Must Know Chest Xray

1.

A 25 yo male, after motorbike accident, presented at BIMC ER with this chest xray. What would you like to do next ?

Arrange consultation to surgeon

Immediately arrange chest tube insertion by surgeon

Admit patient to ward for observation

Perform CT-scan of the chest

With a case of massive pneumothorax, we need to act immediately. Therefore, immediate chest tube insertion performed by surgeon would be ideal. There's no need to do CT-scan with an obvious pneumothorax. We must not only arrange for consultation with surgeon, as he will give advise to put chest tube anyway, which then resulted in more delay of arranging the team, financial, etc.

Explanation

With a case of massive pneumothorax, we need to act immediately. Therefore, immediate chest tube insertion performed by surgeon would be ideal. There's no need to do CT-scan with an obvious pneumothorax. We must not only arrange for consultation with surgeon, as he will give advise to put chest tube anyway, which then resulted in more delay of arranging the team, financial, etc.

2.

What would be the course of action in a 45 yo male with this chest xray ?

Thoracotomy

Chest tube insertion

Thoracentesis for diagnostic only

Thoracentesis for diagnostic and treatment

At first onset of pleural effusion, with a modeate amount of fluid, thoracentesis for diagnostic and treatment would be adequate. Chest tube insertion and Thoracotomy is reserved for persistent cases.

Explanation

At first onset of pleural effusion, with a modeate amount of fluid, thoracentesis for diagnostic and treatment would be adequate. Chest tube insertion and Thoracotomy is reserved for persistent cases.

3.

This 47 year old man presented with sudden onset sharp, central, abdominal pain. He has a history of indigestion. Examination of the abdomen: abdomen was tender; rigid; no masses.
What would be the possible diagnosis ?

Pneumothorax

Diaphragmatic Hernia

Perforated Duodenal Ulcer

Diaphragma Paralysis

Above xray showed Pneumoperitoneum. It is a free air under diaphragm. The most possible cause from above options is Perforated Duodenal Ulcer.

Explanation

Above xray showed Pneumoperitoneum. It is a free air under diaphragm. The most possible cause from above options is Perforated Duodenal Ulcer.

4.

What would be the symptoms of this patient ?

Chest pain, heaviness in character, radiates to left arm and neck

Chest pain, squeezing in character, middle, alleviated upon leaning forward

Chest pain, tearing in character, middle, radiated to the back

Chest pain, retrosternal, burning in character, aggravated with food intake

Xray above is Aortic dissection. The most common character of chest pain is option C.

Explanation

Xray above is Aortic dissection. The most common character of chest pain is option C.

5.

What do you see in this chest xray ?

Cavitary lesion

Lung abscess

Lung Mass

Calcification

From the image, there seems to be a cavity-like structure, suggesting a cavitary lesion. This is characterized by an air-filled space within the lung tissue, which can be due to various causes like infections (e.g., tuberculosis) or other conditions.

Explanation

From the image, there seems to be a cavity-like structure, suggesting a cavitary lesion. This is characterized by an air-filled space within the lung tissue, which can be due to various causes like infections (e.g., tuberculosis) or other conditions.

6.

A 78 yo male with persistent cough for 7 days, productive of greenish phlegm, presented to our hospital with shortness of breath. Xray as shown above. He is a heavy alcoholic drinker. What would be the possible cause of the above findings ?

Streptococcus Pneumoniae

Legionella Sp.

Klebsiella Sp.

H. Influenzae

In alcoholic and Diabetic patient, Klebsiella is more common.

Explanation

In alcoholic and Diabetic patient, Klebsiella is more common.

7.

67 yo male presented with this chest xray in the clinic. His Calcium level is high. What type of cancer do you think this man has ?

Small Cell Lung Cancer

Adenocarcinoma

Squamous cell Lung Cancer

Large Cell Lung Cancer

The above xray showed lung mass. As the patient has Hypercalcemia, the most common type of cancer is Squamous cell, due to the secretion of parathyroid hormone-like peptides. Small cell lung cancer may secret ADH or ACTH.

Explanation

The above xray showed lung mass. As the patient has Hypercalcemia, the most common type of cancer is Squamous cell, due to the secretion of parathyroid hormone-like peptides. Small cell lung cancer may secret ADH or ACTH.