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Feb 11, 2023 8 tweets 3 min read Read on X
What's the most likely diagnosis?

53 year-old with mild shortness of breath

Hiatal hernia

Pneumothorax

Pneumonia

Pulmonary infarct

Left lower lobe atelectasis
Single axial CT scan of the chest on a different patient with same disease
Answer:

5. Left lower lobe atelectasis
Left Lower Lobe Atelectasis

All types of atelectasis involve loss of volume in some or all of a lung with resultant increased density of the involved lung

👉 here is that caused by bronchial obstru, usually a tumor (i.e. a bronchogenic carcinoma), a foreign body or mucus plug
Left lower lobe collapse

👉has distinctive features, and can be readily identified on frontal chest radiographs, provided attention is paid to the normal cardiomediastinal contours
However, the shadow cast by the heart does make it more difficult to see than the right lower lobe collapse.

Some of the findings of right lower lobe collapse can be grouped together as they are almost identical on both sides.
Differential diagnosis

The characteristic shape associated with volume loss usually does not allow for any significant differential diagnosis.

As always one should consider:

left lower lobe consolidation (of the medial basal segment)

pulmonary or posterior mediastinal mass
Reference:

Radiopedia

by Craig Hacking

♦️

learningradiology.com/archives2007/C…

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More from @MoreXGrok

Nov 17
Bullous myringitis

Defined by the presence of blisters on the tympanic membrane which has generally a severe otalgia as a first symptom of presentation.

This clinical picture sometimes may be accompanied by sensori-neural hearing loss

Bullous myringitis can be caused by a variety of viruses and bacteria, including:

Respiratory syncytial virus (RSV)
Influenza viruses
Streptococcus pneumoniae (pneumococcus)
Mycoplasma
Haemophilus influenzae
Moraxella catarrhalis
Group A Streptococcus
Staphylococcus aureusImage
Many microorganisms, especially viruses, m.pneumoniae, chlamydia may cause Bullous myringitis.

In the literature bullous myringitis cases that admitted to ED with sensori-neural hearing loss have been reported.

Diagnosis is made by clinical examination.

Pain control and mild compression may be sufficient for treatment.

If concomitant otitis media is present, antibiotics should be added to treatment.Image
Bullous myringitis Image
Read 4 tweets
Oct 11
Diagnosis? Image
Differential cyanosis in a patient with patent ductus arteriosus, severe PH, and right to left shunt (Eisenmenger syndrome).

Note the severe clubbing and cyanosis of the toes as compared to the lesser degree of clubbing and cyanosis of the fingers
Differential cyanosis

●A difference of at least 5% in oxygen saturation (O2 sat) or 20 mm Hg in partial pressure of oxygen (Pao2) between the arms and legs

●Can be a sign of a patent ductus arteriosus (PDA), persistent pulmonary hypertension of the newborn (PPHN), or left-heart abnormalities

■A rare variation of differential cyanosis is called reverse differential cyanosis, where the upper extremity oxygen value is less than the lower extremity oxygen value.

*This is most often associated with dextrotransposition of the great arteries (dTGA) with coarctation of the aorta/interrupted aortic arch or with PPHN
Read 4 tweets
Sep 29
This 25-yr-old male patient presented to the ED with 3 days of abdominal distension and vomiting.

There is a remote history of laparotomy after getting stabbed.

Thoughts? Image
Final diagnosis

Incarcerated diaphragmatic hernia with large bowel obstruction

*Radiograph

There is a left diaphragmatic hernia that contains a gas-filled viscus with an air-fluid level.

Right and transverse colon, and small bowel are abnormally dilated.

No gas in the rectum or left colon.Image
CT abdomen

The transverse and right colon, and ileum are grossly distended.

Cecum measures more than 10 cm in diameter on sagittal images

Left colon and rectum are collapsed

There is a transition point at a left diaphragmatic hernia (ostium 2 cm).

The hernia contains a short segment of the splenic flexure that is distended with gas and fluid.

The colon is thin-walled and there is no evidence or ischemia/strangulation.

There is some free intraperitoneal fluid, but no free intraperitoneal gasImage
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Aug 24
40-yr-old female with altered mental status and hypercalcemia.

Likely diagnosis? Image
Primary hyperparathyroidism

Skull x-ray (

* "salt and pepper" appearance, characterized by a granular texture that suggests a high turnover bone state,

*a classic sign of hyperparathyroidism Image
Shoulder x-ray:

Subchondral resorption at the clavicle, leading to widening of the articular space and an irregular, feathery articular surface.

These findings are less common and highlight the severity of bone resorption. Image
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Jul 18
Which of the following is the most likely diagnosis?

A. Erythema multiforme

B. Annular urticaria

C. Secondary syphilis

D. Fixed drug eruption

E. Polymorphous light eruption Image
A. Erythema multiforme.

Presents with target lesions favoring the extensor extremities.

Without a hx, one must discover distinguishing features in the clinical photo to arrive at the correct diagnosis.

On the dorsal hand, there are variable edematous urticarial papules, some of which feature three zones:

*a dusky center surrounded by two concentric rings of different colors

Although not all of the lesions are fully developed, based on the presence of typical targets, EM is the best answerImage
A. Erythema multiforme.

Presents with target lesions favoring the extensor extremities.

Without a hx, one must discover distinguishing features in the clinical photo to arrive at the correct diagnosis.

On the dorsal hand, there are variable edematous urticarial papules, some of which feature three zones:

*a dusky center surrounded by two concentric rings of different colors

Although not all of the lesions are fully developed, based on the presence of typical targets, EM is the best answerImage
Read 5 tweets
Apr 20
A 20-wks pregnant patient is admitted to ICU with septic shock.

Culture reveals listeria.

The patient is known to have had severe anaphylactic reactions to penicillin

What is the drug of choice for this patient?

A) TMP-SMX

B) Clindamycin

C) Vancomycin

D) Ciprofloxacin Image
Answer:

A) TMP-SMX

In immunocompromised patients, including pregnant women, listeriosis can present as life-threatening sepsis and/or central nervous system (CNS) infection (invasive infection).

In this clinical setting, the mean incubation period is 11 days.

The manifestations of CNS infection include

meningoencephalitis,

cerebritis,

rhombencephalitis (infection and inflammation of the brain stem),

brain abscess, and

spinal cord abscessImage
●The first line of drugs in severe Listeriosis is ampicillin (or penicillin).

●Some experts add gentamicin, it is not advisable due to its potential toxicity.

●Trimethoprim/sulfamethoxazole (TMP-SMX), is the drug of choice if a pati
nt is PCN allergic.

●Unfortunately, this should be avoided in the first trimester and the last month of pregnancy.

●In the first trimester, this affects folic acid metabolism, and in the last month, it may cause kernicterus in the fetus.

●In those periods, meropenem can be used.

●This patient is way out of those risk periods for the drug, so the answer is A.

●Vancomycin has been proposed, but the failure rate is very high.Image
Image
Read 5 tweets

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