Angry Doctor

Monday, September 19, 2005

X-ray Conference

OK, I'm stumped.

Anyone can tell me what's wrong with this X-ray?


  • A very curious CXR. Given the history supplied, of sudden onset chest pain, effusion and then pneumothorax, followed by tension pneumothorax, I'm thinking:

    - sudden onset suggests acute event such as rupture of a viscus or tube
    - effusion + pneumothorax --> rapid onset suggests it is not reactive in nature but direct transit of contents. this narrows it down to either a communication with [a] a viscus containing fluid and air, or [b] two visci, each containing fluid or air.
    - tension pneumothorax --> one-way valve effect?

    my initial thought were oesophageal transection, but this would not produce this much fluid [?]. but i haven't seen a oesophageal transection before, so maybe this is just b.s.

    hazarding a guess, maybe a strangulated or infected hiatus hernia that subsequently eroded/ruptured into the pleural cavity? thus stomach contents would be present, as well as air. I am harder pressed to explain the tension pneumothorax though, since the stomach only has a fixed volume.

    okay, will give up now. :)

    By Anonymous Anonymous, At September 20, 2005 5:48 pm  

  • What wouldn't go with the oespphagus is that you'd expect a pneumomediastinum and not a tension.

    Stomach bubble isn't there...

    I'm waiting for the answer myself.

    By Blogger angry doc, At September 20, 2005 5:56 pm  

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