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80 yo ♀️ with chronic cough.
What would you do with this "ugly" lung lesion? 🧵👇🏻
#radres #radtwitter #radiology #chestrad
What would you do with this "ugly" lung lesion? 🧵👇🏻
#radres #radtwitter #radiology #chestrad
❓❓❓
If you asked for a mediastinal window 👏👏👏
*️⃣Lipoid pneumonia*️⃣
Lung disease caused by fat accumulation that produces chonic inflammation
Two types:Endogenous and exogenous
Exogenous lipoid pneumonia is caused by aspiration of fatty or oil substances (laxatives in this case)
*️⃣Lipoid pneumonia*️⃣
Lung disease caused by fat accumulation that produces chonic inflammation
Two types:Endogenous and exogenous
Exogenous lipoid pneumonia is caused by aspiration of fatty or oil substances (laxatives in this case)
1/Hello all,Good morning! Happy independence week🇮🇳🎉🎊
Got a beautiful chest teaching case 👇🏻Xray ▶️CT ▶️HPE
🛑27 year old female came with h/o chest discomfort, breathing difficulty, cough x 1 week
Lets breakdown it✍️📝 🔥
#radres #chestrad #Pulmonology #MedTwitter #FOAMrad
Got a beautiful chest teaching case 👇🏻Xray ▶️CT ▶️HPE
🛑27 year old female came with h/o chest discomfort, breathing difficulty, cough x 1 week
Lets breakdown it✍️📝 🔥
#radres #chestrad #Pulmonology #MedTwitter #FOAMrad
2/ Frontal CXR shows homogenous opacity in R.mid & lower zone in paravertebral region
❇️It has well defined superior,inferior&lateral borders, medial border is merged with mediastinum(incomplete border sign)
♉️Opacity has Broad base contact with mediastinum s/o mediastinal origin
❇️It has well defined superior,inferior&lateral borders, medial border is merged with mediastinum(incomplete border sign)
♉️Opacity has Broad base contact with mediastinum s/o mediastinal origin
3/
❇️Lung lesion will be covered by lung margins all side(not always) & form an acute angle with meds
♉️Normal silhouette of right heart border is seen (neg silhouette sign) s/o lesion not in ant med
🉑Hilar vessels are seen coursing through the opacity (Hilum overlay sign +ve)
❇️Lung lesion will be covered by lung margins all side(not always) & form an acute angle with meds
♉️Normal silhouette of right heart border is seen (neg silhouette sign) s/o lesion not in ant med
🉑Hilar vessels are seen coursing through the opacity (Hilum overlay sign +ve)
These frontal & lateral views belong to a patient with a history of lung cancer which presented with a newly developed dyspnea. Considering the patient’s history and CXR findings,what is the most likely cause of the elevation of the right hemidiaphragm?
#chestrad #radiology
#chestrad #radiology
Hint👉 I wanted to discuss about this subject and I incidentally encountered this case! Honestly speaking it's not complicated case ,but the question is worthy of noticing!
So do you think atelectasis of the R.U lobe is the main culprit?The answer based on many references is Not!
So do you think atelectasis of the R.U lobe is the main culprit?The answer based on many references is Not!
🛑Answer part 1
Phrenic nerve paralysis is a common cause of elevation of one side of the diaphragm.
👉Take home message:
The combination of a lung or mediastinal mass and elevation of the diaphragm strongly suggests phrenic nerve paralysis.
Eventration is a different entity!
Phrenic nerve paralysis is a common cause of elevation of one side of the diaphragm.
👉Take home message:
The combination of a lung or mediastinal mass and elevation of the diaphragm strongly suggests phrenic nerve paralysis.
Eventration is a different entity!
#Wetread Case 18
Hx: Chest Pain
Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad #CXRarehard
Hx: Chest Pain
Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad #CXRarehard
#Wetread Case 18
So hopefully everyone saw this pleural based opacity in the RUL. But does anyone see the other finding? 🤔 #CXRarehard #chestrad
So hopefully everyone saw this pleural based opacity in the RUL. But does anyone see the other finding? 🤔 #CXRarehard #chestrad
#Wetread Case 18
Turns out pt had some pain radiating to their neck so they got this C-spine X-ray. Perhaps one of the rare times a non-trauma C-spine X-ray is helpful? 😁
Turns out pt had some pain radiating to their neck so they got this C-spine X-ray. Perhaps one of the rare times a non-trauma C-spine X-ray is helpful? 😁
#WetreadCoW Case 14
Hx: Abominal Pain
Can you identify the source of acute pain and the underlying etiology?
