-
Case Study # 1:
I do understand that the majority of you are not trained to read radiographs. This particular case study is interesting in that it makes few learning points. You will not lose any points if your answers were not correct. Give it a try.There are 2 abnormalities in this CXR following a car accident, probably done with a mobile unit while the patient is still on the stretcher.1) What is the first abnormality (lesion)? Which side?2) What is the second abnormality? (It is an important medical AND a legal pitfall). 
Case Study # 2:
ID/CC A 25 year old white male complains of sudden chest pain and shortness of breath that awakens him at night
HPI He smokes one pack of cigarettes a day and states that his paternal uncle once had a similar episode
PE Tall, thin patient; diaphoretic and feels weak; left chest expands poorly on inspiration; trachea and apex beat displaced to left; left side hyperresonant to percussion; decreased breath sounds; decreased tactile fremitus1. What is the Diagnosis?-
Case Study # 3:
ID/CC A 50 year old white male smoker presents with productive cough, copious sputum, shortness of breath, and fever.
HPI The patient has a 40 pack year smoking history. He has also experienced chronic dyspnea on exertion; chronic productive cough, usually in the mornings, for several years and multiple colds each winter.
PE VS: fever; PE: Stocky build with plethora; wheezes
Labs RBC’s = 7.0 x10 6/mm 3, Hct = 61%1. What is the Diagnosis?2. What is the direct cause of the abnormal lab findings? -
Case Study # 4:
ID/CC A 68 year old male presents with chronic cough and shortness of breath of four years’ duration.
HPI He has a 80 pack year smoking history. He has no history of fever or chest pain but has had pedal edema for two weeks.
PE Skinny and anorexic; pitting ankle edema; elevated jugular venous pressure; barrel-shaped chest with bilateral rhonchi and fine inspiratory basal crepitant rales; extended expiratory phase breathing; no evidence of pleural effusion or ascites; mild tender hepatosplenomegaly.A CXR is shown – just as a visual.1. What is the Diagnosis?2. What is the cause of the ankle edema and the elevated jugular pressure? -
Case Study # 5:
ID/CC A 9 year old white female is brought to the ER by her parents because of breathing difficulty and productive cough with greenish sputum.HPI The patient has a history of recurrent upper respiratory tract infections and foul-smelling, diarrheic stools since infancy. Overall, she has failure to thrive.PE VS: tachycardia, tachypnea.PE: ecchymoses on upper limbs; hyperresonance to percussion with barrel-shaped chest; nasal polyps; scattered rales in both lung fields; hepatomegaly; clubbingLabs H. influenzae and Staph. aureus in sputum culture.CXR: hyperinflation; patchy atelectasis; bronchiectasis.1. What is the Diagnosis? -
Case Study # 6:
ID/CC A 36 year old white male complains of a chronic cough of several months; duration, accompanied by lightheadedness, fatigue, and malaise; yesterday, he coughed up blood.
HPI He also describes intermittent fever and headaches in addition to small volumes of dark orange urine. He denies alcohol use but admits to being a heavy smoker
PE Diffuse pulmonary crackles bilaterally
Labs Azotemia. UA: oliguria; hematuria; proteinuria. Iron deficiency anemia; blood detected in sputum1. What is the Diagnosis? -
Case Study # 7:
ID/CC Paramedics are called at 7:00am because a 2 month old male, cannot be awakened by his mother; upon arrival, it is clear that the child has been dead for a least four hours.
HPI The child was slightly premature, but aside from this, his history was unremarkable. There was nothing that could directly explain the episode. On directed history, the mother admits to being a smoker and remembers that the child had had an upper respiratory infection four days ago.1. What is the Cause of death?2. What is the single risk factor in this particular case? -
Case Study # 8:
A 58-yr-old immigrant man presented for a physical for the first time in 10 years. He has no complaints and his labs are all within normal limits. He stopped smoking 30 years ago.A frontal chest radiograph shows a mildly lobular, well-defined mass, about 2 cm in diameter, located in the right lobe.1. What is thefirst best step in the management of this case? Don’t rush to invasive, think simple first.2. What is the next step? Note: (For this particular case, consider that other radiographic testing (CT, PET, MRI) showed the same as the CXR, solitary well-defined nodule).
Solution:
CASE STUDY # 1:
I do understand that the majority of you are not trained to read radiographs, this particular case study is interesting in that it makes few learning points – it will not affect your grade if you get wrong answers on this one only 🙂 give it a try
There are 2 abnormalities in this CXR following a car accident, probably done with a mobile unit while the patient is still on the stretcher.
1) What is the lesion?
2) Which side?
3) The second abnormality is an important medical AND a legal pitfall?
ANSWER
You all have done a great job searching, thinking and analyzing. This on its own is a great learning experience even if you didn’t find the answer.
The CXR is for Tension Pneumothorax with Right lung Atelectasis and Left Mediastinal shift.
This is an emergency condition, with circulatory collapse very prominent, I’m not even sure if this patient made it or not, it seems pretty bad.
Dx should have been made with PE simply by the shifting trachea and the tympani on percussion with absence of air entry on the right side, and then the next step in management is needle decompression in the 2nd intercostal space at the midclavicular line, which – if performed – is a life saving procedure and should have been apparent on the CXR, which is not! And that is the medicolegal pitfall, which makes this CXR an admissible evidence in court! Hope you will never forget this condition; Tension Pneumothorax = Needle decompression first then we can talk…… for Fill solution, click the icon below to purchase