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  • 1. IMAGE OF THE WEEK
    BY PROF.P.VIJAYARAGHAVAN’S UNIT
    ELAVAZHAGAN.B PG
  • 2. 50 yr male old came with c/o
    Hemoptysis three episodes over 1 day
    Around 100-150 ml per episode
    Blood stained sputum since morning
    No h/o breathlessness.
    Past h/o : not a known DM/HT/BA/PT
    Personal h/o: known smoker 15 yrs
    Contact h/o : no contact with TB
  • 3. O/E conscious ,afebrile
    no pallor/icterus/cyanosis/clubbing/LN/PE
    VITALS - stable
    RS: Tracheal shift to left
    apical impulse at 5 ICS lat to mid
    clavicular line.
    VF,VR diminished Lt side lung fields
    Dullness in same side on percussion
    Lt side BS absent
    Rt side NVBS heard.
  • 4.
  • 5. Chest x ray PA view
    In full inspiration
    Properly positioned
    Adequate penetration
    Soft tissue shadow normal
  • 6. Trachea shifted to left
    Homogenous opacity seen in lt upper/ mid/lower
    lung zones
    Lt diaphragm silhouetted
    Lt heart border couldn’t be made out.
    Lt side crowding of ribs+
    Rt side hyperinflation+
  • 7. CAUSES OF OPAQUE HEMITHORAX
    Rotation,scoliosis
    Largepleural effusion,pleural
    thickening,mesothelioma.
    Collapse,consolidation,fibrosis.
    Pulmonary agenesis,grosscardiomegaly,tumor
    Pneumectomy,thoracoplasty.
  • 8. Differential diagnosis
    • Left lung COLLAPSE
    • 9. Left lung FIBROSIS
  • CHEST PHYSICIAN OPINION
    Collapse left lung
    ? Central type bronchgenic carcinoma
  • 10.
  • 11.
  • 12. CAUSES OF CENTRAL OBSTRUCTION
    In children:
    mucous plug,foreign body
    <40 YRS :
    mucous plug,F.body,endobroncial
    tumour[lowgrade]
    >40YRS:
    bronchogenic ca.
  • 13. Collapse reversed in 3 days.
    Probably a mucous block which has been coughed out.
    CT shows bronchiectactic changes in left lower zone.
    FOB: no mass or block detected.
  • 14. COLLAPSE[complete atelectasis]
    resorptionatelectasis
    relaxation atelectasis
    adhesive atelectasis
    cicatrizationatelectasis
    round atelectasis
    Basal atelectasis due to hypo ventilation.
  • 15. RADIOLAGICAL SIGNS: DIRECT
    displacement of inter lobar fissures
    crowding of vessels& bronchi
    crowded air bronchograms.
  • 16. INDIRECT SIGNS:
    local opacity
    diphragmatic elevation
    mediastinal shift
    Approximation of ribs
    overinflation of remainder lung
    displacement of hila
    absence of visibility of inter lobar A.
  • 17. THANKYOU