During August, Muppet would like to discuss some basic principles of interpretation. The first case is a 46-year-old male with neurofibromatosis and bullous emphysema, who presents with fever.
1. Hidroneumothorax
2. Infected bulla
3. Lung abscess
4. None of the above
PA film shows an air-fluid level, which crosses the right hemithorax (arrows). The same air-fluid level, considerably shorter, is seen in the lateral view, (arrows). This appearance is very suggestive of a hydropneumothorax (A), as opposed to a pulmonary cavity (B), where the air-fluid level is of the same size in both projections (see drawings).The undulated line in the PA chest corresponds to the major fissure outlined by pleural fluid in its superior aspect (yellow arrows).
CT confirms the diagnosis by showing air and fluid in the pleural space (fig 2, arrows). There are numerous bullae, none of which has fluid.
Final diagnosis: hydropneumothorax (empyema, since the patient was febrile)
Teaching point: this case shows the typical features of hydropneumothorax in the plain film:
1. Air fluid levels are of different size in PA and lateral views
2. Lack of upper wall (visible in pulmonary cavities)
4. None of the above.
I do not clearly see the anterior convexity of the 3rd rib in the right hemithorax, suggesting surgery, probably neurinoma surgery.
I think it may be a pleural empyema
Hidroneumothorax
İnfected bulla
There is a fluid collection arising from the pleura abutting the oblique fissure with an air-fluid level. Findings are suggestive of an empyema – ultrasound-guided percutaneous drainage of this collection is recommended.
Infected emphysematous bullae
Pulmonary CT is recommended.
CT will be shown in due time
infected bulla on top of hydropneumotharx
for me i would like to say that all of them could be in this case the hint in the lateral film
INFECTED EMPHYSEMATOUS BULLAE
Sarbesh:
Note that the fluid level is of different lengths in the PA and Lateral, placing the process in the pleural cavity rather than lung itself.
Good basic thinking.
Muppet
La NF tipo 1 ha a livello polmonare alcune lesioni anatomo-patologiche che si compendiano come NF-DLD. Tra le varie lesioni sono comprese le cisti e le bolle: pertanto alla luce del reperto clinico( febbre di tipo non ascessuale) e radiologico( Cisti di cui una con livello idro-aereo) la diagnosi è di cisti infetta.RISPOSTA N 2. PS. il mio Bari ha iniziato il suo campionato , con una secca scofitta 4 ad 1! beati coloro che possono gioire con le grandi squadre!!!!
Happy about Bari winning. Cannot comment about your choice. Still a few days until the final answer.
infected bulla
Le osservazioni di alcuni colleghi mi sembrano esatte: sembra che ci siano due livelli idro-aerei,una nel polmone da cisti infetta e l’altra nel cavo pleurico , con idro-pneumotorace, da rottura di un’altra bolle infetta , sub-pleurica, nel cavo pleurico.Mi scuso per la disattenzione.
infected neurofibromatosis bullae
Right hilum has moved upwards, right lung volume is reduced in comparison to the left side, right diaphragm is elevated.
Pleural gas / fluid level dorsal, consistent with hydropneumothorax if the Patient underwent surgery recently (anterior portions of 2nd and 3rd right ribs appear missing).
In case of fever empyema is a possibility i guess.
Looking forward to the solution!!!
Answer next Monday. But you already have it.
good you’re bringing us information. lista de emails lista de emails lista de emails lista de emails lista de emails