▫️Select the most likely diagnosis on these 10 cases and then expand the thread and scroll through for explanations
▫️Some may be normal!
✅All cases consented
CASE 1: Female 60s, right sided pain
CASE 1: the most likely cause for the right sided lesion is:
CASE 1: explanation 1/3
CASE 1: explanation 2/3
CASE 1: explanation 3/3
Further reading: clinicalradiologyonline.net/article/S0009-…
‘Non-malignant lesions tend to exhibit thinner walls, but more perilesional consolidation and centrilobular nodules than malignant lesions.’
CASE 2: Male 70s cough
CASE 2: Which of the following best describes the findings?
CASE 2: explanation 1/5
CASE 2: explanation 2/5
CASE 2: explanation 3/5
CASE 2: explanation 4/5
CASE 2: explanation 5/5
CASE 3: Male 20s, cough and haemoptysis
CASE 3: Which of the following is most likely?
CASE 3: explanation 1/3
CASE 3: explanation 2/3
CASE 3: explanation 3/3
CASE 4: female 60s, cough
CASE 4: diagnosis?
CASE 4: explanation 1/4
CASE 4: explanation 2/4
CASE 4: explanation 3/4
CASE 4: explanation 4/4
CASE 5: Male 60s, breathless
CASE 5: what best describes the abnormality?
CASE 5: explanation 1/3
CASE 5: explanation 2/3
CASE 5: explanation 3/3
CASE 6: Female 40s cough
CASE 6: what best describes the main abnormality?
CASE 6: explanation 1/4
CASE 6: explanation 2/4
CASE 6: explanation 3/4
CASE 6: explanation 4/4
CASE 7: Male 70s, breathless
CASE 7: what best describes the main abnormality
CASE 7: explanation 1/5
CASE 7: explanation 2/5
CASE 7: explanation 3/5
CASE 7: explanation 4/5
CASE 7: explanation 5/5
CASE 8: Male 80s, cough
CASE 8: what best describes the main abnormality?
CASE 8: explanation 1/3
CASE 8: explanation 2/3
CASE 8: explanation 3/3
CASE 9: Female 40s, breathless
CASE 9: what best describes the main abnormality?
CASE 9: explanation 1/3
CASE 9: explanation 2/3
CASE 9: explanation 3/3
CASE 9: further reading - recently published hypersensitivity pneumonitis ATS/JRS/ALAT Clinical Practice Guideline
Some thoughts on Chest X-Ray interpretation in the COVID era (thread)...
1. Peripheral consolidation is now the first thing to look for. Can be really tricky with overweight patients and AP films. Comparing to prior, looking for asymmetry and inverting the film can help avoid overcalling
2. Unilateral consolidation can be difficult to call as definite COVID so will always need to correlate with clinical picture (fever, CRP, lymphocytes) - new peripheral consolidation and having bloods open has helped sway decisions as a radiologist...
Just finished an on call. Very different to the last on call I did with a clear change in the landscape and a sharp rise in number of COVID-19 cases. A few observations from the last two weeks:
1. The vast majority of proven PCR positive patients that required hospitalisation have shown bilateral consolidation on admitting CXR. Smaller number started as unilateral consolidation and progressed to bilateral. One started as normal CXR.
2. In some, swabs have needed to be repeated before becoming positive. When can you truly call a patient ‘negative’? Given long turnaround time for PCR results is there a role for a clinicoradiological scoring system involving CRP, lymphopenia, CXR +\- CT