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Osce Chest

Date post: 02-Jun-2018
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    OSCE Chest

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    THEN, Look at the key!

    A well-defined, metallic density, sharp edge,triangular shaped, 0.5 x 0.3 cm in size at rightmain bronchus

    Decreased right lung volume compared withthe left

    Diagnosis : a tooth in right main bronchuscausing partial right lung collapse

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    See sharpmargin

    above clavicle

    Click for lateral view

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    Cervicothoracic sign

    Which compartment do you think this mass isin?

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    Massdisappears

    at clavicle

    Click for answer

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    Cervicothoracic sign

    Answer: mass lies in anterior mediastinum.We know this because it disappears at thelevel of the clavicle where it extends into theneck.

    This particular example is Non-Hodgkinslymphoma

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    Thoracoabdominal sign

    A sharply marginated mediastinal mass seen throughthe diaphragm must lie entirely within the chest. The posterior costophrenic sulcus extends far more

    caudally than the anterior aspect of the lung Therefore

    Any mass that extends below the dome of the diaphragmand remains sharply outlined must be in the posteriorcompartments and surrounded by lung, and Any massthat terminates at dome of diaphragm must be anterior

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    Can yousee the

    outline of themass below

    the diaphragm?

    Click for answer

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    Thoracoabdominal sign

    Answer: margin of mass is apparent andbelow diaphragm, therefore this must be inthe middle or posterior compartments whereit is surrounded by lung

    This example is a lipoma

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    Hilum overlay and convergence signs

    Principle of hilum overlay the proximal segments of the

    R and L main pulmonaryarteries lie lateral to thecardiac silhouette on PA film

    With pericardial effusion orcardiac enlargement , thisrelationship is unchanged

    Conversely, an anteriormediastinal mass will

    overlap the mainpulmonary arteries,therefore they will be seenwithin the margins of themass

    Hilum convergence To distinguish between

    enlarged pulmonary arteryand mediastinal mass

    If branches of thepulmonary artery convergetoward a central mass enlarged PA

    If branches of PA convergetoward the heart ratherthan the central mass mediastinal tumor

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    Hilum canbe seenthrough

    mass

    Click for answer

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    Hilum overlay sign

    Answer: this must be an anterior mediastinalmass because it overlaps rather than pushesout the main pulmonary arteries

    This particular example is a thymoma

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    Yes!!

    Click for more info

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    Hilum overlay sign

    Heart is enlarged, but hilar vessels still visiblelateral to the cardiac silhouette

    This case is pericardial effusion

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    Lesions Fluid Fat Vascular

    Anterior ThymicLymphoma

    Germ cellGoiter

    Thymic CThymoma

    Pericardial CGerm cellLymphoma

    Germ cell bThymolipoma

    Fat pad

    ThyroidCardiac

    Coronary

    Middle Lymph nodes

    Duplication C Arch anomaly

    Duplication C

    Necrotic nodesPericard recess

    Lipoma

    Esophageal FVpolyp

    Arch anomaly

    Azygous veinVascular nodes

    Posterior NeurogenicBone andmarrow

    Neuroenteric CSchwannomaMeningocele

    Extramedullaryhematopoiesis

    Desc aorta

    > 1 comp InfectionHemorrhageLung cancer

    LymphangiomaMediastinitis

    Liposarcoma Hemangioma

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    Imaging Findings

    Bilateral paraspinal masses with round, lobulated margins

    Medullary expansion of the bony structures with widening of the ribsbeing the most pronounced bony finding

    Resorption of trabeculae produces coarsened appearance to bonesSplenomegaly (or absent spleen )Masses do not calcify and do not usually cause bone erosionThe lesions are usually of low -attenuation on non -contrast CT and

    may mildly enhance after contrast

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