Diagnosis

Can you tell why this patient is short of breath?

Tension pneumothorax

Shift of heart
and trachea to
left

Complete rightsided
pneumothorax

Lung is
compressed
against
mediastinum

Tension pneumothorax

Ant

Post

Pneumothorax

With person lying on

their back, air in
pleural space rises to
top and displaces
normal lung

Diagnosis

This person developed chest pain after vomiting

Streaky, linear
densities due
to air in the
mediastinum

Streaky, linear
densities due
to air in the
mediastinum

Pneumomediastinum

Air
surrounding
esophagus in
mediastinum

Pneumomediastinum CT scan

Extraluminal
contrast from
perforation
along left
lateral wall of
distal
esophagus

Diagnosis

Why does this patient have abdominal pain?

Air outlines
under surface of
right
hemidiaphragm

Air outlines
under surface of
left
hemidiaphragm

Pneumoperitoneum

Air outlines both

sides of the wall
of the stomach-a
sign of free air in
the peritoneal
cavity

Pneumoperitoneum

Free air

Free air

CT scans on 2 different people show a small and large amount of free air in the
peritoneal cavity which rises to the highest point (anterior abdomen with the
person lying on their back) and is not contained within bowel

Pneumoperitoneum - CT

Diagnosis

57 year-old female with shortness of breath

Meniscusshaped density
at left base from
a pleural
effusion

Meniscusshaped density
at right base
from a pleural
effusion

Pleural Effusions

Meniscusshaped density
at right base
from a pleural
effusion

Meniscusshaped density
at left base from
a pleural
effusion

Pleural Effusions

Effect of Position - Layering

Supine

Erect

In the supine position, the fluid layers out posteriorly and produces a
haziness, especially near the bases (since the patient is actually semirecumbent). In the erect position, the fluid falls even more to the bases.

Diagnosis

This patient has atrial fibrillation and a heart murmur

Size (not
number) of
vessels at the
apex exceeds
size of vessels
at the base in
this upright
person. This is
called
cephalization.
Normally the
vessels at the
base exceed the
size of the
vessels at the
apex

Pulmonary Venous Hypertension from Mitral Stenosis

Pulmonary interstitial edema produced by Kerly A and C lines

Pulmonary Interstitial Edema

Bilateral,
diffuse
airspace
disease more
marked
centrally than
at the
periphery of
the lung
(bat-wing
appearance)

Pulmonary Alveolar Edema

Diagnosis

63 year-old man with chest pain

Linear lucency
in the contrastfilled
descending
aorta is the
intimal flap of an
aortic dissection

Aortic Dissection

 Widened
mediastinum
Left pleural effusion
Chest pain
Should make you think
of an aortic dissection

Aortic Dissection

Classification of Dissecting Aneurysms

Widened mediastinum
Left pleural effusion
Chest pain

Stanford classification

Diagnosis

Newborn with tachypnea

Heart and
trachea are
displaced to
right by bowel in
opposite
hemithorax

Left hemithorax
contains
multiple
lucencies--air in
the lumen of
bowel, now
located in the
chest

Diaphragmatic Rupture

Diaphragmatic Rupture
General

5% of all diaphragmatic hernias

Most (90%) are left-sided

Central and posterior >10cm in length

Contain stomach, colon, small bowel,
omentum, spleen

Half have no initial abnormal radiographic

findings
Half are missed clinically

Diaphragmatic Rupture
General

Associated with

Fx ribs

Pneumoperitoneum

Ruptured spleen

Delayed diagnosis = higher mortality

MRI most useful in showing site of tear

The End