seems like ghon complex (primary TB), faint lines radiating to the enlarged hilar nodes but usually it's in the upper lobes, don't know. ok other DDx is hamartoma, tuberculoma, hydatid cyst. it could also be an abscess that's not open yet.

I think as a solitary nodule it would be Hamartoma or Hydatid Cyst or benign pulmonary tumor... I can't tell specificly

Well, U all Right ..
It is one of your D.Dx ..

It is " Hamartoma " ..

If U concetrate on the lesion, it looks like a " Pop-Corn " Non-Homogenous Rounded Opacity, which is characteristic feature of Hamartoma ..

Good Job Doctors ..

But, why no one of our STAGERS participate in solving these CXRs, only GRADUTED DOCTORS do ..


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Ahmed A. Al-Jubouri

Well Ahmed I think that your colleagues are somewhat busy or don't have the time to participate here while we have nothing to do right now and we need to practice ourselves and refresh our minds to keep it working

You are wonderful man I'm getting benefit and I thought it would be nice to give you a hand here...

Now what is your Dx? Stagers...please give it a shot here

Dear Dr. Zaid ..

It is plain X-ray film of the chest in P-A view, of a female, not named, not labeled, & not dated ..

There is a Non-Homogenous Radiological Opacity affecting the Apical Segment of the Lower Lobe of the Left Lung, I said Apical Segment of the Lower Lobe of the Lung because the Horizental Fissure is quite prominant ( white arrows ) ..

So, mostly it goes with " Lobar Pneumonia " ..

& also, there is Obliteration of the Left Costo-Phrenic Angle ( large black arrow ) due to Pleural Effusion, which could be a " Post-Pneumonic Effusion " ..

But, if we concetrate on this Lobar Opacity, there is some Circular Shadow which is Less Dense than the lobar opacity lying behind it ( small black arrows ), which could a Cavity due to Pulmonary Tuberculosis, or Peripheral Ca. of the Lung ..
So, we need a Lateral Chest film to see this lesion ..

& also there is Enlarged Cadiac Shadow ..

I hope this was enough ..

Thanx Dr. Zaid ..


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Ahmed A. Al-Jubouri

thx Dr. Zaid
thx for u ahmed
but it is the right lung

noor th. noori

by the way ahmed
how can u differentiate between a male or female X-ray?
i heard that it is from the breast shadow
but i see it is not clear here
waiting for ur help ahmed
thx



noor th. noori

I mean Right Lung .. loooool

Well, It is quite obvious that breast shadow present out of the chest wall ( black arrows ) ..

I hope that U see it & get benefit from these topics ..


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Ahmed A. Al-Jubouri

thank u Dr.
u r really helpful

noor th. noori

hi

when i 1st saw this x ray, i thought of lobar pneumonia too but then it seemed not to fit coz how come the lower lobe is above the transverse fissure?! this is against anatomy, and it can't be the middle lobe either and if it was upper lobe, it would've been higher. so after some discussion with my friend Sarah, she suggested why not "pulmonary infarction" and that's what we agreed on and i think it fits perfectly, it's peripheral and wedge shaped and the obliterated costo phrenic angle goes with it.

smiles

Well, Dr. Hammodi ..

I'm totally agree with ..

Actually, I forget that there is a Pulmonary Infarction ..

& it is the calssical Wedge -Shape of Pulmonary Infarction ..

Thanx Dr. Hammodi for this Correct answer ..


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Ahmed A. Al-Jubouri

Nice thinking Hammodi and better re-thinking Ahmed

and this is the aim of practicing coz we may know things but forget to name it correctly...I feel this awesome topic is going to give us a huge boost forward

GOD bless you guys

Hi all Docters & Stagers
I'd like to participate in this realy teaching topic & I put in ur hand this chest x-ray & hope to see ur diagnosis

hi omar

this 1 is lobar pneumonia of the middle lobe of right lung. there's consolidation and the right heart border is not clear (silhouette sign).

smiles

Hi Omar we are happy to have you here

I agree with Hammodi completely