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IMAGE OF THE WEEK
Prof .Dr. P. Vijayaragavan’s Unit.
Dr. A. Karthick Ramalingam.
CLINICAL SUMMARY 58 year old Mrs.Samundeswari was admitted with C/o sudden onset breathlessness and facial
swelling. H/o cough with expectoration present Initially drug allergy was suspected O/E the facial swelling was found to be due
to subcutaneous emphysema.
CXR PA VIEW
FINDINGS
Bony cage is normal. Soft tissue: Subcutaneous emphysema. Trachea in midline. Slight mediastinal shift towards left. Emphysematous change seen in right lung field .
8 ribs can be counted posteriorly. Flat diaphragm and air can be seen below heart Left upper zone shows a ellipsoidal translusent
area devoid of lung markings surrounded by thin wall .A septa is seen within that area.
Fibrotic changes are present in left mid and lower zone and right lower zone.
Pneumomediastinum present.
Bullae with a septa within it
Pneumomediastinum
Air under heart
CT CHEST
PNEUMOMEDIASTINUM
PNEUMOTHORAX
EMPHYSEMATOUS BULLAE
BRONCHIECTASIS
CXR FINDINGS IN PNEUMOMEDIASTINUM
Mediastinal emphysema appears as a thin line of radiolucency that outlines the cardiac silhoutte, as well as thin lucent vertically oriented streaks of air within the mediastinum
Aorta and other posterior mediastinal structures may be highlighted, and well defined lucency around the right pulmonary artery may be seen (ring around the artery sign)
Unlike in pneumothorax or pneumoperitoneum, the air remains fixed and does not rise to the highest point
An unbroken line may extend from one hemidiaphragm to other beneath the heart – the continuous diaphragm sign
CXR FINDINGS
Inner margin that is concave than convex
They should not conform to the costophrenic angle when they are at lung base
A bullae is limited to one lobe
Thin curvilinear line that is convex
Costophrenic angle will be free of vascular markings
Not limited to one lobe In a small pneumothorax
costophrenic angle blunting due to small amount of pleural fluid that collects
Deep sulcus sign positive
BULLAE PNEUMOTHORAX
BULLAE
Inner margin that is concave
PNEUMOTHORAX
DEEP SULCUS
Curvilear convex line
Absent lung markings
Thank you