Discover and read the best of Twitter Threads about #Chestrad

Most recents (15)

80 yo ♀️ with chronic cough.
What would you do with this "ugly" lung lesion? 🧵👇🏻

#radres #radtwitter #radiology #chestrad
❓❓❓
If you asked for a mediastinal window 👏👏👏
*️⃣Lipoid pneumonia*️⃣
Lung disease caused by fat accumulation that produces chonic inflammation
Two types:Endogenous and exogenous
Exogenous lipoid pneumonia is caused by aspiration of fatty or oil substances (laxatives in this case)
Read 3 tweets
1/Hello all,Good morning! Happy independence week🇮🇳🎉🎊
Got a beautiful chest teaching case 👇🏻Xray ▶️CT ▶️HPE

🛑27 year old female came with h/o chest discomfort, breathing difficulty, cough x 1 week

Lets breakdown it✍️📝 🔥
#radres #chestrad #Pulmonology #MedTwitter #FOAMrad Image
2/ Frontal CXR shows homogenous opacity in R.mid & lower zone in paravertebral region
❇️It has well defined superior,inferior&lateral borders, medial border is merged with mediastinum(incomplete border sign)
♉️Opacity has Broad base contact with mediastinum s/o mediastinal origin Image
3/
❇️Lung lesion will be covered by lung margins all side(not always) & form an acute angle with meds
♉️Normal silhouette of right heart border is seen (neg silhouette sign) s/o lesion not in ant med
🉑Hilar vessels are seen coursing through the opacity (Hilum overlay sign +ve) ImageImage
Read 7 tweets
These frontal & lateral views belong to a patient with a history of lung cancer which presented with a newly developed dyspnea. Considering the patient’s history and CXR findings,what is the most likely cause of the elevation of the right hemidiaphragm?
#chestrad #radiology Image
Hint👉 I wanted to discuss about this subject and I incidentally encountered this case! Honestly speaking it's not complicated case ,but the question is worthy of noticing!
So do you think atelectasis of the R.U lobe is the main culprit?The answer based on many references is Not!
🛑Answer part 1
Phrenic nerve paralysis is a common cause of elevation of one side of the diaphragm.
👉Take home message:
The combination of a lung or mediastinal mass and elevation of the diaphragm strongly suggests phrenic nerve paralysis.
Eventration is a different entity!
Read 6 tweets
#Wetread Case 18

Hx: Chest Pain

Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad #CXRarehard Image
#Wetread Case 18

So hopefully everyone saw this pleural based opacity in the RUL. But does anyone see the other finding? 🤔 #CXRarehard #chestrad Image
#Wetread Case 18

Turns out pt had some pain radiating to their neck so they got this C-spine X-ray. Perhaps one of the rare times a non-trauma C-spine X-ray is helpful? 😁 Image
Read 8 tweets
#WetreadCoW Case 14

Hx: Abominal Pain

Can you identify the source of acute pain and the underlying etiology?

Professionally appropriate gif responses only please. No spoilers! #FOAMrad #FOAMed #radres

A case for everyone 😀 #errad #bodyrad #chestrad #NeuroRad ImageImageImageImage
#WetreadCoW Answer: Tuberous Sclerosis

More specifically - multiple large bilateral renal angiomyolipomas through the kidneys (green) with acute R perinephric hemorrhage (red arrows)

*remember ⬆️size of AMLs = ⬆️ risk of hemorrhage

#FOAMed #FOAMrad #bodyrad #radres Image
Tuberous Sclerosis (aka Bourneville Dz)

-neurocutaneous disorder (phakomatosis)
-numerous benign tumors of ectodermal orgin (skin, eyes, CNS)
-usually sporatic
-Classic: child with Vogt's triad (seizures, intellectual disability, adenoma sebaceum rb.gy/rlkgei
Read 5 tweets
#WetreadCoW Case 13

Hx: 50 yo male with cough

Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #FOAMrad #FOAMed #radres #errad #chestrad Image
@WetreadCoW Case 13 Answer: Mounier-Kuhn syndrome (aka tracheobronchomegaly)

-cystic dilation of trachea&bronchi
-absence/atrophy of elastin fibers&smooth muscle
-?congenital (not agreed upon)
-assoc w Ehlers-Danlos

#FOAMed #FOAMrad #chestrad #radres #thoracicrad Image
Read 4 tweets
#WetreadCoW Case 9

Hx: MVA, chest pain

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad ImageImage
#WetreadCoW Case 9 Answer: Diverticulum of Kommerell

Focal outpouching of the distal aortic arch + h/o trauma ➡️ think traumatic PSA⭐️, but lets look a bit closer here

No perioaortic stranding
No wall thickening
location = medial (retroesophageal 🤔)
#FOAMrad #radres #chestrad Image
Kommerrell Diverticulum

-focal outpouching of the distal aortic arch at the origin of an aberrant subclavian artery (here artery is very small)

-can be aberrant L subcl in setting of R aortic arch OR aberrant R subcl in normal L aortic arch (here) #FOAMed #FOAMrad #radres
Read 5 tweets
#WetreadCow Case 7

Hx: chest pain

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad @thoracicrad @chestcases @TanMohammedMD Image
#WetreadCow Answer: Sprengel's Deformity

-M/C congenital abnl of the shoulder

-Failure of ⬇️ scapula (starts mid-cervical)

-often part of Klippel-Feil Deformity (cervical vert fusion)

-shoulder asymmetry w ⬇️ ABduction

#FOAMed #radres #chestrad #chestcases #orthorad ImageImage
Sprengel's Imaging:

