Age 31-60 – Page 3 – ChestDB.com

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, Lines/Tubes/Devices / Age 31-60, Bronchiectasis, Cystic Fibrosis, Port

This radiograph shows 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 also seen.

An implanted right internal jugular port is also seen with the tip terminating in the superior vena cava, presumably for administration of antibiotics due to recurrent infections in this patient population. The port reservoir is placed in the inferior chest wall in this patient, which is an unusual location.

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Case 17

Emergency & Trauma, Infectious/Inflammatory / Age 31-60, Consolidation, Infection, Parapneumonic Effusion, Pleural Effusion, Pneumonia

This radiograph shows poorly defined peribronchovascular opacities in the left lung with an associated moderate pleural effusion. In this patient with a cough and leukocytosis, this appearance is consistent with pneumonia with parapneumonic effusion.

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Case 12

Emergency & Trauma / Age 31-60, Nodule, 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, Infection, Lobar Pneumonia, Pneumonia, Silhouette Sign

This radiograph shows a poorly defined focal opacity in the left lower lung most 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 due to body habitus. The exam is otherwise unremarkable.

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Case 8

Normal/Variants & Congenital / Age 31-60, Diaphragm, Eventration

This case shows 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 congenital or acquired. In adults it is usually asymptomatic. The study is otherwise unremarkable.

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Case 4

Normal/Variants & Congenital / Age 31-60, Normal

This is a normal chest radiograph in a middle age adult.

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Case 3

Normal/Variants & Congenital / Age 31-60, Dextrocardia

This radiograph demonstrates true dextrocardia, which was confirmed by reviewing multiple past radiographs. If no prior radiographs are present, discussion with the technologist to ensure that the image was not inadvertently mirrored would be appropriate. The study is otherwise unremarkable.

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