can anyone read x-rays

[booshwa]

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Hey if so..can you give me a hand.

This is a horrible image, but hopefully anythign obvious is still visible.

Thanks

x-ray

 

[Adcadet]

I'm struggling with radiographic anatomy of the thorax and abdomen as we speak.

Seems like a chest X-ray. Looks like there may be non-human material in there (tubing?) coming from the axilla and something (prosthesis? medical device?) posteriomedial to the glenohumoral joint. I see a heart and some great vessels, too.

Perhaps somebody with some real knowledge and skill can help ya out.

 

[NYDOC925]

Cardiomegaly with questionable pleural effusion at the left lung base. Mediastinum is widened with prominence of aortic knob and pulmonary arteries. There may be a tracheal deviation to the right. Looks like 2 ECG leads on the right and left chest.

My 2 cents, hope it helps.

 

[Careofme]

Has this patient suffered a deceleration accident?

I can't realy tell the densities well since its a bad film. Abnormal aortic arch (fuzzy/lumpy), abnormal superior mediastinum (widening), and other signs over the left apical (cap) might be suggestive of traumatic aortic injury. Threre might be something going on the right superior but I'm not sure....anywhoo what do I know? GL

My Dx: reshoot the film.

 

[Whisker Barrel Cortex]

This image is so bad that it is completely non-diagnostic. The gross abnormalites are:

1. Enlarged cardiac sillhoutte (big heart or pericardial effusion which means fluid around the heart).

2. Widened superior mediastinum. With this image it is hard to say the cause. The well circumscribed mass above the hilum (upper lung) is very hard to diagnose based on this image alone. It may be large mediastinal mass (lymphoma, carcinoma, thymoma) or it may be vascular. I would favor a mediastinal mass.

3. Likely small left pleural effsion.

4. Opacity at the left lung base medially (behind the heart) which may just be due to the bad film or may be a real finding.

5. Dilated aorta.

Tracheal deviation is difficult to asses do to patient rotation.

You really do need a better image to figure out whats going on. The tube-like things are just EKG leads overlying the patient.

 

[Goofyone]

How about a pericardial sac with about 27lbs worth of junk it it.

 

[Adcadet]

Originally posted by Whisker Barrel Cortex
This image is so bad that it is completely non-diagnostic. The gross abnormalites are:

1. Enlarged cardiac sillhoutte (big heart or pericardial effusion which means fluid around the heart).

2. Widened superior mediastinum. With this image it is hard to say the cause. The well circumscribed mass above the hilum (upper lung) is very hard to diagnose based on this image alone. It may be large mediastinal mass (lymphoma, carcinoma, thymoma) or it may be vascular. I would favor a mediastinal mass.

3. Likely small left pleural effsion.

4. Opacity at the left lung base medially (behind the heart) which may just be due to the bad film or may be a real finding.

5. Dilated aorta.

Tracheal deviation is difficult to asses do to patient rotation.

You really do need a better image to figure out whats going on. The tube-like things are just EKG leads overlying the patient.

Woo hoo! So I was right. It is a CXR showing the heart and great vessels (thought I missed the lungs!), and some non-human material. Man, I'm getting good at this radiology stuff. Maybe I can pass the radiographic anatomy section of my second anatomy exam afterall.

 

[Rads Resident]

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[tofurious]

Not being a radiology person myself, I can only pick out the really obvious:

1. Baboon heart (aka cardiomegaly)
2. The "mediastinal mass" everyone speaks of is probably just the bilateral hilar infiltrate nobody makes a big deal of, secondary to the big heart.
3. Where is the gastic air-fluid level?

And I even did well in radiology...

 

[Mossjoh]

Well, the first think I recognized was the boot-shaped heart, which reminded me of Tetrology of Fallot, but this CXR is obviously of a much older person, so that is ruled out.

I don't see much of the Lung Markings, and the lungs appear hyperinflated bilaterally, suggesting some type of airway disease, most likely COPD.

This appearance would suggest to me congestive heart failure, however, with that I would expect pulmonary edema and fluid at the lung bases, which frankly I don't see. I see a clear costodiaphagmatic angle on the right and probably would see one on the left except that its obscured by the cardiomegaly.

I don't see much in the way of pulmonary vasculature, which makes me suspicious. However, the ascending thoracic aorta looks dilated.

This may be an aortic aneurysm in the area of the aortic arch with related cardiomegaly...........

the theory...I just am not sure!!

Mossjoh

 

[ac808]

Before you jump to the conclusion of cardiomegaly, I would always consider that this may be an AP view. I think professors love to trick students on these types of Xrays. Look for scapula overylaying the thorax to diagnose the "AP" view.

 

[Homunculus]

also, be sure to check for "fingerprint sign". that is the area of the film everyone points at and touches, often leaving telltale fingerprints. it's usually where the pathology is 🙂

 

[kcrd]

Originally posted by Homonculus
also, be sure to check for "fingerprint sign". that is the area of the film everyone points at and touches, often leaving telltale fingerprints. it's usually where the pathology is 🙂

hey, that's pretty clever. I'll have to remember that.

 

[Whisker Barrel Cortex]

I wish I could put arrows on it to show the findings.

The heart is grossly enlarged, even if this is an AP view (which it most likely is).

There is no such thing as "bilateral hilar infiltrates" that have no signifcance. Hilar prominance can have many causes. I won't go into that because that is not the mediastinal mass.

If you look to the right lung above the hilum there is a large round opacity. That is the mass. It may be mediastinal or in the lung parenchyma. I cannot say what it is exactly because the film is such bad quality.

 

[12R34Y]

I'm just curious as to why everyone is still throwing out guesses AFTER a radiology resident has offered his opinion.

seems like he will probably be the most correct. wouldn't you think?

later

 

[ItsGavinC]

ditto to that.

 

[paramed2premed]

Originally posted by booshwa
Hey if so..can you give me a hand.

This is a horrible image, but hopefully anythign obvious is still visible.

Thanks

x-ray

Let me give it a shot --- Does anybody think that there is a tiny chance that the OP was being sarcastic?

This is the sort of thing I say when the film shows two orthogonal femur segments; "hey doc, can you help me out with this one?"

 

[Jim Picotte]

I concur with Whisker. Garbage film forget about reading anything subtle in this thing. Big heart, mass in Upper Right...likely mediastinal. Patient would get an echo and a Chest CT without much thought and we'll figure out what's really going on.

 

[mile_26]

Originally posted by paramed2premed
Let me give it a shot --- Does anybody think that there is a tiny chance that the OP was being sarcastic?

This is the sort of thing I say when the film shows two orthogonal femur segments; "hey doc, can you help me out with this one?"

Is there a chance this is a non-human chest x-ray...ie: animal/chimp/whatever??

 

[booshwa]

No, this was a serious question (yes its human). When I posted this it was my second day of school (I'm now a veteran of a week), and I was assigned an x-ray to read. The original image is not much better than this scan by the way.

Part of my PBL curriculum...Right now I'm looking into the possibility of an aneurysm in the descending aorta-which seems to fit the patients history (and some of your guys' guesses). I can post the patients history if you are interested.