Part 3 x ray station hot favourit x ray

hi could u please answer these questions for us?just enlist them as a reply to this post?thanx

 

Likely Diagnosis: Cardiomegaly
RVD ( right ventricular dysfunction / failure ) ---- ref: to @drwatson for further correction.
Treatment: Treatment of the underlying cause
- preload optimization
- afterload
- RV contractility; maintain sinus rhythm; and atrioventricular synchrony.
- Avoid hypotension.
- Avoid precipitating factors
- General measures: sodium & fluid restriction, moderate physical activity.

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@drwatson I did recognise it as RVF but your expertise required further for diagnosing it correctly.​

 

Likely Diagnosis: Tuberculosis
Q 3 what further investigations to confirm the diagnosis? ---------- DIY , its easy ya
Q 4 what is treatment? ------------- DIY , its easy

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@drwatson Your expertise needed for further correction if applicable.

 

Likely Diagnosis: Sarcoidosis , stage I i think.
Its a posterioanterior chest x-ray of a male patient.
X-ray showing; extensive bilateral hilar , mediastinal lymph node swelling ( enlargement ).
No pulmonary abnormality is seen.

Q2 what is most likely diagnosis? --- DIY , its easy
Q3 what is treatment? --- DIY

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Ref: to @drwatson for further correction if applicable.

 

Likely Diagnosis: X-ray of Pneumonia
A standard PA x-ray of a male patient. X-ray shows; the indistinct borders, air bronchograms, and silhouetting of the right heart border.
Q3 what is treatment? DIY -- very easy, isn't it
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Ref: to @drwatson for correction if any.

 

Diagnosis: Left - sided tension Pneumothorax
PA x-ray of a patient. This x-ray shows; trachea away from the side with the tension, (deviation of trachea ) a hyper-expanded chest, increased percussion note and a hyper-expanded chest that moves little with respiration.

• Deviation of the trachea away from the side of the tension.
• Shift of the mediastinum.
• Depression of the hemidiaphragm.

This occurs due to blunt trauma or falling from a height.
What is treatment? --- DIY ,
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Ref: to @drwatson for further correction if any.

 

Diagnosis: Miliary Tuberculosis
X-ray showing: millet seed pattern ( miliary tb ) , pin-point opacities , various nodules
DD: ascites, blastomycosis, cardiac tamponade, DIC, pneumocystis carinii pneumonia, bacterial pneumonia, community-acquired pneumonia, fungal pneumonia viral pneumonia, ARDS, pneumoconiosis, sarcoidosis, metastatic lung disease, silicosis, etc.
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Ref: to @drwatson for further correction if any.

 

Answered. Make sure to cross check it with text books.

Answered with diagnosis and described x-rays where necessary. Rest you can figure it out. Make sure to cross check it with text books.

 

yes its RVF, and its seems LVF too.
other xrays are correctly answered.

 

1. what is most likely diagnoses?
2. causes ?
   
3. how can make dd bw exudate and transudate ?
4. treatment?

2




ANS
1 Pleural effusion term denoting a collection of fluid within the pleural cavity.

2
causes of Exudate PE

• bronchial carcinoma
• secondary malignancy
• pulmonary embolism and infarction
• pneumonia
• tuberculosis
• mesothelioma
• rheumatoid arthritis
• systemic lupus erythematosus (SLE)
• lymphoma

Causes of Transudate

• cardiac failure
• nephrotic syndrome
• cirrhosis: hepatic hydrothorax 3
• Dressler syndrome
• trauma
• asbestos exposure
• yellow nail syndrome

3

• Transudate
  • protein concentration
    • <30g/L absolute
    • total protein fluid: serum <0.5
  • lactic acid dehydrogenase (LDH)
    • <20 IU/L
    • LDH fluid: serum <0.6
  • specific gravity <1.016
• exudate
  • protein concentration
    • >30g/l
    • total protein fluid: serum >0.5
  • lactic acid dehydrogenase (LDH)
    • >20 IU/L
    • LDH fluid: serum >0.6
  • specific gravity >1.016

4 treatment

The treatment of pleural effusions is usually targeted to the underlying condition (e.g. treat congestive cardiac failure, or the malignancy etc...). In some instances patients are symptomatic from large effusions (especially if they have underlying cardiovascular disease) and therapeutic aspiration can be carried out.

When effusions are very large, this can safely be done 'blind' although increasingly ultrasound is used to at least mark an appropriate site. Ultrasound guided aspiration is reliable and fast and enables loculated effusions to be drained. A catheter can be left in situ, although care must be taken to ensure that it is connected either to an underwater drain or to a sealed system such that air cannot enter the pleural cavity.

If effusions re-accumulate despite repeated aspirations and systemic therapy (where appropriate), a tunelled semi-permanent pleural drain or video assisted thoracic surgery (VATS) pleurodesis.