Age 31-60 – Page 2 – ChestDB.com

Case 30

ICU/Surgery, Lines/Tubes/Devices / Age 31-60, IABP, Intra-Aortic Balloon Pump, Malposition, Peripherally Inserted Central Catheter, PICC, Portable, Pulmonary Edema, Swan-Ganz Catheter

This radiograph demonstrates a misplaced right IJ Swan-Ganz catheter. Not only is the catheter too deep in the right pulmonary artery, the course of the catheter extends all the way into the abdominal IVC before looping back into the right atrium and crossing the tricuspid valve. Other lines and devices include a left upper extremity PICC with the tip terminating in the SVC, and an intra-aortic balloon pump (IABP) with the distal marker appropriately located just inferior to the aortic knob.

The cardiac silhouette is prominent and there is mild interstitial edema, which makes sense in the context of an IABP indicating that the patient is in heart failure.

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Case 28

Chronic & ILD / Age 31-60, Albers-Schönberg Disease, Fracture, Marble Bone Disease, Osteopetrosis, Portable

This radiograph demonstrates osteopetrosis (also known as marble bone disease and Albers-Schönberg disease), a disorder of osteoclasts which leads to unopposed osteoblastic activity. The bones are diffusely thickened and sclerotic. Multiple rib fractures are noted, highlighting the fragility of the disorganized bone.

The lungs and mediastinum are unremarkable.

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Case 26

ICU/Surgery, Lines/Tubes/Devices / Age 31-60, Portable, Pulmonary Edema, Tracheostomy Mask, Tracheostomy Tube

This radiograph demonstrates unilateral pulmonary edema in the right lung. The differential for this appearance is limited and includes severe mitral regurgitation (such as a papillary muscle rupture), unilateral pulmonary venous obstruction, and lymphangitic spread of malignancy mimicking edema. Those etiologies rarely present with as much uniformity as this case, which was due to prolonged decubitus positioning that rapidly resolved on subsequent radiographs.

Incidentally noted is the presence of a tracheostomy tube with an overlying tracheostomy mask supplying oxygen to the patient.

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Case 24

Lines/Tubes/Devices, Normal & Variants / Age 31-60, Peripherally Inserted Central Catheter, Persistent Left SVC, PICC

This radiograph demonstrates a left upper extremity peripherally inserted central catheter (PICC) with tip terminating in a persistent left SVC. The presence of a persistent left SVC was confirmed on review of prior cross sectional imaging. A PICC in the internal thoracic vein can have a similar appearance on AP/PA radiographs, however a lateral radiograph easily distinguishes the two as a persistent left SVC will course centrally and the internal thoracic vein will course anteriorly.

The radiograph is otherwise unremarkable.

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Case 22

Malignancy / Age 31-60, Kerley B Lines, Lymphadenopathy, Metastatic Disease, Paratracheal Stripe Thickening, Venolymphatic Obstruction

This patient presented with a mass at the base of his right neck which is evident on this radiograph. There is a unilateral increase in vascular markings seen only in the right lung. Kerley B lines are also seen in the right lung base, but there is little other evidence to suggest pulmonary edema or fluid overload. Other pertinent findings include thickening of the right paratracheal stripe and an asymmetrically prominent right hilum.

This constellation of findings is concerning for malignancy causing venous and lymphatic obstruction and should prompt further evaluation with CT. In this case, the neck mass, thickening of the paratracheal stripe, and the prominent right hilum all corresponded to lymphadenopathy on CT. Further investigation in the abdomen revealed a large renal mass as the likely primary malignancy.

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Case 20

Chronic & ILD / Age 31-60, Bronchiectasis, Cystic Fibrosis, Port

This radiograph demonstrates severe cylindrical bronchiectasis, also referred to as tubular bronchiectasis, in an adult patient with cystic fibrosis. This patient has symmetric upper lobe disease which is a common pattern in this condition, though other distributions are not uncommon.

An implanted port is also seen with the tip terminating in the superior vena cava. The port reservoir is placed in the inferior chest wall in this patient, which is an unusual location.

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Case 17

Infectious/Inflammatory / Age 31-60, Consolidation, Parapneumonic Effusion, Pleural Effusion, Pneumonia

This radiograph demonstrates patchy mixed ground-glass and consolidative airspace opacities in the left lung with an associated moderate pleural effusion. In this patient with a cough and a white count, this appearance is consistent with pneumonia with parapneumonic effusion.

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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 11

Infectious/Inflammatory / Age 31-60, Pneumonia, Silhouette Sign

This radiograph demonstrates a poorly defined focal opacity in the left inferior lung field consistent with pneumonia. The opacity silhouettes the left heart border, which localizes it to the lingular segment. There is a high degree of soft tissue attenuation consistent with obesity. The exam is otherwise unremarkable.

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Case 8

Normal & Variants / Age 31-60, Eventration

This case demonstrates bilateral eventration of the diaphragm. Eventration is the result of localized atrophy of the diaphragmatic muscle or localized replacement with fibroelastic tissue, which gives the diaphragm an irregular contour on imaging. It can be part of normal aging, as in this case, congenital, or post-traumatic. The study is otherwise unremarkable.

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