Grand Rounds - Opaque hemithorax.

Pulmonary Medicine Blog By Dr Deepu

Grand Rounds:

This patient an elderly lady presented to us with breathlessness and cough eith sputum with increased sputum in right lateral position. Spo2 was 89% 

Examination revealed trachea deviated to left. Apicak impulse felt in left axilla 5th Ics. Breath sounds diminished on left with added crepitations on left side.

This X ray was taken in emergency room.

 CT confirmed fibrosis of left lung.

Complete white out(opacification) of the hemithorax on CXR has a limited number of causes.

 The differential diagnosis can be zeroed on with one simple observation - the position of the trachea. 

Is it central, pulled or pushed from the side of opacification?

• pulled trachea : pneumonectomy, total lung collapse, pulmonary fibrosis,pulmonary agenesis
• central: consolidation, mesothelioma, collapse with effusion. Lung mass 
• pushed: pleural effusion, diaphragmatic hernia.

Radiology- chest X Ray Spotters.

Pulmonary Medicine Blog By Dr Deepu

spotter 1.
A middle Aged male who is HIV+ presents with a cough of 3 months and cachexia. Auscultation reveals crepitations b/l . Differentials???

Clinical Case - Give Your Diagnosis!!!

Pulmonary Medicine Blog By Dr Deepu

An elderly female came to the outpatient department with a history of cough since 2 weeks minimally productive sputum, she also give history of increased breathlessness since 3 weeks, the symptom of breathlessness being present since three years, she also complains of decreased sleep due to productive cough, and a known hypertensive since 5 years.
  Clinical examination reveals pitting pedal edema and bilateral basal crepitations and no other significant clinical findings were present.
Investigations revealed a total count of 13000 and this chest x ray. EKG was normal. What could be the differential diagnosis????