When communication is key:

10 chest-related scenarios that should prompt immediate discussion Baker KS, Moore WH

Department of Radiology, Stony Brook University Medical Center

Background: Radiologic examinations of the chest are extremely common. While many imaging findings can be readily apparent, some can be subtle, unexpected/surprising, or of the utmost urgency. Familiarity with

these kinds of scenarios is of the utmost importance for radiologists, as accurate and timely diagnosis will have significant and immediate impact on treatment. Radiologists should be actively participate in patient care by

promptly communicating with the clinical service to ensure full knowledge of any subtle, unexpected, or emergent radiologic findings.

Case 1

Anterior pneumothorax in an infant

Case 4

60 y/o M with unsuspected lung mass seen on neck

MRA

Case 2

72 y/o M with malpositioned endotracheal tube in R

mainstem bronchus

Case 6

26 y/o M with non-TB cavitary pneumonia

Conclusions: Radiologists need to be familiar with pathology in the chest as accurate and timely diagnosis can be of vital importance for emergent treatment. Communication is also critical to ensure proper patient care

and radiologists need to be active members of their patients’ care team and recognize situations where immediate discussion with clinicians is needed.

Case 3

16 y/o M with metal bristle in esophagus from barbecue

cleaning brush

Case 9

84 y/o F with ruptured abdominal aortic aneurysm

Case 5

51 y/o M with active TB

Case 8

59 y/o M with hemodynamic instability

Case 7

63 y/o F with saddle embolus in study performed for

evaluation of suspected metastatic cancer

Case 10

61 y/o F with pneumopericardium

Cases with subtle findings

Increased left lung lucency Follow-up showing

visceral pleural line

Left lung atelectasis with ET

tube in R mainstem bronchus Prior from 3 hours earlier

with no ET tube

Radiodense

foreign

body seen

on x-ray

and

confirmed

by CT to be

in

esophagus

Cases with unsuspected findings

Lung mass seen on MRA

Performed for stroke

Further evaluation showed

adenocarcinoma

Cases with emergent/life threatening findings

Extensive

pulmonary

emboli with

saddle

embolus

spanning

pulmonary

arteries

Don’t forget to check for a deep venous source of emboli!

Large pericardial

effusion with

resultant cardiac

tamponade

Significant hemoperitoneum from ruptured

8.5 cm abdominal aortic aneurysm

Large right pleural

effusion and right

hilar adenopathy also

present