Answer: Can you find the abnormalities?

December 2, 2013

Chest, Chest, Chest XR, CT, Trauma, XR


I gave you this xray a couple days ago, can you find all the abnormalities?

GSW

1.  Intubated into the right mainstem bronchus

2.  Metallic foreign bodies coursing up the left chest to the neck

3.  Completely opacified left lung:  differential diagnosis of pulmonary contusion, hemothorax, or complete atelectasis from right mainstem intubation

4.  There is a chest tube in the right chest cavity, it looks to be in good position but could be coursing into the fissure between the left lobes

5.  Deep sulcus sign on the left side indicates possible pneumothorax vs. hemothorax

6.  Orogastric tube courses below the diaphragm in good position

7.  Subcutaneous emphysema in upper neck

8.  Two radiodense objects in the midline cardiac silhouette near the mid-portion of the coursing orogastric tube

Interestingly, this patient was shot in the chest coursing to the upper neck and the bullet was found in his posterior pharnyx.  He had a tooth found on chest CT (calcified opacity seen below) among other injuries.   Later EGD intraoperatively showed two tooth fragments in the stomach.  The radiodensities seen #8 above were presumed to be these teeth in the esophagus.

Tooth

Image Contributor:  Julie Phan, MD

Author:  Russell Jones, MD

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2 Comments on “Answer: Can you find the abnormalities?”

  1. Vince DiGiulio Says:

    Nice case. As a correction, you stated the chest tube was in the right chest when you meant to say the left. Thanks for posting these interesting and educational cases!

    Reply

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