Tag Archives: chest x-ray

Pulmonary Sequestration

Pulmonary sequestration is a congenital disorder characterized by anomalous lung tissue that lacks normal communication with the tracheobronchial tree, which increases the likelihood of infection.

Pulmonary Sequestration. Shailvi Gupta, M.D., and Sunghoon Kim, M.D. NEJM January 31, 2013 (image link)

Cinical case:

A 9-year-old boy with a history of a lung lesion suspected to be a pulmonary sequestration or a congenital cystic adenomatoid malformation presented to the emergency department with fever and chest pain. A chest radiograph (above) showed a large opacity in the right lung, abutting the minor fissure and displacing it downward. Computed tomography of the chest revealed a large heterogeneous mass with scattered areas of low attenuation, suggesting mucous impaction, and a single large systemic artery  providing vascular supply from the descending aorta. No air bronchograms were evident within the mass. A vein arising from the posterior portion of the mass drained into the right superior pulmonary vein. The patient underwent a right upper lobectomy. The patient recovered without complications and since the operation has had no further pulmonary problems.  (adapted from NEJM)

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RUL pneumonia

Case history: 4 year old with high fever, and a one day history of cough and shortness of breath.

Image from Anatomybox.com

Because the RUL consolidation was so dense, a CT scan was obtained to ensure that this represented a pneumonia and not a mass or fluid collection.

After 24 hours of IV antibiotics his fever had resolved and he was discharged  two days later to complete a course of antibiotics as an outpatient.

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Secondary Pneumothorax

Secondary spontaneous pneumothorax occurs in the setting of a variety of lung diseases. The most common is COPD, which accounts for approximately 70% of cases.  Known lung diseases that may significantly increase the risk for pneumothorax are diseases of the airways (COPD, severe asthma, cystic fibrosis), infections of the lung, interstitial lung disease, connective tissue disease, and cancer. (adapted from wikipedia)

Image found on fuckyeahnarcotics tumblr (link)

Case Summary: “A 65-year-old man with a 50-pack-year smoking history complains of sudden-onset, severe shortness of breath that began 4 hours ago. The shortness of breath is associated with mild left-sided chest pain when he takes a deep breath. He denies experiencing any precordial chest pain, nausea, vomiting, or diaphoresis. He states that the pain does not extend to his extremities. The patient does not have a history of heart disease or a history of diseases in his family.

On physical examination, the patient has a normal blood pressure of 124/87 mm Hg, with a resting heart rate of 115 beats/min. His respiratory rate is 25 breaths/min, with an oxygen saturation of 82% on room air.  He is in mild respiratory distress but can speak in full sentences without difficulty. His lung sounds are difficult to auscultate, but they seem to be diminished on the left side. The results of his cardiac examination are normal, with no gallop or jugular venous distention.” (reblogged from Medscape, case provided by Dr. Michael Cetta)

It was determined that this patient had a secondary spontaneous pneumothorax, the chest radiograph shows a left sided pneumothorax of approximately 50% the volume of the left lung

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Absent Clavicles

Virtually absent clavicles.  Absent Clavicle is often associated with  cleidocranial dysostosis

Image from American Journal of Radiology (link)                                    Larger image 1728 x 1551

41-year-old woman with imaging workup for metastatic medullary thyroid carcinoma. Posteroanterior chest radiograph shows absent clavicles with drooping shoulders.

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