CXR: Complete collapse of lung & Total re-expansion

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CXR: Complete collapse of lung & Total re-expansion

  1. 1. IMAGE OF THE WEEK BY PROF.P.VIJAYARAGHAVAN’S UNIT ELAVAZHAGAN.B PG
  2. 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. 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. 4.  Chest x ray PA view  In full inspiration  Properly positioned  Adequate penetration  Soft tissue shadow normal
  5. 5.  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+
  6. 6.  CAUSES OF OPAQUE HEMITHORAX  Rotation,scoliosis  Large pleural effusion,pleural thickening,mesothelioma.  Collapse,consolidation,fibrosis.  Pulmonary agenesis,gross cardiomegaly,tumor  Pneumectomy,thoracoplasty.
  7. 7. Differential diagnosis Left lung COLLAPSE Left lung FIBROSIS
  8. 8. CHEST PHYSICIAN OPINION  Collapse left lung  ? Central type bronchgenic carcinoma
  9. 9.  CAUSES OF CENTRAL OBSTRUCTION  In children: mucous plug,foreign body  <40 YRS : mucous plug,F.body,endo broncial tumour[lowgrade]  >40YRS: bronchogenic ca.
  10. 10.  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.
  11. 11.  COLLAPSE[complete atelectasis]  resorption atelectasis  relaxation atelectasis  adhesive atelectasis  cicatrization atelectasis  round atelectasis  Basal atelectasis due to hypo ventilation.
  12. 12. RADIOLAGICAL SIGNS: DIRECT displacement of inter lobar fissures crowding of vessels& bronchi crowded air bronchograms.
  13. 13.  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.
  14. 14. THANKYOU

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