Hola amigos, Dr. Pepe sigue missing. En su lugar, os presento el caso de una señora de 71 años que fue encontrada inconsciente. Al ingresar en el hospital se le realizó una radiografía de tórax en supino.
¿Cuál sería vuestro diagnóstico?
1. Pliegue cutáneo
2. Neumotórax
3. Discreta pérdida de volumen LID
4. Nada de lo expuesto
Podéis dar vuestra opinión hasta el viernes, día en el que se publicará la solución.
Haz click aquí para ver la respuesta
Hallazgos: la radiografía en supino muestra una línea paralela a la pared torácica (A,B flechas), que simula un neumotórax. Este diagnóstico puede descartarse porque la cisura menor se extiende más allá de la línea (A,B flecha roja), además de verse vasos que la cruzan en la base pulmonar. La línea no sigue el trayecto de la cisura mayor, que se curva y se une al tercio superior del mediastino, lo que descarta pérdida de volumen del LID. Por consiguiente, el diagnóstico más probable es un pliegue cutáneo. Una placa en espiración y un TAC de control (C,D) demuestran la desaparición de la línea, lo que confirma esta sospecha.
Diagnóstico final: pliegue cutáneo que simula un neumotórax.
Felicidades a Carly, que fue la primera en mencionar el diagnóstico correcto.
Teaching point: una evaluación correcta y sentido común son fundamentales para el diagnóstico. En este caso hubieran evitado repetir la placa de tórax y ahorrado un TAC innecesario.
Pliegue cutáneo. Neumotórax no es puesto que se ve trama vascular a través de la línea así como la cisura menor que la atraviesa.
Me da la sensación de que la cisura menor está un poco tirada hacia abajo y entonces quizás también una discreta pérdida de volumen en LID.
Pliegue cutáneo.
Sólo dos respuestas; pero correctas.
Felicidades a Carly y Angela.
Thank you for your unwavering belief in me, even when I doubted myself.
It is great. Their life looks very happy and joyful
You have a unique perspective that adds great value to the discussion.
I can’s understand anything in the picture. Wish that I can!
Hope everything will be better
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Es importante que el equipo médico revise los resultados de la radiografía para identificar cualquier anomalía.
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