Dear Friends,
Sorry about the delay in posting a new case, but Muppet was invited to the ECR, got drunk every night and did not cooperate at all. By the way, he sends his warmest regards to Marina, a very smart resident.
Our new patient is a 36 year-old lady with lupus, admitted with mild dyspnea.
Diagnosis:
1. Myocardiopathy
2. Pericarditis
3. Hilar adenopathy
4. None of the above
36 year-old woman. PA chest
36 year-old woman, lateral chest
Click here for the answer to case #14
The PA chest radiograph shows convexity of the pulmonary arch (Fig 1 arrow), as well as prominent central pulmonary arteries, with diminished vascularity of the lungs.
This appearance is very typical of pulmonary arterial hypertension. The lateral view is very helpful because it helps to differentiate between the enlarged right and left pulmonary arteries (Fig 2 arrows) and lymph nodes, which present as the ‘donut sign’ (Fig 3).
Fig. 1&2
Fig. 3
Enhanced CT (Fig. 4) confirms the increased size of the main pulmonary artery, which measures 34.5mm in diameter.
Fig. 4
Pulmonary arterial hypertension has many causes, among them COPD, chronic pulmonary embolism, idiopathic, inverted shunt, vasculitis, etc. In this particular patient, the pulmonary hypertension was ascribed to lupus vasculitis.
Teaching point: to differentiate PAH from enlarged lymph nodes a) look at the mediastinum to see if other lymph nodes are present, and b) look for the ‘donut sign’ on the lateral view, which is a sign of enlarged lymph nodes.
proeminent pulmonary hilum
enlarged pulmonary artery (middle left cardiac arch)
perriferic olighemia
dyspnea
=> pulmonary hypertension
im thinking about pulmonary embolism …there is large right hilum …large pulmonary arch and right pulmonary artery ..Westermark sign, (combination of:
1.the dilation of the pulmonary arteries proximal to the embolus and
2.the collapse of the distal vasculature creating the appearance of a sharp cut off ).
small hump on the right diafragm (may be Hampton’s hump?) ..,,,
Signs of pulmonary hypertension and RV hypertrophy – large right hillum, pruning, concave left middle arch, ascending of the apex. Left pulmonary hillum is too small by comparison to the right; it could be a large PTE on the left (especially with lupus), but since the dyspnea is mild -Swyer James Mcleod syndrome?
sorry convex
Look at the lateral film. Do you still believe that the left hilum is small?
i first thought that the enlarged artery on the profile was the right one. But i see now that it might as well be a left pulmonary artery aneurysm, and it also fits better the pulmonary hypertension. Pulmonary hypertension is a serious complication that occurs less frequently in lupus, it seems (after some reading…)
Good. The lateral view is very useful in the study of the hila and this is a good example.
Pulmonary hypertension (probably related with her collagen vascular disease).
Muppet advice: Working at night on weekends may be bad for your health!
I know, but I was so excited with Muppet’s autograph that I couldn’t wait till Monday.
4. None of the above
Both pulmonary arteries are big as it can be seen at the lateral view.
A pulmonary hypertension is a good posibility for me.
It seems to me the vessels of the left upper lobe are smaller than the right ones. Lupus can be associated with antiphospholipid syndrome that is acause of PE. PE can be the cause of the pulmonary hipertension in this patient.
4. None of the above.
I agree with Lola: pulmonary hypertension
Hiler adenopathy I think
With hilar adenopathy, you see the “donut sign” in the lateral view. It is not visible in this patient
when it will be explained ?
By the end of the week.
Ipersione polmonare da Lupus .
Ipertensione polmonare associata a Lupus.
Ipertensione polmonare associata a Lupus.
none of the above
maybe aortic aneurysm
4. None of the above
I suppose to be Pulmonary Thromboembolism or hypertension
Pulmonary Arterial Hypertension because:
1- Central pulmonary arterial enlargement
2- Decreased peripheral lung vascular markings
3- Right ventricle hypertrophy and dilatation (on lateral radiograph)
4- History of mild dyspnea
5- Female patient with SLE
Excellent. Muppet very happy about the significant amount of correct diagnosis.
Beware of the next case, though…
Thank you for a nice complement, Mr.Muppet)
My husband said that I have a halo over my radioactive head))))
Looking forward to seeing a new clinical case)
I missed the case..I will be waiting for the netx one!!
Pulmonary hypertension
-prominent main and branch pulmonary arteries with perpheral pruning consistent with pulmonary arterial hypertension.
answer is 4
may be it is pulminary artery aneurysm due to vasculitis? it is a rare condition often associated with Behcet’s disease.
answer is 4
it seems like pulmonary artery aneurysm which developed as a result of vasculitis
answer is 4
it seems like pulmonary artery aneurysm which developed as a result of vasculitis
answer is 4
pulmonary artery aneurysm
it seems like pulmonary artery aneurysm which developed as a result of vasculitis
Pulmonary Hypertension, probably due to Lupus
I agree with the rest of the people in pulmonary hypertension. I didn´t have the opportunity to thank you and Mr Muppet for your kind answer to my reply in the previous case. It was very helpful! thanks a lot!
our pleasure
must look at this fake chanel bags for more
check cheap chanel bags at my estore
My shunt propositions ended in total failure.
I was thinking of a new idea: it could be vasculitis,
for instance Behçet’s disease.
I apologize for the mistake, wanted to post on Case 94.