Emergency & Trauma

Case 34

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

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

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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