple eusion


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Comparison o" our pa!ien!'i!$Hydropneumothora! and!$e model represen!ing !$elung #allon and !$e 9uid

le,el do!!ed arro's.

Comparison o" in9a!ed#alloon in 'ine glasssimula!ing meniscus signarro's 'i!$ ase o"pleural e"usion 'i!$ou!

pneumo!$ora% on !$e rig$!.


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T$an+ HouL

Radiology Case Presentation Final

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