An unusual CXR
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An unusual CXR
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this is an unusual cardiological diagnosis. Suggestions please
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Cat:OpenClinicalForum:083a12c9-861a-4a42-a5af-ddc3263b34bc
Cat:OpenClinicalForum:083a12c9-861a-4a42-a5af-ddc3263b34bcDiscussion:44b29e53-f03e-4150-9acb-cd97066470f9
Forums » Open clinical » Cardiology » An unusual CXR
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Re: An unusual CXR
posted at 9/7/2011 6:01 PM BST
on bmj.com
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Posts: 2
First: 6/7/2011 Last: 9/7/2011 |
In Response to An unusual CXR: This is a really interesting post. I would like to have some information regarding the clinical history, however i can appreciate a pneumopericardium in the CXR image posted. |
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Re: An unusual CXR
posted at 10/7/2011 9:42 AM BST
on bmj.com
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Posts: 220
First: 10/12/2010 Last: 1/6/2012 |
She is an aged female patient. Oblique lines running across the chest; ? wired up Obliteration of right costopherinic angle; Fluid A prominent left hilar shadow: ? Lymph node, ? CA lung, ? Cosolidation Increased bronchovascular markings in both lower zones, more so on left side. ? mediastinal shift towards right ? mediastinum width increased. ? Heart size enlarged. |
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Re: An unusual CXR
posted at 11/7/2011 8:53 AM BST
on bmj.com
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Posts: 873
First: 17/6/2011 Last: 17/5/2013 |
Hello a few more details. This is an elderly lady who presented with relapsed nonsmall cell carcinoma of the lung (not suitable for surgery- has had radiotherpay and chemo ). She intially presented with a left hilar mass and I think you can appreciate this on the admittedly poorly reproduced CXR. I first met her when she presented with tamponade (engorge neck veins, sinus tachy, BP90/50 ) and approx 4cm global pericardial effusion. You can just about see our pogtail catheter in the pericardium as after discussion with our surgical colleagues we were asked to drain this percutaneously. Any further comments? Best, sadian |
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Re: An unusual CXR
posted at 12/7/2011 11:11 AM BST
on bmj.com
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Posts: 7
First: 12/7/2011 Last: 7/3/2012 |
Notably an AP film. I agree with the finidng of air in the mediastinum. Dense left upper lobe shadowing consistent with NSCLC that you describe. Clinically how did the patient progress? How much pericardial fluid was drained and how many days post-insertion of the pigtail catheter is this? |
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Re: An unusual CXR
posted at 12/7/2011 11:37 AM BST
on bmj.com
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Posts: 873
First: 17/6/2011 Last: 17/5/2013 |
Dear All, I've labelled the picture to hopefully highlight the pneumopericardium and the pigtail. This image was day 1 after pigtail insertion and we drained 1.2l by this time from the pericardium. The patient's blood pressure improved immediately after the drain improved - the tachycardia settled and she felt less breathless. 
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Re: An unusual CXR
posted at 12/7/2011 3:25 PM BST
on bmj.com
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Posts: 220
First: 10/12/2010 Last: 1/6/2012 |
Well thanks Saadian Arrows did help. The upper air shadow was visible to me earlier but due to small size of image, I ascribed that to lung between cardiac border and mass. But after seeing your oblique upper arrow this was still seemed part of the lung tissure but only zooming to 400 % showed the border of cardiac shadow and this air shadow is within the cardiac shadow. Lower air shadow is still being confused with air bubble in the stomach. Thanks any way. It has been very educating; so enjoyable. |
Forums » Open clinical » Cardiology » An unusual CXR
