Pick the finding ?

Pneumomediastinum
Was managed conservatively.

What is the procedure done on the left side ? What was the problem for which this was done ? How lon ago?
Answer - Thoracoplasty, This was done to close tubercular cavity, more than 45 years ago.

Shubh Deepawali

Acute or chronic

Right middle lobe -silhoutte for heart border

Comment about silhouetting.

What is your diagnosis ? Why are the two images different ?
Pulmonary embolism.
Image below is low resolution spiral CT image.Image above is CT pulmonary angio image done on multi detector CT.

What is the radiological pattern described as ? Write most likely diagnosis?

Canon ball . Metastatic cancer.

This is a tuberculin test reaction in a patient who has cervical adenopathy which was biopsied and has noncaseating granuloma consistent with sarcoidosis.

Patient on ventilator suddenly develops hypotension.Xray shows new hyperlucency .Diagnose the condition and likely etiologies?
Tension pneumothorax.Notice the central line ,one of the likely causes for the same.

Comment about acute /chronic nature of this problem?
Chronic volume loss on left with bronchiectatic changes on left.Hyperinflation of the right with herniation of lung to left indicates slowly evolving process.

43 year old female , progressive exertional dyspnoea last 1 year, FVC -.57 litres , patient diagnosed as ILD , CT thorax - interstitial paattern dominent - ground glass opacification.

Medical thoracoscopy with lung biopsy done .What is the expected histopath pattern ?

Comment about the left upper lobe radiodensity ? 47 year old female , presents with background bonchiectasis, was treated with ATT 12 years ago. This time around reports with substantial weight loss 8 kg over 8 months (40-32 ) new shadow lul , cellulitis on dorsum of rt foot.

LUL shadow looks like a solid mass lesion .Bronchosccopy revealed lot of thick pus draining from lul.Hopefully this will be a lung abcess.

The lower image is 7 days earlier.20 year old male with poly trauma with cervical cord injury and quadriparesis, underwent surgery 3 days later he worsened and needed needed mechanical ventilation due to resp.insufficiency. The upper image is the new X ray. What is your diagnosis and what will be the next step ?

In view of the history this is most likely a collapse consolidation .Bronchoscopy is next choice intervention.

Similar yet different ? How will these nodes be described as ? 22 year old female has fever, weight loss and loss of appetite for 2 months.

60 year old male presented with fever, cough ,exertional dyspnoea and some weight loss over last 2 months. What is the likely DD and which investigation will you choose next?

Extensive mediastinal adenopathy . Bronchoscopic TBNA will be next test.

25 year old male Known MDR TB for past 4 years , on ATT with second line agents, smear and culture negative for last 1 year.Describe radiological findings and comment on activity?

Ribs removal gives away the surgical intervention.Right upper lobectomy has left a cavity like residual space.Left upper lobe infiltrates are fibrotic scars. Mostly not an active disease.In any case that is decided by sputum/BAL better than radiology.

l
Middle aged female with recurrent LRTI is adviced CT thorax. Based on these images will you advice lobectomy? Justify your answer .

Bronchieactasis is localized to left lower lobe and recurrent severe infections will be an indication to consider lobectomy.Complicating factor is evolving emphysema in left upper lobe, V/Q scan,Bronchoscopy and lung function needs to be carefully done before taking decision on surgery.

Write all findings on this X ray ?

Bilateral interstitial infiltrates, Rt pneumothorax collapsed lung border, surgical Emphysema

50 year old female , presented with chest pain, cough,weight loss and occasional hemoptysis.

Bronchoscopy revealed narrowed right upper lobe lumen but biopsy from mucosa was nonconclusive.

Finally CT guided FNA was done from the mass.This was difficult due to close proximity of big vessels. FNA cytology - Adenoca

Write the radiological description and DD for the CT images , 57 year old , nonsmoker,male, symptoms s/o mild intermittent asthma since last 15 years.

Write a description of radiological findings and list DD.

65 year old nondiabetic male farmer, presented with high grade fever and cough with progressive dyspnoea over 8-10 days.Patient is on supplmental oxygen in ICU.

Pt had received ATT 10 years ago.

What is the differential , how will you investigate?

25 year old male presents with severe acute onset dyspnoea.Describe the findings and give your diagnosis?

25 year old lady presents with cough and chest pain with 3 kg weight loss. Describe the radiodensity and plan the work up.

