1Diagnosis0

Can you tell why this patient is short of breath?0

Tension pneumothorax0

Complete right-sided pneumothorax

Lung is compressed against mediastinumShift of heart and trachea to leftTension pneumothorax0

PneumothoraxPostAntWith person lying on their back, air in pleural space rises to top and displaces normal lung0

2Diagnosis0

This person developed chest pain after vomiting0

PneumomediastinumStreaky, linear densities due to air in the mediastinumStreaky, linear densities due to air in the mediastinum0

Pneumomediastinum CT scanAir surrounding esophagus in mediastinumExtraluminal contrast from perforation along left lateral wall of distal esophagus0

3Diagnosis0

Why does this patient have abdominal pain?0

PneumoperitoneumAir outlines under surface of left hemidiaphragmAir outlines under surface of right hemidiaphragm0

PneumoperitoneumAir outlines both sides of the wall of the stomach-a sign of free air in the peritoneal cavity0

Pneumoperitoneum - CTCT 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 bowelFree airFree air0

4Diagnosis0

57 year-old female with shortness of breath0

Pleural EffusionsMeniscus-shaped density at left base from a pleural effusionMeniscus-shaped density at right base from a pleural effusion0

Pleural EffusionsMeniscus-shaped density at right base from a pleural effusionMeniscus-shaped density at left base from a pleural effusion0

Effect of Position - LayeringSupineErectIn the supine position, the fluid layers out posteriorly and produces a haziness, especially near the bases (since the patient is actually semi-recumbent). In the erect position, the fluid falls even more to the bases.0

5Diagnosis

This patient has atrial fibrillation and a heart murmur

Pulmonary Venous Hypertension from Mitral StenosisSize (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 Interstitial EdemaPulmonary interstitial edema produced by Kerly A and C lines

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

6Diagnosis

63 year-old man with chest pain0

Aortic Dissection0Linear lucency in the contrast-filled descending aorta is the intimal flap of an aortic dissection

Aortic Dissection Widened mediastinum Left pleural effusion Chest painShould make you think of an aortic dissection

Classification of Dissecting AneurysmsStanford classification Widened mediastinum Left pleural effusion Chest pain

7Diagnosis

Newborn with tachypnea

Diaphragmatic RuptureLeft hemithorax contains multiple lucencies--air in the lumen of bowel, now located in the chestHeart and trachea are displaced to right by bowel in opposite hemithorax

Diaphragmatic RuptureGeneral 5% of all diaphragmatic herniasMost (90%) are left-sidedCentral and posterior >10cm in lengthContain stomach, colon, small bowel, omentum, spleenHalf have no initial abnormal radiographic findingsHalf are missed clinically

Diaphragmatic Rupture General Associated withFx ribsPneumoperitoneumRuptured spleenDelayed diagnosis = higher mortalityMRI most useful in showing site of tear

The End