1/ Short case focusing on CXR findings and a pulmonary differential (taking a break from #COVID19)
50s F admitted after a fall with a femur fracture, found to have hypoxemia. Chest X-ray is shown below.
@cardionerds @DxRxEdu @thecurbsiders @tony_breu @CPSolvers @sanjayvdesai
50s F admitted after a fall with a femur fracture, found to have hypoxemia. Chest X-ray is shown below.
@cardionerds @DxRxEdu @thecurbsiders @tony_breu @CPSolvers @sanjayvdesai
2/ What do you see on the Chest X-ray to help explain the patient's hypoxemia?
3/ The CXR shows signs of a left upper lobe collapse. The upper lungs should be the most lucent, with increased opacity as you go down. LUL collapse can be subtle, but you can see increased haziness at the lung apex. There is also rib crowding and left hemidiaphragm elevation
4/ You can also see a small luftsichel sign. Luftsichel sign is a thin strip of air that can be seen between the collapsed LUL and the superior mediastinum created by the still aerated superior segment of the lower lobe.
You can see the lobar collapse more clearly on CT.
You can see the lobar collapse more clearly on CT.
5/ Now we know she has a left upper lobe collapse. What do you want to do next?
6/ Bronchoscopy was performed to investigate the etiology of the lobar collapse. On the bronchoscopy there was an endobronchial lesion completely occluding the left upper lobe bronchus.
The mass was biopsied and sent for histopathology
The mass was biopsied and sent for histopathology
7/ Here is my differential diagnosis for endobronchial lesions
8/ The pathology returned positive for a carcinoid tumor, which can typically arise as endbronchial lesions. PET/CT showed only local disease (femur fracture unrelated), and she is planned for rigid bronchoscopy with laser therapy and corecath ablation for definitive resection.
