Tag Archives: CXR

Posterior Rib Fractures

Posterior rib fractures have a high specificity for child abuse.  In this case, a 2 month old was brought to the emergency department lethargic and in respiratory distress.  On radiographic examination, multiple posterior and lateral rib fractures were noted.  The child additionally was fournd to have subdural hematomas, and despite all attempts at resuscitation, succumbed to her injuries.

Anatomybox image.

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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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Pacemaker

pacemaker (or artificial pacemaker) is a medical device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart. The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart’s native pacemaker is not fast enough, or there is a block in the heart’s electrical conduction system. (adapted from wikipedia)

Image from AnatomyBox.    Image of dual chamber pacemaker in an 81 year old man.

Dual-chamber pacemaker. Here, wires are placed in two chambers of the heart. One lead paces the atrium and one paces the ventricle. This type more closely resembles the natural pacing of the heart by assisting the heart in coordinating the function between the atria and ventricles.

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