ms1 case #2 - michigan medicinems1 case #2 . history •let's learn some basic anatomy on a...
TRANSCRIPT
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MS1 case #2
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History
• Let's learn some basic anatomy on a chest
radiograph, and then see some interesting
cases of how you can use the things you
learned in week 1 to make a diagnosis.
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Normal frontal chest radiograph
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What don't you see here?
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What don't you see here?
• We no longer see the right
heart border (it is
'silhouetted') because of an
adjacent pneumonia.
Pneumonia - essentially
pus/fluid filled lung - is soft
tissue density, and so is the
heart, so the two densities
will be the same on x-rays.
• This is a right middle lobe
pneumonia, which we can
confirm on the lateral view
(see next image)
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Lateral view on the same patient
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Lateral view on the same patient
• Soft tissue density
where the right
middle lobe should
be confirms the
presence of a right
middle lobe
pneumonia
suspected on the
frontal view
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Right lower lobe collapse
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Right lower lobe collapse
• When two structure of
similar density are next
to each other, they
obscure each other
(called 'the silhouette
sign'). In this example
there is collapsed lung
(soft tissue density) next
to the diaphragm (soft
tissue density), so the
diaphragm is
'silhouetted' and you
don't see it.
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What structure don't we see here?
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What structure don't we see here?
• The left hemidiaphragm
is completely obscured
(silhouette sign).
• This is left lower lobe
collapse (atelectasis),
probably because of
mucus blocking up the
airway
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Do you see anything here?
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Do you see anything here?
• Up near the top of the
right lung, there is
abnormal soft tissue
density representing the
collapsed right upper
lobe - the lung is not
aerated and is collapsed
on itself (atelectasis).
• The minor fissure is
elevated (pulled
upwards) because of
volume loss from the
collapsed lung.
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Discussion
• You can see lots of anatomy - even on
radiographs. By using the "silhouette sign" and
some other tricks, you can localize abnormalities
on a chest radiograph.
• As a review, there are 5 basic densities on a
radiograph - air, fat, fluid/soft tissue, bone, metal.
If two structures of similar density are next to
each other, the become indistinguishable (or
silhouette each other).
• We can use this knowledge to localize lung
findings (usually):
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Discussion
• Airspace opacities in the right lower lobe obscure
the right hemidiaphragm.
• Airspace opacities in the right middle lobe
obscure the right heart border.
• Airspace opacities in the left lower lobe obscure
the left hemidiaphragm.
• Airspace opacities in the left upper lobe
(especially in the lingula - the anterior most part
of the left upper lobe) obscure the left heart
border.