Dr. Pepe’s Diploma Casebook: Case 44 – SOLVED!

Diploma_casebook_case44

Dear Friends,

Presenting the case of a 45-year-old man with fever, one week after coronary surgery. I apologise for the poor quality of the PA radiograph, but it does not influence the diagnostic evaluation.

Check the images below and leave your opinion in the comments. The answer will be posted on Friday.
Diagnosis:

1. Pericardial fluid
2. Pleural fluid
3. Both
4. Anything else


45-year-old man with fever one week after coronary surgery

45-year-old man with fever one week after coronary surgery

Click here for the answer

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    21 Responses to : Dr. Pepe’s Diploma Casebook: Case 44 – SOLVED!

    1. genchi bari italia says:

      atelettasia rotonda.

      • genchi bari italia says:

        Sindrome post-perfusionale, dovuta alla reazione fisiopatologica delle alterazioni micro-circolatorie e parafisiologiche della CEC(circolazione extra-corporea),con accumulo interstiziale ed imbibizione di un lobo-segmento polmonare.

    2. MANOLIS says:

      Pleural fluid

    3. Patrycja says:

      Dressler’ syndrome

    4. yavuz aydemir says:

      round atelectasis..

    5. gus says:

      I think both of them
      fat pad sing on the lateral view (pericardial effusion)
      and pleural effusion on the right base.
      there is also material crirurgical on the posterior space on the lateral view. i cant see it on the frontal view.

    6. sameh khodair says:

      I think there is left side free as well as subpulmonic effusion

    7. kirjana says:

      pleural fluid on the left side, infected retained hemothorax, empyema post op.

    8. Elham says:

      I think 3,
      Dressler syndrom

    9. gus says:

      🙂 oops someone forgot a little bit wire in the heart.
      could be a sternal wire ruption after surgery….;)

    10. Katerina says:

      It is either a LLL pneumonia or a LLL atelectasis. I cant tell because I cant see where the left major fissure and the left hilum are. But I think I see air bronchogram in the profil view. The cause might be retained/forgotten surgical material.

      • Dr. Pepe says:

        Good answer. Did you read Gus’ opinion?
        Do you think there is pericardial fluid?

        • Katerina says:

          I always read Gus’s opinion 🙂
          I don’t know if there is pericardial fluid or not, but I think that I can see air around the heart shadow (in the profil view) which continues behind the trachea all the way up.
          Maybe this retained surgical material provoked pneumopericardium-pneumomediastinum.
          But don’t see anything in the AP view …
          GUS HELP !!!!

    11. gus says:

      i think post inflamation is not correct answer (is too short period). iatrogenic is better.

    12. genchi bari says:

      ..potrebbe essere una complicanza della intubazione tracheale, con fistola tracheo-esofagea, il che spiegherebbe sia la polmonite, da aspirazione , a carico del lobo polmonare inferiore sx, sia il pneumomediastino.

    13. Livi says:

      Might be a stupid answer, but my guess is it’s either a slow, continuous, but limited “blood leaking” caused by the sternal wire in the chest cavity resulting in a small amount of haemothorax and haemopericardium (that’s why the pleural effusion seems to be “demarcated” anteriorly)…. or it might be an infection caused by that same wire, resulting in a pneumonia and small amount of pyothorax in the LLL + pus leaking into the pericardial cavity, causing pyopericardium… might be way off the mark, but these are the things I could come up with… 😉

      • Dr. Pepe says:

        There are no stupid answers in this blog. The important thing, if one’s wrong, is to review the case and learn why the answer was incorrect.
        And hope to be right the next time!

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