Case 10 Interpreting Chest X-Ray
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I N T E R P R E T I N G C H E ST X- R AY S
Illustrated with 100 Cases
Interpreting chest X-rays can seem baffling and intimidating for junior doctors. This highly illustrated guide provides the ideal introduction to chest radiology. It uses 100 clinical cases to illuminate a wide range of common medical conditions, each illustrated with a chest X-ray and a clear description of the significant diagnostic features and their clinical relevance. Where appropriate, CT scans and bronchoscopic imaging are also included as part of the investigation. Pulmonary medicine is largely based on the strong foundation of the plain chest radiograph. Indeed, chest radiography is the single most common investigation carried …show more content…
10.1
Case 10. This 80-year-old male presented with right-sided chest pain and breathlessness. He gave a long history of exertional dyspnea. The CXR is shown (Fig. 10.1).
CASE 10
Interpreting Chest X-Rays
20
C A S E 1 0 S I L I CO S I S W I T H P R O G R E S S I V E M A S S I V E F I B R O S I S (PMF)
This patient’s CXR shows a right pneumothorax. In addition, there are bilateral diffuse nodules ( 10 mm but 2 mm) which could be due to metastatic adenocarcinoma, silicosis, disseminated histoplasmosis, or varicella infection. In silicosis, some nodules may coalesce to form conglomerate masses in the upper lobes called progressive massive fibrosis. Patients with silicosis are predisposed to pulmonary tuberculosis and serial CXR comparison is useful.
21
Interpreting Chest X-Rays
CASE 11
Fig. 11.1
Case 11. This 40-year-old male of African origin was asymptomatic and had a routine CXR (Fig. 11.1). What is the likely diagnosis?
CASE 11
Interpreting Chest X-Rays …show more content…
In this clinical context, dissection of the arch of the aorta has to be excluded. CT Thorax in another patient shows the presence of an aneurysm (Fig. 12.2) at the aortic arch with thrombus.
25
Interpreting Chest X-Rays
CASE 13
Fig. 13.1
Case 13. This 80-year-old male smoker is a known case of COPD. He presented with epigastric pain and worsening of shortness of breath. Arterial blood gas showed acute metabolic acidosis. This was his CXR (Fig. 13.1). What is the most obvious abnormality?
CASE 13
Interpreting Chest X-Rays
26
C A S E 1 3 P N E U M O P E R I TO N E U M D U E TO P E R F O R AT E D P E P T I C U LC E R
The CXR shows free air under the right hemidiaphragm, in addition to features of hyperinflation. The possibilities include perforated peptic ulcer or GI malignancy, recent laparoscopy/laparotomy, and peritoneal dialysis. It is important to do an erect CXR for the free air to rise to the top of the abdomen. For patients with a nasogastric tube in place, instillation of 200 ml of free air before the CXR may aid the diagnosis.
I N T E R P R E T I N G C H E ST X- R AY S
Illustrated with 100 Cases
Interpreting chest X-rays can seem baffling and intimidating for junior doctors. This highly illustrated guide provides the ideal introduction to chest radiology. It uses 100 clinical cases to illuminate a wide range of common medical conditions, each illustrated with a chest X-ray and a clear description of the significant diagnostic features and their clinical relevance. Where appropriate, CT scans and bronchoscopic imaging are also included as part of the investigation. Pulmonary medicine is largely based on the strong foundation of the plain chest radiograph. Indeed, chest radiography is the single most common investigation carried …show more content…
10.1
Case 10. This 80-year-old male presented with right-sided chest pain and breathlessness. He gave a long history of exertional dyspnea. The CXR is shown (Fig. 10.1).
CASE 10
Interpreting Chest X-Rays
20
C A S E 1 0 S I L I CO S I S W I T H P R O G R E S S I V E M A S S I V E F I B R O S I S (PMF)
This patient’s CXR shows a right pneumothorax. In addition, there are bilateral diffuse nodules ( 10 mm but 2 mm) which could be due to metastatic adenocarcinoma, silicosis, disseminated histoplasmosis, or varicella infection. In silicosis, some nodules may coalesce to form conglomerate masses in the upper lobes called progressive massive fibrosis. Patients with silicosis are predisposed to pulmonary tuberculosis and serial CXR comparison is useful.
21
Interpreting Chest X-Rays
CASE 11
Fig. 11.1
Case 11. This 40-year-old male of African origin was asymptomatic and had a routine CXR (Fig. 11.1). What is the likely diagnosis?
CASE 11
Interpreting Chest X-Rays …show more content…
In this clinical context, dissection of the arch of the aorta has to be excluded. CT Thorax in another patient shows the presence of an aneurysm (Fig. 12.2) at the aortic arch with thrombus.
25
Interpreting Chest X-Rays
CASE 13
Fig. 13.1
Case 13. This 80-year-old male smoker is a known case of COPD. He presented with epigastric pain and worsening of shortness of breath. Arterial blood gas showed acute metabolic acidosis. This was his CXR (Fig. 13.1). What is the most obvious abnormality?
CASE 13
Interpreting Chest X-Rays
26
C A S E 1 3 P N E U M O P E R I TO N E U M D U E TO P E R F O R AT E D P E P T I C U LC E R
The CXR shows free air under the right hemidiaphragm, in addition to features of hyperinflation. The possibilities include perforated peptic ulcer or GI malignancy, recent laparoscopy/laparotomy, and peritoneal dialysis. It is important to do an erect CXR for the free air to rise to the top of the abdomen. For patients with a nasogastric tube in place, instillation of 200 ml of free air before the CXR may aid the diagnosis.