Here is a case where most to all of the medical history could be obtained from the chest x-ray. Patient is an 81 yo W found apneic and cyanotic and EMS was called and patient was intubated. Patient had never been here before and no history came with the patient. The history was obtained with this chest x-ray.
Read the chest x-ray in formal layout for gift card.
Let me know you thoughts and your care for the patient.
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mritchie
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4 Comments
aregan · April 2, 2013 at 9:01 pm
AP portable film. Fractures of ribs 5, 6 and 7 on the right. Small right pleural effusion versus hemothorax. No consolidation or pneumothorax. ETT looks to be in good position. Correlate clinically. 🙂
cdesmond · April 3, 2013 at 2:12 am
AP Portable Exam
Tracheal deviation to right from mass vs enlarged aorta, ET tube in place >4cm above carina (unable to measure at this time)
Healing fractures of ribs of 8 and 9 on the left, no other fractures noted
Widened mediastinal silhouette with loss of curve of aortic bulb, no evidence of cardiolmegaly but on AP film this is limited
Obscuring of costophrenic angle on right, likely a small pleural effusion
Congestion and opacities seen in right lung field, concerning for aspiration
No evidence of pneumothorax seen
Retrocardiac opacity cannot be ruled out on AP exam
PA Lateral recommended or chest CT for further evaluation
Impression:
Deviated trachea with enlarged mediastinum, chest CT recommended for further evaluation of aorta and mediastinum
Congestion on right concerning for aspiration
andygrock · April 5, 2013 at 4:38 pm
You guys are all giving classic radiology reads. But none of you are doing the interesting part and trying to figure out what’s going on.
Read:
AP portable.
R – mildly rotated
I – mediocre inspiration
P – poor penetration
A – Airway: trachea deviated to R, mass vs enlarged aortic knob, ET tube in place (passed minimal depth of clavicles but could be advanced to 1cm proximal to carina), Rt sided small pleural effusion, no ptx
B – Bones: No fractures. (I don’t know what high tech computer ya’ll are looking at, it would help to be able to change contrast like on PACS to look at ribs)
C – cardiac: anterior mediastinal mass vs enlarged aorta, no cardiomegaly
D – diaphragm: Rt pleural effusion, no air under the diaphragm.
Clare’s interpretation is pretty good…see clare’s post. Only difference, I thought on AP CXR’s the heart is supposed to look bigger than it actually is, therefore, if you see cardiomegaly, you aren’t sure if it’s artifact or true enlargement. But if the heart looks normal in size then you know it’s normal (or small I guess).
Interesting Part.
let’s put the picture together, old lady, found by ems apnic/cyanotic. Is she found at home? On the street? Witnessed syncope/fall? Can we get some VS?
I’m calling aortic dissection (mediastinal mass) down to carotid arteries leading to AMI resulting in syncope/collapse. Differential also includes lympthoma/thymoma/teratorma/TAVPR (just kidding with that last one…Ha!).
Lady needs a CT. I would definitely do with contrast to eval aorta (can also delineate mass better if cancer).
mritchie · April 7, 2013 at 1:28 am
That is a great job Grock of doing a formal read. It is good to have a standardized method of reading chest x-rays. I think that these are good answers but I would warn that a trachea being deviated does not always mean its being pushed. Keep the guesses coming!