Chest Radiography Interpretation Part IV

M Chadi Alraies, MD
Chief Medical Resident St. Vincent Charity Hospital Case Western Reserve University Thursday, April 18, 2013

www.chadialraies.blogspot.com

Patient 16

www.chadialraies.blogspot.com

www.chadialraies.blogspot.com

www.chadialraies.blogspot.com

Right large bullae with flattening of the diaphragm in patient with COPD/Emphysema
www.chadialraies.blogspot.com 5

Patient 17

www.chadialraies.blogspot.com

www.chadialraies.blogspot.com

ARDS

www.chadialraies.blogspot.com

Patient 18
56 year old white male with history of kidney transplant 4 year ago on immunosuppressant therapy presented with fever and hemoptysis for 2 days duration associated with SOB and DOE.
www.chadialraies.blogspot.com 9

www.chadialraies.blogspot.com

10

www.chadialraies.blogspot.com

11

Differential? What is the next step?

www.chadialraies.blogspot.com

12

www.chadialraies.blogspot.com

13

www.chadialraies.blogspot.com

14

www.chadialraies.blogspot.com

15

www.chadialraies.blogspot.com

16

www.chadialraies.blogspot.com

17

www.chadialraies.blogspot.com

18

RUL fungus ball (Pulmonary zygomycosis)

www.chadialraies.blogspot.com

19

Treatment?
Aggressive surgical debridement Amphotericin B

www.chadialraies.blogspot.com

20

Prognosis?
Mortality rates 87 %

www.chadialraies.blogspot.com

21

Patient 19

www.chadialraies.blogspot.com

22

www.chadialraies.blogspot.com

23

Right upper lobe collapse Right hilar mass Left upper lobe necrotizing pneumonia Right chest tube

www.chadialraies.blogspot.com

24

www.chadialraies.blogspot.com

25

Same patient with right tension pneumothorax

www.chadialraies.blogspot.com

26

Patient 20

www.chadialraies.blogspot.com

27

www.chadialraies.blogspot.com

28

www.chadialraies.blogspot.com

29

RUL cpllapse

www.chadialraies.blogspot.com

30

Patient 21

www.chadialraies.blogspot.com

31

www.chadialraies.blogspot.com

32

Diagnosis? Next step? Management?

www.chadialraies.blogspot.com

33

Interstitial reticular infiltrate Left upper lobe mass

www.chadialraies.blogspot.com

34

www.chadialraies.blogspot.com

35

www.chadialraies.blogspot.com

36

www.chadialraies.blogspot.com

37

www.chadialraies.blogspot.com

38

www.chadialraies.blogspot.com

39

www.chadialraies.blogspot.com

40

www.chadialraies.blogspot.com

41

www.chadialraies.blogspot.com

42

Treatment?
Steroids?

www.chadialraies.blogspot.com

43

What 2 problems do you rule out in a person with probable IPF before starting steroids?

www.chadialraies.blogspot.com

44

www.chadialraies.blogspot.com

45

Patient 22

www.chadialraies.blogspot.com

46

www.chadialraies.blogspot.com

47

www.chadialraies.blogspot.com

48

Right Hydropneumothorax RLL mass Lung CA

www.chadialraies.blogspot.com

49

Palliative care consult?

www.chadialraies.blogspot.com

50

Patient 23

www.chadialraies.blogspot.com

51

www.chadialraies.blogspot.com

52

Right heart border silhouette sign

RLL infiltrate or mass

www.chadialraies.blogspot.com

53

Patient 24

www.chadialraies.blogspot.com

54

www.chadialraies.blogspot.com

55

Left upper lobe infiltrate with a mass lesion

www.chadialraies.blogspot.com

56

Patient 26

www.chadialraies.blogspot.com

57

www.chadialraies.blogspot.com

58

Patient 27

www.chadialraies.blogspot.com

59

www.chadialraies.blogspot.com

60

Patient 28

www.chadialraies.blogspot.com

61

www.chadialraies.blogspot.com

62

Left subcutaneous emphysema Left total lung resection (pneumonectomy) Left hiatal hernia Compensating expanding right lung.

www.chadialraies.blogspot.com

63

Patient 29

www.chadialraies.blogspot.com

64

www.chadialraies.blogspot.com

65

www.chadialraies.blogspot.com

66

Patient 30

www.chadialraies.blogspot.com

67

www.chadialraies.blogspot.com

68

www.chadialraies.blogspot.com

69

www.chadialraies.blogspot.com
Thank you

www.chadialraies.blogspot.com

70