Emergency & Trauma – ChestDB.com

Case 46

Emergency & Trauma, Infectious/Inflammatory / Age 31-60, Consolidation, Infection, Lobar Pneumonia, Pneumonia

This radiograph demonstrates a right upper lobe consolidation most consistent with lobar pneumonia in this patient with a cough and elevated white count. The consolidation has poorly defined margins with the exception of the inferior margin, which is sharp and linear. This is due to the consolidation abutting the minor fissure. The position of the consolidation superior to the minor fissure definitively localizes it to the right upper lobe. Uncomplicated community acquired lobar pneumonia does not typically cross fissures. While malignancy is not entirely excluded, a mass would be unlikely to respect the fissural boundary without exerting mass effect.

The exam is otherwise unremarkable.

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Case 43

Emergency & Trauma, Mediastinum / Acute Aortic Syndrome, Age <30, Portable, Traumatic Aortic Injury, Widened Mediastinum, Widened Vascular Pedicle

This previously healthy young patient presented to the emergency department after a motor vehicle collision. There is marked widening of the vascular pedicle and loss of the normal contour of the aortic arch. This finding is consistent with acute traumatic aortic injury. The lungs are clear and there are no radiographically evident fractures.

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Case 40

Emergency & Trauma, Infectious/Inflammatory / Age 31-60, Pneumonia

This case demonstrates multiple poorly defined opacities in the right lung. In a clinical setting suspicious for infection, this finding is most consistent with multifocal pneumonia as was the case here.

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Case 39

Emergency & Trauma, ICU/Surgery, Mediastinum / Age 31-60, Chest Tube, Clamshell Sternotomy, Lung Transplant, Pneumopericardium, Pneumothorax, Portable

This case demonstrates both a right pneumothorax and pneumopericardium. In this case, the cause was iatrogenic during a bronchoscopy. A right chest tube is in place, though a small apical pneumothorax is still visible.

Clamshell sternotomy closure hardware is also seen, indicating that this is a lung transplant patient.

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Case 34

Emergency & Trauma / Age <30, Atelectasis (Compressive/Passive), Central Venous Catheter, CVC, Kerley B Lines, Pleural Effusion, Portable, Pulmonary Edema

This radiograph demonstrates typical findings of pulmonary edema. The vessels are hazy with indistinct margins. Kerley B lines are seen peripherally. There are bilateral layering pleural effusions creating a gradient of opacification extending from the bases. Bibasilar opacities are silhouetting the diaphragm and the right heart border, representing a combination of pleural effusions and associated atelectasis.

A dual-lumen central venous catheter is also in place.

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Case 23

Emergency & Trauma, Infectious/Inflammatory / Age <30, Asthma, Peribronchial Cuffing, Portable, Reactive Airway Disease

This is a radiograph demonstrates peribronchial cuffing, which is increased density around the bronchioles when viewed end-on. This may represent thickening of the wall itself or fluid around the wall due to lymphatic congestion. The finding is nonspecific and can be seen in pulmonary edema, infectious and inflammatory bronchiolitis, and reactive airway disease. This particular case was a toddler with a previous diagnosis of asthma who presented to the emergency department with an acute asthma exacerbation.

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Case 18

Emergency & Trauma, Infectious/Inflammatory / Age <30, Aspiration, Consolidation, Endotracheal Tube, Enteric Tube, Esophageal Temperature Probe, Fracture, Portable

This radiograph demonstrates obvious consolidation in the right lower lung field, with more subtle retrocardiac left lower lobe consolidation. There is a displaced left mid-clavicular fracture. Lines and tubes include an endotracheal tube, an enteric tube, and an esophageal temperature probe. Without additional history, the lung findings are not specific. The distribution is typical for aspiration, though infection is also high on the differential. Contusion is also a consideration in a trauma patient. In this case, the EMS report included witnessed aspiration which makes it the likely etiology.

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Case 12

Emergency & Trauma / Age 31-60, Pneumomediastinum

This radiograph demonstrates pneumomediastinum in the form of streaky lucencies at the base of the neck. A benign calcified granuloma is noted in the left lower lung field. The study is otherwise unremarkable.

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Case 5

Emergency & Trauma / Age <30, Pneumothorax

This radiograph demonstrates a left pneumothorax without evidence of tension physiology. This was a spontaneous pneumothorax in a young patient, unknown etiology.

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