CHEST Jorge Vidal
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Right pericardial density • Right pericardial density • Atelectasis • Infiltrate • Malignancy • Fluid collection
Rheumatoid Lung • Male to female:: 5:1 • Stage 1: multifocal ill-defined alveolar infiltrates • Stage 2: fine interstitial reticulations (histio- and lymphocytes) • Stage 3: honeycombing
Sudden Chest Pain and SOA • Initial CXR may be normal or near normal • High clinical suspicion for thromboembolic event? • Coagulopathy, recent trauma, bed-ridden, immobile. • CT Pulmonary Angiogram • Filling defects • May present with atelectasis, pleural effusions, and/or infiltrates.
Wide Mediastinum • 1. Rupture of aorta / brachiocephalic arteries • 2. Venous hemorrague • 3. CHF • 4. Rupture of esophagus • 5. Rupture of thoracic duct • 6. Magnification on supine CXR
ASD • The heart is slightly rotated toward the right side, but the aortic arch is on the left and the stomach is on the left, suggesting situs solitus and dextroversion. Some people have referred to this position as "mesocardia". Whenever the heart is rotated into the right chest, one has to search for external reasons such as atelectasis, emphysema, effusion, hypoplasia of the lung, etc. If there is true dextroversion, the incidence of congenital heart disease with corrected transposition is high. The pulmonary vasculature is probably normal and a specific diagnosis cannot be made in this case. • After echocardiography, an ASD was found.
SVC compression • Mediastinal mass causing compression of SVC and right main pulmonary artery.
Bilateral hilar masses • Large pulmonary arteries • Bilateral hilar lymphadenopathy • Neoplastic: • Lymphoma, mets, leukemia, Primary bronchogenic CA, plasmacytoma • Inflammatory: • sarcoidosis, silicosis, histiocytosis X • Infectious: • Rubella, ECHO virus, varicella, mononucleosis, TB • “Please Helen Lick My Popsicle Stick”
Desquamative Interstitial Pneumonia • HRCT • Predominant subpleural distribution • Patchy ground glass • Architectural distortion (50%) • Honeycombing and traction bronchiectasis • Mainly middle and lower lung zones (73%) • Bilateral and symmetric (86%)
Sarcoidosis • Hilar lymphadenopathy (1-2-3) • Reticulonodular pattern (46%) • HRCT • Irregular septal thickening • Perilymphatic nodules • Traction bronchiectasis • Ground-glass opacity • honeycombing
Pericardial effusion • Apparent cardiomegaly when the effusion is large enough. • However, note that the vasculature is normal • Heart border is smooth