test your skills

[booshwa]

Hey everybody,

I'm trying to get some information on this x-ray. I know nothing about them, but am in the process of learning.

Does anything jump out at you from this x-ray?

Any input would be great.

Thanks

x-ray

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[sixteenstones]

Your patient has a very severe hypertrophic cardiac silohuette with unappreciable inferior borders. Also, some mediastinal widening can be appreciated with increased opacity in the mediastinum. Also, some diffuse interstitial markings in the right upper lobe. Without any history, it is hard to say what a next step would be, but if you don't know the CV status you need a cardiac echo.

Sicteenstones

 

[ckent]

Agree with the widened mediastinum and the enlarged heart (even though it looks like a portable). If I had to guess at a diagnosis (ie if this were a test question looking for a dx with no hx), I would guess aortic insufficiency with congestive heart failure. The aortic knob looks large to me. It's either CHF or it could be that the guy has some serious pericardial effusions. Anyways, I haven't had my radiology elective yet, but that's how I'd read it without knowing the history.

 

[booshwa]

Here's the history as I have it:

-50 yr old Caucasian woman
-At clinic reporting 8-month history of difficulty in swallowing
-Since then, progressively more difficult to swallow liquids and solids
-10 lb weight loss in last 8 months
-Over past few years she has begun "washing down" food with liquid
-Difficulty in swallowing regardless of eating pace
-No prior history of heartburn, indigestion or anorexia
-At times difficulty in swallowing is so severe substernal pain develops as if it "hurts my heart"
-No choking or coughing while eating, nor while sleeping
-No muscle weakness, feelings or malaise, fever, chills or signs of arthritis
-No feeling of constant "lump in her throat"
-No history of regurgitation of acid material
-No regurgitation of liquids through nose
-Complains of chronic hoarseness and pain in upper back

It's only my second day of school, so my understanding of radiology is bascially zero.

 

[ckent]

It sounds like they are trying to get you to say that she has an aortic aneurysm with aortic regurg (aortic insufficiency) and associated CHF. The pain could be from a dissection.

 

[odoreater]

Chagas disease