Friday, September 21, 2012

Another Friday Chest X-Ray

Click image to enlarge

Just your basic Friday chest x-ray on an asymptomatic patient with hypertension and atrial flutter.

Any thoughts?



Allen said...

Send them to the ER!

Happy doctor said...

I think it is aortic aneurysm or mediastinal mass. It also shows hyperaeration which reflect chronic lung disease and possible smoking history which increase the risk of aneurysm or lung cancer. I also concern about right lower lobe patchy infiltrate, blunting of left costophrenic angle and haziness in right upper lung field close to mediastinum.

I'm amazed to see "an asymptomatic patient" was hooked with telemetry and got portable CXR rather than regular PA and lateral which would yield much more information.

More history and physical exam, previous CXR and obtaining CXR PA and lateral should help.

suesweeney said...

Is that the apex of the heart sticking up to the left? It looks like the cardiac shadow is sideways. I don't read xrays but is the diaphragm in the right place? Is "something" pushing the heart up and to the left?

Anonymous said...

Do a needle biopsy in the office.

DrWes said...

It's not every day you see a descending aortic aneurism that exceeds 8 cm in diameter (confirmed by CT).

Needless to say, we didn't do an atrial flutter ablation until the aneurism was addressed and no office-based needle biopsy was performed.