Karuturi Rounds 1 >What is your Radiological Diagnosis? - Answered

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Permalink Reply by Dindukurthi Sudhakar on June 28, 2009 at 4:44pm

Pneumothorax Rt. ..... probably a 'tension' type, seeing the extension beyond the midline. Is that an injury into the thoracic cage?

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Permalink Reply by dr t. rajesh patnaik on June 29, 2009 at 4:42pm

this may be PA view of chest x ray suggestive of tension pneumothorax of right side of the chest x ray taken end expiratory. features suggestive are shift of both upper and lower mediastinum and as the air is trapped in right lung, suspect to be the film to be taken at end expiratory.

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Permalink Reply by Subrahmanyam Karuturi on June 30, 2009 at 7:59am

No yaar.

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Permalink Reply by dr t. rajesh patnaik on July 2, 2009 at 5:14pm

answer pl.......with full explanation and then u can add few more things for further discussion

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Permalink Reply by M. G. on July 1, 2009 at 7:28am

The radiography is with excessive penetration (you can see all the spine), that's why the right side seems darker than normal...
But in the left side you can see what looks like a massive atelectasis (all the opaque region), we can differentiate from a pleural effusion since the trachea is shifted to the left (same side of the opaque region).

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Permalink Reply by Subrahmanyam Karuturi on July 1, 2009 at 4:17pm

Excellent! You are right! Can you predict the etiology?

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Permalink Reply by Dindukurthi Sudhakar on July 1, 2009 at 4:28pm

Marilia Gusmao has sharp eyes. KUDOS!

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Permalink Reply by Dindukurthi Sudhakar on July 1, 2009 at 4:31pm

This is very interesting.

The excess penetration is the cause for invisible lung markings the right field. Now how will you differentiate? The opacity in the left lung field is due to the collapse of the left lung. What if the collapse of the left lung is due to tension pneumothorax on the right side?

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Permalink Reply by M. G. on July 1, 2009 at 10:15pm

To differentiate from a pneumothorax (as you suggested), it could be useful to know about the physical exam, to be a pneumothorax the right hemithorax should be tympanic, and the breath sounds should be decreased in this same side. The exam should suggest atelectasis if it is dull to percussion on the left side and the breath sounds are decreased, this could be also found in a pleural effusion (but the findings on the x ray would be different - as explained in the message above).
... Or... you could take another radiography with adequate techinique... but I doubt that an atelectasis or pneumothorax with this extension could be unnoticed on the physical exam.

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Permalink Reply by Dindukurthi Sudhakar on July 2, 2009 at 2:38pm

Thank you, Marilia. But, I meant the radiological differentiation with reference to this particular image.

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Permalink Reply by M. G. on July 1, 2009 at 10:28pm

Thank you... I don't know... I'll research ;)

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Permalink Reply by dr t. rajesh patnaik on July 2, 2009 at 5:11pm

i could not understand few thinfs in ur explanation, would u be kind enough to clarify them........

a} if its due to tension pnuemothorax and the mediastinum is shifted to opp side then wont be the spine visible....?
b} one more thing to rule out pleural effusion is the absence of air fluid levels and the coastophrenic angle is free on left side...........

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