Professionally appropriate gif responses only please. No spoilers! #FOAMrad #FOAMed #radres
A case for everyone 😀 #errad #bodyrad #chestrad #NeuroRad
Hx: Abominal Pain
Can you identify the source of acute pain and the underlying etiology?
Professionally appropriate gif responses only please. No spoilers! #FOAMrad #FOAMed #radres
A case for everyone 😀 #errad #bodyrad #chestrad #NeuroRad
#WetreadCoW Answer: Tuberous Sclerosis
More specifically - multiple large bilateral renal angiomyolipomas through the kidneys (green) with acute R perinephric hemorrhage (red arrows)
*remember ⬆️size of AMLs = ⬆️ risk of hemorrhage
#FOAMed #FOAMrad #bodyrad #radres
More specifically - multiple large bilateral renal angiomyolipomas through the kidneys (green) with acute R perinephric hemorrhage (red arrows)
*remember ⬆️size of AMLs = ⬆️ risk of hemorrhage
#FOAMed #FOAMrad #bodyrad #radres
Tuberous Sclerosis (aka Bourneville Dz)
-neurocutaneous disorder (phakomatosis)
-numerous benign tumors of ectodermal orgin (skin, eyes, CNS)
-usually sporatic
-Classic: child with Vogt's triad (seizures, intellectual disability, adenoma sebaceum rb.gy/rlkgei
-neurocutaneous disorder (phakomatosis)
-numerous benign tumors of ectodermal orgin (skin, eyes, CNS)
-usually sporatic
-Classic: child with Vogt's triad (seizures, intellectual disability, adenoma sebaceum rb.gy/rlkgei
#WetreadCoW Case 13
Hx: 50 yo male with cough
Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #FOAMrad #FOAMed #radres #errad #chestrad
Hx: 50 yo male with cough
Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #FOAMrad #FOAMed #radres #errad #chestrad
@RyanBPetersonMD @ER_Rad_Hanna @StefanTigges @RadioGyan @jannimd @thoracicrad #WetreadCoW Case 13
Got the CT for you. Does it help?
Got the CT for you. Does it help?
@WetreadCoW Case 13 Answer: Mounier-Kuhn syndrome (aka tracheobronchomegaly)
-cystic dilation of trachea&bronchi
-absence/atrophy of elastin fibers&smooth muscle
-?congenital (not agreed upon)
-assoc w Ehlers-Danlos
#FOAMed #FOAMrad #chestrad #radres #thoracicrad
-cystic dilation of trachea&bronchi
-absence/atrophy of elastin fibers&smooth muscle
-?congenital (not agreed upon)
-assoc w Ehlers-Danlos
#FOAMed #FOAMrad #chestrad #radres #thoracicrad
#WetreadCoW Case 9
Hx: MVA, chest pain
Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad
Hx: MVA, chest pain
Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad
#WetreadCoW Case 9 Answer: Diverticulum of Kommerell
Focal outpouching of the distal aortic arch + h/o trauma ➡️ think traumatic PSA⭐️, but lets look a bit closer here
No perioaortic stranding
No wall thickening
location = medial (retroesophageal 🤔)
#FOAMrad #radres #chestrad
Focal outpouching of the distal aortic arch + h/o trauma ➡️ think traumatic PSA⭐️, but lets look a bit closer here
No perioaortic stranding
No wall thickening
location = medial (retroesophageal 🤔)
#FOAMrad #radres #chestrad
#WetreadCow Case 7
Hx: chest pain
Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad @thoracicrad @chestcases @TanMohammedMD
Hx: chest pain
Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad @thoracicrad @chestcases @TanMohammedMD
#WetreadCow Answer: Sprengel's Deformity
-M/C congenital abnl of the shoulder
-Failure of ⬇️ scapula (starts mid-cervical)
-often part of Klippel-Feil Deformity (cervical vert fusion)
-shoulder asymmetry w ⬇️ ABduction
#FOAMed #radres #chestrad #chestcases #orthorad
-M/C congenital abnl of the shoulder
-Failure of ⬇️ scapula (starts mid-cervical)
-often part of Klippel-Feil Deformity (cervical vert fusion)
