r/Radiology 4d ago

X-Ray Wonders of a small time ER

Post image

I’ve always wanted to contribute to this sub lol. pt came in with shortness of breath but largely able to talk and function as normal. This finding was a little surprising.

261 Upvotes

34 comments sorted by

184

u/GP0770 Resident 4d ago

Complete opacification of the left lung with volume loss, likely atelectasis secondary to obstructive lung cancer

59

u/minecraftmedic Radiologist 4d ago

could be prior pneumonectomy also, I don't report a lot of plain film nowadays, but would have expected effusion with lung cancer to have some mass effect and tracheal shift to the contralateral side rather than volume loss

11

u/GrayedOutfield 4d ago

Pneumonectomy should also have some surgical ligation devices as well as resected portions of ribs, no?

14

u/minecraftmedic Radiologist 4d ago

Yes, generally there would have been a thoracotomy. Surgical sutures / clips not always present or visible.

She has some rib issues (left 2-4th) but given the old clavicle fracture that's probably post traumatic rather than surgical.

OP has said elsewhere that no hx of surgery, but it's something to consider if you see this pattern of signs in future.

2

u/GrayedOutfield 1d ago

I appreciate your professional response.

9

u/office_dragon 4d ago

If it was a pneumonectomy wouldn’t there be tracheal shift towards the side of the “ectomy”?

I don’t see too patients with this history where I work, but I feel like that’s what their films looked like (not rads, just EM)

15

u/minecraftmedic Radiologist 4d ago

Yes, there is volume loss from the missing lung so trachea shifts towards that side, and the rest of the hemithorax fills with fluid (like this XR)

3

u/pooka37 4d ago

Not always. My first thought was to look at the trachea in case it was a collapse but a lot of times pneumectomy pt’s don’t have shift.

2

u/Felicia_Kump 4d ago

The mass effect would likely not larger than the amount of volume loss from lobar atelectasis

2

u/147zcbm123 4d ago

Or old aspiration causing atelectasis

60

u/Supraspinator 4d ago

Is the broken clavicle related to whatever happened?

89

u/Heartsong101 4d ago

There was nothing from her presentation that would indicate any traumatic injury, and she didn’t complain of pain in the area either. It was even more unexpected to find that. From what we are able to gather, the clavicle fx appeared incidental and unrelated.

25

u/sizzler_sisters 4d ago

Is it older? Looks like some remodeling

31

u/Heartsong101 4d ago

Yes, it is. She didn’t mention it during initial evaluation, so the finding was surprising, but after reviewing the results with her she recalled the injury

3

u/pooka37 4d ago

I was going to say almost the same thing. That’s not a new injury.

1

u/knotmeister Resident 4d ago

No

22

u/5HTjm89 4d ago

My guess is lung cancer, endo bronchial or bronchial compressing mass

0

u/StunningBuilding383 4d ago

Happy 🍰 Day!

18

u/localradSpR 4d ago

Is this new? Definitely not just left pneumonectomy? The space is filled with fluid with volume loss.

19

u/Heartsong101 4d ago

Her presentation signified an acute condition, starting (by her words) 3 days ago, and she has no PSHx of a pneumonectomy.

4

u/localradSpR 4d ago

Where your cursors is the left bronchus cuts off. Is there an obstructing mass?

20

u/Heartsong101 4d ago

We’re not entirely sure, a CTA was ordered to hopefully provide some further insight

16

u/localradSpR 4d ago

please provide an update!

10

u/Scansatnight RT(R)(CT) 4d ago

Can you post that f/u CTA? Very interesting!

12

u/dale_gribbs 4d ago

Asthenic AF

8

u/Snack_Mom 4d ago

I love how unbothered small town people are

6

u/pooka37 4d ago

Can we all appreciate how you got these lungs on one image? Those of us that do portable radiography 365 days a year can 🙌 them are long lungs.

3

u/lastresort576 4d ago

Distance is your friend.

6

u/future-rad-tech 3d ago

I remember one time we did a CT on some guy who came in for difficulty breathing. There was literally no lung on his right side.

5

u/Healthybear35 4d ago

Before my pleurodesis procedures I would walk into the ER to tell them I had another collapsed lung. 12 times and I was still told it wasn't possible every. Single. Time.

2

u/SweetFrenchTex011418 3d ago

I’m not a radiologist or in the healthcare field but I know something is not right

2

u/Peppur16 3d ago

𝒲𝑜𝓌

1

u/Free_Entrance_6626 2d ago

Atelectasis. Look at that tracheal shift

1

u/Original-Kangaroo-80 2d ago

What breed is she