Radiography
*Left Upper Lobe* It looks like it could be lower, but remember that the upper lobe of the left lung basically goes all the way to the bottom of the lung, but since we have a *silhouette* sign (cant see the heart border) we know it is the upper lobe.
General: Where is the consolidation?
*Right Middle Lobe*
General: Where is the consolidation?
*Right Upper Lobe*
General: Where is the consolidation?
*Right Upper Lobe* (seems like there could be some in the left lobe as well, slide did not say that though)
General: Where is the consolidation?
*ARDS* The 'typical' radiographic appearance of ARDS is that of diffuse, bilateral ground glass opacities (hazy, but its not actually blocking out the blood vessels and heart... thats what the notes say. ok then.)
Most likely dx
*Atypical Pneumonia* Diffuse bilateral hazy *ground glass* opacities (meaning borders and blood vessels can still be seen through the opacities)
Most likely dx
*Complete Left Lung Collapse* The entire left pleural space is opasified, meaning it is filled with fluid.
Most likely dx
*Hydropneumothorax of left lung* Easily seen horizontal line in the left lung means air AND fluid in the lung.
Most likely dx
*LLL or LUL Pulmonary Nodule* White nodule seen where left border of heart meets diaphragm.
Most likely dx
*Large Left Hilar Mass* Pretty obvious gigantic mass off the left costophrenic angle
Most likely dx
*Left Lower Lobe Pneumonia* Infiltrate seen on left side, but the fact the heart's border can still be clearly seen (no silhouette sign)most likely means its in the lower lobe. Presence of a *spine sign* would confirm this.
Most likely dx
*Left Tension Pneumothorax* Due to air escaping the lung into the plural space, but unable to return. Usually collapsing the lung completely. Signs of this are *diaphragm depression* on same side (present) and *mediastinal shift* away from the collapse (heart and trachea have shifted more to the right)
Most likely dx
*Left Upper Lobe Actelectasis* Left hemithorax has smaller volume, trachea is deviated to the left, left diaphragm has risen, left heart border cannot be seen (a *silhouette sign* that signifies upper lobe), and hazy *ground glass* also seen over the mid/upper left hemithorax. All those signs point to a LUL collapse.
Most likely dx
*Left Upper Lobe Collapse* The trachea has shifted to the left side, the left side of diaphragm has raised, and the left heart border is no longer seen. Finally, there is a faint 'veil' of white in the middle of the left chest. These are all distinctive signs of LUL collapse.
Most likely dx
*NOTHING* =) Normal CXR
Most likely dx
*Plural Fluid Pseudotumor* Fluid has collected and pooled inside the fissure of the lung, NOT inside the lobe itself, making it look like a tumor, but it is not (why its called a PSEUDO tumor, durr), this is often associated with CHF... we don't know why.
Most likely dx
*Right Lower Lobe Pneumonia* Border of heart is still visible (no silhouette sign), meaning fluid is in the lower lobe. A *positive spine sign* would confirm this.
Most likely dx
*Right Middle Lobe Pneumonia* Border of the right heart is obscured (*silhouette sign*) meaning the fluid is present in the middle lobe of right side
Most likely dx
*Right Upper Lobe Mass* Large mass easily seen in upper right lung, and since it is obviously >3cm it is considered a mass.
Most likely dx
*Spontaneous Left Pneumothorax* The faint, but obvious, wide vertical line is a classic sign. Since this was taken during expiration you can see the 'ghost image' of where the lung should be, but the pleural space is instead filled with air. If this was taken during inspiration, it wouldn't be as easily seen.
Most likely dx
Most likely a *LLL Atelectasis* We can no longer see the left diaphragm, and there is opacity behind the heart. Which signifies a lower lobe problem (an upper lobe issue would be in FRONT of the heart, making the heart invisible) This can also be LLL pneumonia, or pleural effusion.
Most likely dx
*Left Upper Lobe Lingula Pneumonia* Heart border is no longer seen (called a *silhouette sign*) d/t pneumonia causing the alveoli air to be replaced with fluid/tissue/blood, blocking the view of the heart.
Most likely dx (left picture)
*Lower Lobe Pneumonia* Easily detectable d/t the presence of the *spine sign* (the lower vertebrae appear whiter and lose their *silhouette sign*, or border)
Most likely dx (right picture)
*Bronchogram* Air-filled bronchi within the consolidation (white area)
What the little arrows are pointing at