24 year old lady with progressive exertional dyspnoea, Describe the radiological findings ?

Cardiomegaly with RV hypertrophy and prominent pulmonary conus.

67 year old male , non smoker , no DM, no HT , presented with progressive exertional dyspnoea , moderate restriction and hypoxia at rest, needed steroids to stabilize , stabilized steroids tapered and lung biopsy done

( He had similar episode about 18 months ago ).Looking at radiological pattern what can be predicted as histopath type.?

Dominent pattern is ground glass opacification and there is not much honeycombing. This is likely to be a non UIP disease.

35 year old female patient presents with history of cough, occasioanl hemoptysis, no weight loss, or loss of appetite, no fever,

ESR is raised, 3 sputum samples are negative for AFB , Sputum koh prep - no fungi seen

Describe the radiological findings .How will you investigate?

35 year old lady ,presented with fever off and on , cough and chest pain .what is the radiological finding ? What is the most likely diagnosis?

Right hemidiaphragm appears elevated, likely rt subpulmonic effussion.

60 year old diabetic male , survives serious sepsis ( intraabdominal ,post op), Needs prolonged ICU care , multiple antibiotics and just after discahrge starts getting cough and exertional dyspnoea. He is on linezolid and Levofloxacin at discahrge.He has normal WBC counts and procalcitonin levels are low. Clinically no sepsis.Describe the radiodesnsities and possible diagnosis?

multiple patchy consolidations, some nodular densities and areas with lot of bronchial wall thickening, clinical set up indicates non infective etiology.This was bronchiolitis obliterans with organizing pneumonia.

The symptoms responded to steroids and within 2 weeks CT normalized.

55 year old male with cough and fever for about 3 weeks, lower image is the one on day 1 , upper image is after 2 weeks . Spot the change between the two images ?

There are tiny air fluid levels within the radiodensity in the second image.This was a lung abcess which was masquereding as possible mass lesion in the lower image.

Look at the follow up X ray( on top ).

50,non smoker, non diabetic , asthmatic male on inhaled steroids 3 months, cough expectoration

wheeze, obbstruction on spirometry , on inhaled budesonide 1000 mcg /day.

SputumAFB- 3 negative , Describe findings? write possible DD.

Bilateral discrete nodular densities with two tiny cavities, Likely to be infective ,DD- tubercular,fungal

(Incidentally the lavage in this case confirmed Nocardiosis)

Person with a malignant pleural effusion on the right, Can you notice some additional findings? Clue - patient is getting face and upper limb edema.

Some mediastinal widening noted , New face and upper limb edema indicates SVC obstruction.

Identify and describe the radiological pattern ?

Radiodensities along the bronchi ,extending into nodular branching pattern .Tree in bud appearence.

48 year old ,nondiabetic ,nonsmoker male, presented with 8 days history of fever and dyspnoea.

History of similar illness 10 years ago.What is your diagnosis ?

Massive cyst with air fluid level , thin walled , mostly a bronchogenic cyst.

Elderly male , non diabetic, recently treated for TB , Enumerate all findings

1) Kyphoscoliosis 2) distorted lung architecture 3) Pleural tag left base with blunted CP angle

4) crowded ribs, elevated left hemidiaphragm left side.

1

This is a middle aged person who has been on ATT for last 3 years including second line agent.Comment on the Xray 1) regarding activity 2) Left lung findings

RUL fibrotic healed ,RLZ- ? active process, left lung fibrotic collapse, mediastinum pulled to left,trachea pulled to left, left hemidiaphragm pulled up. Don't pass the final verdict on activity unless sputum/BAL is repeatedly ZN smear and culture negative.
The lower image is the CT scan of the same patient who had a large bulla.

52 year old nonsmoker, known severe COPD with increasing dyspnoea over last 2 years. Is their any radiological abnormality which can explain the relatively new dyspnea ?

Large emphysematous bulla in right lung. ( Needed surgical resection after 3 years of supportive therapy.)

Both are bronchiectasis,Can you see the differences?

The top one is much older patient , (78 yrs), has more one sided disease process, there is no secondary infection.Also notice very prominent pulmoary vasculature on right and volume loss on left( incidentally he has severe pulmonary hypertension)

The lower one is a younger patient, bilateral disease, some air fluid levels s/o secondary infection