-shoulder asymmetry w ⬇️ ABduction
#FOAMed #radres #chestrad #chestcases #orthorad
Sprengel's Imaging:
- ⬆️ (blue arrows) and ↪️(red arrow) scapula so inf tip points to spine (? smaller)
- Uni- or Bi- lateral
-👀 for bony omovertebral bone (bony or fibrous scapulo-vertebral connection - usually C4-C7) - up to 50%
-👀 for rib/spine abnl (green arrows) (K-F)
- ⬆️ (blue arrows) and ↪️(red arrow) scapula so inf tip points to spine (? smaller)
- Uni- or Bi- lateral
-👀 for bony omovertebral bone (bony or fibrous scapulo-vertebral connection - usually C4-C7) - up to 50%
-👀 for rib/spine abnl (green arrows) (K-F)
#WetreadCow Case 6
Hx: survey CXR after MVA
Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad
Can I play? 😀 @thoracicrad @chestcases @TanMohammedMD
Hx: survey CXR after MVA
Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad
Can I play? 😀 @thoracicrad @chestcases @TanMohammedMD
#WetreadCoW Case 6 Answer: Continuous Diaphragm sign of Pneumomediastinum
The heart rests on the medial diaphragms, so normally they are silhouetted out. When we see them (blue arrows) it means there is air between the heart and diaphragm @chestcases #FOAMed #errad #chestrad
The heart rests on the medial diaphragms, so normally they are silhouetted out. When we see them (blue arrows) it means there is air between the heart and diaphragm @chestcases #FOAMed #errad #chestrad
This can be seen with pneumomediastinum or pneumopericardium.
There is a more subtle lucency about the high left heart border (yellow arrow) which is also consistent with pneumomediastinum.
These findingscan be difficult to see on CXRs, esp when not involving the neck/axilla.
There is a more subtle lucency about the high left heart border (yellow arrow) which is also consistent with pneumomediastinum.
These findingscan be difficult to see on CXRs, esp when not involving the neck/axilla.
#WetreadCoW Case 3
Hx: Chest pain
Diagnosis? (it's August, we're starting easy! I'm giving you PA AND Lat! 😀)
Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad #bodyrad
Hx: Chest pain
Diagnosis? (it's August, we're starting easy! I'm giving you PA AND Lat! 😀)
Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad #bodyrad
#WetreadCOW Case 3 Answer: Bochdalek Hernia
Large round opacity right lung base.
On frontal does NOT obscure anterior diaphragm or R heart border - ie posterior/RLL
On lateral DOES "obscure" entire posterior R diaphragm
#Chestrad #ERRad #radres #FOAMrad
Large round opacity right lung base.
On frontal does NOT obscure anterior diaphragm or R heart border - ie posterior/RLL
On lateral DOES "obscure" entire posterior R diaphragm
#Chestrad #ERRad #radres #FOAMrad
#WetreadCoW Season 9 Case 1 - back to the basics
Hx: Line placement 😮 OR is calling now for a STAT report. Look OK?
Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad
Hx: Line placement 😮 OR is calling now for a STAT report. Look OK?
Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad
#WetreadCoW S9C1 Answer
1)Malpositioned left subclavian catheter (extends into R IJ)
2)Malpositioned right jugular Swan-Ganz catheter (extends into hepatic vein)
Did you see both? You have to check every one! 🤬
#FOAMrad #FOAMed #radres #chestrad #radtwitter #MedTwitter
1)Malpositioned left subclavian catheter (extends into R IJ)
2)Malpositioned right jugular Swan-Ganz catheter (extends into hepatic vein)
Did you see both? You have to check every one! 🤬
#FOAMrad #FOAMed #radres #chestrad #radtwitter #MedTwitter
Let go through them. Correct ones first.
