Portable – Page 2 – ChestDB.com

Case 19

ICU/Surgery, Lines/Tubes/Devices / Age <30, Enteric Tube, NAVA, Neonatal Respiratory Distress Syndrome, Neurally Adjusted Ventilatory Assist, PIE, Portable, Premature Neonate, Pulmonary Interstitial Emphysema, RDS (Neonatal), Surfactant Deficiency Disorder

This radiograph is of a premature infant in the first week of life. The right lung demonstrates diffuse microatelectasis typical of Neonatal Respiratory Distress Syndrome (RDS), also known as Surfactant Deficiency Disorder, caused by insufficient surfactant production in the setting of prematurity (typically <35 weeks gestation). The left lung is hyperinflated relative to the right lung, with diffuse linear lucencies radiating from the hilum. This appearance is typical for Pulmonary Interstitial Emphysema (PIE), a condition secondary to barotrauma from ventilation seen in premature infants in the first weeks of life. An NG/OG tube terminates in the body of the stomach. A second tube, thicker and denser than the NG/OG, with multiple rounded lucencies along the distal aspect is also seen. This is a NAVA tube (Neurally Adjusted Ventilatory Assist), which detects electrical activity of the diaphragm to improve synchrony with the ventilator.

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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 16

ICU/Surgery, Lines/Tubes/Devices / Age >61, Aortic Valve Replacement, Atelectasis (Compressive/Passive), Endotracheal Tube, Enteric Tube, Left Atrial Appendage Closure Device, Loop Recorder, Malposition, Portable, Watchman

This radiograph demonstrates a malpositioned enteric tube which is looped in the oropharynx/hypopharynx. There are a number of incidental findings including an appropriately positioned endotracheal tube, a loop recorder projecting over the left chest wall, postsurgical changes of sternotomy with a prosthetic aortic valve, and a Watchman left atrial appendage occlusion device which is difficult to see on the default window and level. The lung volumes are low overall with some linear subsegmental atelectasis in the left lung base.

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Case 15

ICU/Surgery, Lines/Tubes/Devices / Age <30, Atelectasis (Lung), Bronchial Intubation, Endotracheal Tube, Enteric Tube, Malposition, Portable

This radiograph demonstrates a malpositioned endotracheal tube in the right main bronchus with resultant atelectasis of the entire left lung. The heart is shifted toward the left side. This supports the diagnosis of atelectasis over a large pleural effusion, which would look similar except that the heart would shift to the contralateral side. An enteric tube is also seen entering the stomach and terminating inferiorly beyond the border of the study. EKG wires, bra clasps, and bra underwires are seen externally.

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Case 14

Lines/Tubes/Devices / Age >61, Malposition, Peripherally Inserted Central Catheter, PICC, Portable

This radiograph demonstrates a malpositioned left upper extremity PICC (peripherally inserted central catheter). The tip is turned upward within the superior vena cava and is beginning to course medially, consistent with placement in the azygous vein. A lateral radiograph may be helpful to confirm, if available. The study is otherwise unremarkable for the patient’s age.

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Case 13

Lines/Tubes/Devices / Age >61, Left Atrial Appendage Closure Device, Portable, Watchman

This radiograph demonstrates an endovascular left atrial appendage closure device, in this case a Watchman™ device, projecting over the left heart. This prevents clot formation in the left atrial appendage in atrial fibrillation patients, which could otherwise embolize to the brain and cause stroke. The exam is otherwise unremarkable for the patient’s age.

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Case 9

Malignancy / Age >61, Cervicothoracic Sign, Pancoast Tumor, Portable, Rotation

This radiograph demonstrates a paramedian mass in the right lung apex, colloquially referred to as a Pancoast tumor. The lateral margin of the mass is visible above the clavicle, which localizes the mass to the posterior mediastinum (negative cervicothoracic sign). The patient is slightly rotated to the left. Multiple chronic bilateral rib fractures are present. A nipple ring projects over the left chest wall.

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Case 1

Normal & Variants / Age >61, Artifact, False Positive, Pneumothorax, Portable, Skin Fold

This radiograph demonstrates a skin fold projecting over the right hemithorax that could be easily mistaken for a pneumothorax. Skin folds are frequently identified as such because they cross anatomic boundaries such as the mediastinum or lateral chest wall. The lack of clinical symptoms such as shortness of breath can be reassuring, but not definitive. In this case, the only imaging finding that distinguishes the skin fold from a pneumothorax is the minor fissure which remains intact across the pseudo-pleural separation. A repeat chest radiograph was obtained with instruction to the technologist to smooth the patient’s skin and clothing prior to acquisition and the finding was no longer present. A left lateral decubitus radiograph would have also been an appropriate next step.

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