- ⬆️ (blue arrows) and ↪️(red arrow) scapula so inf tip points to spine (? smaller)

- Uni- or Bi- lateral

-👀 for bony omovertebral bone (bony or fibrous scapulo-vertebral connection - usually C4-C7) - up to 50%

-👀 for rib/spine abnl (green arrows) (K-F)
Read 4 tweets
#WetreadCow Case 6

Hx: survey CXR after MVA

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad

Can I play? 😀 @thoracicrad @chestcases @TanMohammedMD This is a chest X-ray that ...
#WetreadCoW Case 6 Answer: Continuous Diaphragm sign of Pneumomediastinum

The heart rests on the medial diaphragms, so normally they are silhouetted out. When we see them (blue arrows) it means there is air between the heart and diaphragm @chestcases #FOAMed #errad #chestrad ImageImage
This can be seen with pneumomediastinum or pneumopericardium.

There is a more subtle lucency about the high left heart border (yellow arrow) which is also consistent with pneumomediastinum.

These findingscan be difficult to see on CXRs, esp when not involving the neck/axilla. Image
Read 5 tweets
#WetreadCoW Case 3

Hx: Chest pain

Diagnosis? (it's August, we're starting easy! I'm giving you PA AND Lat! 😀)

Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad #bodyrad ImageImage
#WetreadCOW Case 3 Answer: Bochdalek Hernia

Large round opacity right lung base.

On frontal does NOT obscure anterior diaphragm or R heart border - ie posterior/RLL

On lateral DOES "obscure" entire posterior R diaphragm

#Chestrad #ERRad #radres #FOAMrad ImageImage
Bochdalek Hernia

-congenital defect in posterior diaphragm attachment
- Can be either side (classic =L side in symptomatic infants➡️lung hypoplasia, but R m/c in adults?)
- typically only fat but ~25% can contain abd organs

Hint: 🅱️ochdalek = 🅱️ack

#radres #chestrad #FOAMed Image
Read 3 tweets
#WetreadCoW Season 9 Case 1 - back to the basics

Hx: Line placement 😮 OR is calling now for a STAT report. Look OK?

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad Image
#WetreadCoW S9C1 Answer

1)Malpositioned left subclavian catheter (extends into R IJ)
2)Malpositioned right jugular Swan-Ganz catheter (extends into hepatic vein)

Did you see both? You have to check every one! 🤬

#FOAMrad #FOAMed #radres #chestrad #radtwitter #MedTwitter ImageImage
Let go through them. Correct ones first.

ETT - tip below the thoracic inlet and >2cm above carina ✅

GI tube - tip/side port below GE junction (hard to see but I think so)✅

Mediastinal drain ✅

Right chest tube x 2✅ (No pneumothorax)

I'm not @radiologistpage but I try 🤣
Read 6 tweets
Wetread Case 38 (Answer)

Hx: Chest Pain

Answer: Penetrating Atheromatous Ulcer (PAU)

wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad

Original tweet:
L infrahilar mass - Does NOT obscure L heart border (blue) but does obscure aortic border (red - dashed lines being expected course and dark red line outlining mass).

Hilum overlay sign apparent as we still see hilar vessels through the mass (orange), ie mass is not the hilum
How about the lateral? While there may be some artistic license here, it suggests enlargement of the mid-descending thoracic aorta
Read 10 tweets
Wetread Case 35

Hx: chest and neck pain.

What are the important findings? Recommendations?

Diagnosis? 🤔

Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Answer: Thrombophlebitis of the left bracheocephalic vein with mediastinitis (variant of Lemierre's syndrome)

New X-ray: widening of the upper mediastinum. Can we be more specific? Did you go with aortic etiology?

#WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad #Neurorad
We can see on our current exam that the contour of the aortic silhouette (red arrow) is maintained thus it should not be adjacent to the aorta. If fact it actually obscures the left subclavian artery silhouette (yellow arrows) so it has to be in the anterior mediastinum.
Read 9 tweets
Wetread Case 32

Hx: Cough, shortness of breath, fever 😡😡 (yep, I did 😁)

Any pertinent hx questions? 🤔

Feel free to answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Would it help to know that the pt is immunosuppressed?

and NO it's NOT COVID-19! 😁

@RadioGyan @AdamSingerMD @xyzabrz @lala_layla_1
Answer: Kaposi’s Sarcoma

KS is a low-mid grade mesenchymal tumor that involves blood/lymphatic vessels of the skin, lymph nodes, lungs, GI tract, etc.

Not considered a true “sarcoma”

Believed related to human herpes virus type 8 (HHV8)

👏 to @DrAliya85 #chestrad #FOAMrad
Read 7 tweets
Wetread Case 22
Hx: Chest Pain

What is your diagnosis/diagnoses? 🤔

Feel free to answer with professionally appropriate gif responses only. No spoilers.
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad ImageImage
@StefanTigges @RyanBPetersonMD @ER_Rad_Hanna Everyone is doing well! But there is arguably another finding (one that is usually better seen in hindsight 🤣).

Anyone up for the "read the attending's mind" finding 🤣
@StefanTigges @RyanBPetersonMD @ER_Rad_Hanna Answer: double aortic arch (R desc aorta)

CT shows that plus bilateral pulmonary emboli. In hindsight maybe there is left vascular redistribution and maybe some lower lobe oligemia? Not that I would call on the front end 😀

#WetreadCow #FOAMrad #radres #errad #chestrad
Read 3 tweets

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