ETT - tip below the thoracic inlet and >2cm above carina ✅
GI tube - tip/side port below GE junction (hard to see but I think so)✅
Mediastinal drain ✅
Right chest tube x 2✅ (No pneumothorax)
I'm not @radiologistpage but I try 🤣
ETT - tip below the thoracic inlet and >2cm above carina ✅
GI tube - tip/side port below GE junction (hard to see but I think so)✅
Mediastinal drain ✅
Right chest tube x 2✅ (No pneumothorax)
I'm not @radiologistpage but I try 🤣
Wetread Case 38 (Answer)
Hx: Chest Pain
Answer: Penetrating Atheromatous Ulcer (PAU)
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Original tweet:
Hx: Chest Pain
Answer: Penetrating Atheromatous Ulcer (PAU)
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Original tweet:
L infrahilar mass - Does NOT obscure L heart border (blue) but does obscure aortic border (red - dashed lines being expected course and dark red line outlining mass).
Hilum overlay sign apparent as we still see hilar vessels through the mass (orange), ie mass is not the hilum
Hilum overlay sign apparent as we still see hilar vessels through the mass (orange), ie mass is not the hilum
How about the lateral? While there may be some artistic license here, it suggests enlargement of the mid-descending thoracic aorta
Wetread Case 35
Hx: chest and neck pain.
What are the important findings? Recommendations?
Diagnosis? 🤔
Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Hx: chest and neck pain.
What are the important findings? Recommendations?
Diagnosis? 🤔
Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Answer: Thrombophlebitis of the left bracheocephalic vein with mediastinitis (variant of Lemierre's syndrome)
New X-ray: widening of the upper mediastinum. Can we be more specific? Did you go with aortic etiology?
#WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad #Neurorad
New X-ray: widening of the upper mediastinum. Can we be more specific? Did you go with aortic etiology?
#WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad #Neurorad
We can see on our current exam that the contour of the aortic silhouette (red arrow) is maintained thus it should not be adjacent to the aorta. If fact it actually obscures the left subclavian artery silhouette (yellow arrows) so it has to be in the anterior mediastinum.
Wetread Case 32
Hx: Cough, shortness of breath, fever 😡😡 (yep, I did 😁)
Any pertinent hx questions? 🤔
Feel free to answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Hx: Cough, shortness of breath, fever 😡😡 (yep, I did 😁)
Any pertinent hx questions? 🤔
Feel free to answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Would it help to know that the pt is immunosuppressed?
and NO it's NOT COVID-19! 😁
@RadioGyan @AdamSingerMD @xyzabrz @lala_layla_1
and NO it's NOT COVID-19! 😁
@RadioGyan @AdamSingerMD @xyzabrz @lala_layla_1
Answer: Kaposi’s Sarcoma
KS is a low-mid grade mesenchymal tumor that involves blood/lymphatic vessels of the skin, lymph nodes, lungs, GI tract, etc.
Not considered a true “sarcoma”
Believed related to human herpes virus type 8 (HHV8)
👏 to @DrAliya85 #chestrad #FOAMrad
KS is a low-mid grade mesenchymal tumor that involves blood/lymphatic vessels of the skin, lymph nodes, lungs, GI tract, etc.
Not considered a true “sarcoma”
Believed related to human herpes virus type 8 (HHV8)
👏 to @DrAliya85 #chestrad #FOAMrad
Wetread Case 22
Hx: Chest Pain
What is your diagnosis/diagnoses? 🤔
Feel free to answer with professionally appropriate gif responses only. No spoilers.
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Hx: Chest Pain
What is your diagnosis/diagnoses? 🤔
Feel free to answer with professionally appropriate gif responses only. No spoilers.
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
@StefanTigges @RyanBPetersonMD @ER_Rad_Hanna Everyone is doing well! But there is arguably another finding (one that is usually better seen in hindsight 🤣).
Anyone up for the "read the attending's mind" finding 🤣
Anyone up for the "read the attending's mind" finding 🤣
@StefanTigges @RyanBPetersonMD @ER_Rad_Hanna Answer: double aortic arch (R desc aorta)
CT shows that plus bilateral pulmonary emboli. In hindsight maybe there is left vascular redistribution and maybe some lower lobe oligemia? Not that I would call on the front end 😀
#WetreadCow #FOAMrad #radres #errad #chestrad
CT shows that plus bilateral pulmonary emboli. In hindsight maybe there is left vascular redistribution and maybe some lower lobe oligemia? Not that I would call on the front end 😀
#WetreadCow #FOAMrad #radres #errad #chestrad
