Hi again
I think I'm annoying U with my medical subjects
But let's teach each other, OK

Describe the following Chest-X-Ray, & give the possible Dx ?



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Ahmed A. Al-Jubouri

Hi ...iam sorry to give my replay coz Iam not very sure( we didn't take x-ray yet) but i find this topic very intresting.
I think this pateint may have cardiomegally
plz let us know the dx!!!
thank u

On the contarary Ahmed You are doing a great job here

Although it is not so clear x-ray (the film doesn't show the letral chest wall clearly) but I think it shows cardiomegaly with perihilar shadows due to pulmonary oedema...

So my Dx would be Left Ventricular Heart Failure

hi

thankyou so much

i think in the x-ray there is cardiomegaly and pulmonary congestion and the heart has the shape of boot

it is tof i gess

thanks ahamed,
well it is a chest x-ray ,showing increase of vascularity and congetion all over the lung, there is a cardiomegaly (it really looks like a boot) so i will go with tetralogy of falot also.

ali

Thanx alot for your replies ..
Dr. Zaid had put the correct answer ..

first, for the discription of any chest-x-ray we start like this :
It is a plain chest-x-ray in P-A view, not named, not dated, & not labeled .. These are the important things to describe a chest-x-ray at the beginning ..

then, we start to describe the abnormality :
There is a non-homogenous radiological opacity affecting both lungs, it more concentrated at the hilum of the lung & fed away peripherally, & that is what is called " Bat - Wing appearance ", which characteristic of Alveolar Pulmonary Edema ..
& there is an increased Cardio-Thoracic Ratio ( CTR ), & this cardiac enlargement maily affects the Left Ventircle ..

So, That's how we should describe a chest-x-ray ..
& the accurate Dx should be like this :

Bat-Wing Appearance due to Alveolar Pulmonary Edema in a patient with Acute Lt. Ventricular Failure following Myocardial Infarction ..

** About some doctors said that is looks like a Boot - shape heart ( as in TOF ), but actually in TOF there should be Enlargement of the Left Atrium, but the cardiac shadow is obscured in the upper left cardiac border by the lung opacity which concentrated at that area .. When the heart border is obscured for any reason or pathology in the lung or the pericardium or the plurae, this sign has a specific name & it is called " Silhouette Sing " ..

I hope U enjoy this


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Ahmed A. Al-Jubouri

well done Ahmed

thnx thnx thnx
خليتني اتذكر ملاحضات والدك د. عدنان... كانت لا تنضب ملاحضاته

سلملنا...افتقدنا كلش

Yallah Doctors...

Decribe this x-ray and give us a Dx

Well,
It is a plain film of the chest of a male in P-A view, not named, not dated ..
There is homogenous opacity affecting the whole left lung, & the Costo-Phrenic Angle is obliterated, Silhouette sign is +ve, Unrecognized cardiac shadow & borders, elevated stomache gas, & increase vascularity of the whole right lung ..

So, It is one of two :
1- Massive Left Pleural Effusion ..
or 2- Collapse of the whole Left Lung ..

& mostly it goes with Collapse of the whole Left Lung , because of two things :
a) The Treachea is pulled to the side of the collpse ..
b) The left hemidiaphragm is elevated more than its normal position because the stomache gas appear higher ..

* If it was Massive Left Pleural Effusion, the trachea should be pushed to the other side, & the stomache gas will be normal position ..

So, my final Dx is Collapse of the whole Left Lung ..

I wish this will be sufficient
Thanx Dr. Zaid ..


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Ahmed A. Al-Jubouri

Well Ahmed you are so right in your nice detailed description

And the Dx is as you said Collapse of the whole Left Lung or Pneumonectomy of the Left Lung

Man you are so good

Tell me what's about this one??

Thanx dear Dr. Zaid ..
I really interristed in Radiology

About this CXR ..
It is mostly goes with Situs Inervsus ..
because the heart is rotated to the right side & the stomache gas is in the right side, & the left hemidiaphragm is elevated, & all these sign is typically the opposit of the normal one ..

Also, there is some inrease in the lung marking ( vascularity ), in both sides & enlarged cardiac shadow ..



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Ahmed A. Al-Jubouri

Wonderful Dr.Ahmed I'm really impressed

I wish you the best of luck

wow ahmed great job i would not dx in millions years

thanks zayood for this wonderful job.

ali

wow you are sooooooooooooo good

you must be genius