Discussion in 'Spot Diagnosis' started by Egyptian Doctor, Dec 6, 2012.
What is your medical diagnosis for this case ?
clearly visible air/fluid level indicating hemothorax, massive pleural effusion or empyema possibly..... confirm with history of presentation.
No visible lung markings in right lung meaning the lung is collapsed- pnemuothorax also we see a typical air-fluid level in right lung meaning there is hemo/hydrothorax (and a rather large one at that)
I disagree with your statement " no lung markings mean collapsed lung" ...since there are many other conditions where you will not see lung markings as well..e.g pulmonary hypertension or any obstruction to pulmonary outflow tract. A safer way of identifying a pneumothorax is to look for the separation of pleura ( double lines on x ray with air in between).. along with clinical presentation and findings.
Pneumothorax with hemothorax l.dx.
True there can be others causes and you are correct better is to look for the collapsed lung which you can actually see (as neostar has so graciously pointed) in this picture. That being said you will usually have some lung markings on pulmonary hypertension not a complete lack of them and also unless you have a complete pneumothorax- as this patient seems to you will still see lung markings on a pnuemothorax CXR. Thank you for pointing out my mistake!
Pneumothorax with hemothorax
The Question: "WHAT IS YOUR MEDICAL DIAGNOSIS FOR THIS CASE" is wrong, Since there are other factors to consider in arriving at a correct Medical Diagnosis and they are the presenting signs and symptoms, history of the patient's problem, physical examination - vital signs and yes this Chest Xray film. Judging the film will only give us the IMPRESSION OF THE READER which has to be correlated to the complaint/s, history and physical examination findings. Other diagnostic procedures can be further requested to arrive at a correct Medical Diagnosis, like right lateral decubitus xray, blood count, etc.
Answer ; Hemopneumothorax
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