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CXR: Complete collapse of lung & Total re-expansion

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    CXR: Complete collapse of lung & Total re-expansion CXR: Complete collapse of lung & Total re-expansion Presentation Transcript

    • IMAGE OF THE WEEK
      BY PROF.P.VIJAYARAGHAVAN’S UNIT
      ELAVAZHAGAN.B PG
    • 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
    • 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.
    • Chest x ray PA view
      In full inspiration
      Properly positioned
      Adequate penetration
      Soft tissue shadow normal
    • 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+
    • CAUSES OF OPAQUE HEMITHORAX
      Rotation,scoliosis
      Largepleural effusion,pleural
      thickening,mesothelioma.
      Collapse,consolidation,fibrosis.
      Pulmonary agenesis,grosscardiomegaly,tumor
      Pneumectomy,thoracoplasty.
    • Differential diagnosis
      • Left lung COLLAPSE
      • Left lung FIBROSIS
  • CHEST PHYSICIAN OPINION
    Collapse left lung
    ? Central type bronchgenic carcinoma
  • CAUSES OF CENTRAL OBSTRUCTION
    In children:
    mucous plug,foreign body
    <40 YRS :
    mucous plug,F.body,endobroncial
    tumour[lowgrade]
    >40YRS:
    bronchogenic ca.
  • 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.
  • COLLAPSE[complete atelectasis]
    resorptionatelectasis
    relaxation atelectasis
    adhesive atelectasis
    cicatrizationatelectasis
    round atelectasis
    Basal atelectasis due to hypo ventilation.
  • RADIOLAGICAL SIGNS: DIRECT
    displacement of inter lobar fissures
    crowding of vessels& bronchi
    crowded air bronchograms.
  • 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.
  • THANKYOU