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1Diagnosis0
Can you tell why this patient is short of breath?0
Tension pneumothorax0
Complete right-sided pneumothorax
Lung is compressed against mediastinumShift of heart and trachea to leftTension pneumothorax0
PneumothoraxPostAntWith person lying on their back, air in pleural space rises to top and displaces normal lung0
2Diagnosis0
This person developed chest pain after vomiting0
PneumomediastinumStreaky, linear densities due to air in the mediastinumStreaky, linear densities due to air in the mediastinum0
Pneumomediastinum CT scanAir surrounding esophagus in mediastinumExtraluminal contrast from perforation along left lateral wall of distal esophagus0
3Diagnosis0
Why does this patient have abdominal pain?0
PneumoperitoneumAir outlines under surface of left hemidiaphragmAir outlines under surface of right hemidiaphragm0
PneumoperitoneumAir outlines both sides of the wall of the stomach-a sign of free air in the peritoneal cavity0
Pneumoperitoneum - CTCT scans on 2 different people show a small and large amount of free air in the peritoneal cavity which rises to the highest point (anterior abdomen with the person lying on their back) and is not contained within bowelFree airFree air0
4Diagnosis0
57 year-old female with shortness of breath0
Pleural EffusionsMeniscus-shaped density at left base from a pleural effusionMeniscus-shaped density at right base from a pleural effusion0
Pleural EffusionsMeniscus-shaped density at right base from a pleural effusionMeniscus-shaped density at left base from a pleural effusion0
Effect of Position - LayeringSupineErectIn the supine position, the fluid layers out posteriorly and produces a haziness, especially near the bases (since the patient is actually semi-recumbent). In the erect position, the fluid falls even more to the bases.0
5Diagnosis
This patient has atrial fibrillation and a heart murmur
Pulmonary Venous Hypertension from Mitral StenosisSize (not number) of vessels at the apex exceeds size of vessels at the base in this upright person. This is called cephalization. Normally the vessels at the base exceed the size of the vessels at the apex
Pulmonary Interstitial EdemaPulmonary interstitial edema produced by Kerly A and C lines
Pulmonary Alveolar EdemaBilateral, diffuse airspace disease more marked centrally than at the periphery of the lung (bat-wing appearance)
6Diagnosis
63 year-old man with chest pain0
Aortic Dissection0Linear lucency in the contrast-filled descending aorta is the intimal flap of an aortic dissection
Aortic Dissection Widened mediastinum Left pleural effusion Chest painShould make you think of an aortic dissection
Classification of Dissecting AneurysmsStanford classification Widened mediastinum Left pleural effusion Chest pain
7Diagnosis
Newborn with tachypnea
Diaphragmatic RuptureLeft hemithorax contains multiple lucencies--air in the lumen of bowel, now located in the chestHeart and trachea are displaced to right by bowel in opposite hemithorax
Diaphragmatic RuptureGeneral 5% of all diaphragmatic herniasMost (90%) are left-sidedCentral and posterior >10cm in lengthContain stomach, colon, small bowel, omentum, spleenHalf have no initial abnormal radiographic findingsHalf are missed clinically
Diaphragmatic Rupture General Associated withFx ribsPneumoperitoneumRuptured spleenDelayed diagnosis = higher mortalityMRI most useful in showing site of tear
The End