IMAGE OF THE WEEK <ul><li>Prof .Dr. P. Vijayaragavan’s Unit.  </li></ul><ul><li>Dr. A. Karthick Ramalingam. </li></ul>
CLINICAL SUMMARY <ul><li>58 year old Mrs.Samundeswari was admitted with  </li></ul><ul><li>C/o sudden onset breathlessness...
CXR PA VIEW
FINDINGS <ul><li>Bony cage is normal. </li></ul><ul><li>Soft tissue: Subcutaneous emphysema. </li></ul><ul><li>Trachea in ...
Bullae with a septa within it Pneumomediastinum Air under heart
CT CHEST <ul><li>PNEUMOMEDIASTINUM </li></ul><ul><li>PNEUMOTHORAX  </li></ul><ul><li>EMPHYSEMATOUS BULLAE </li></ul><ul><l...
CXR FINDINGS IN PNEUMOMEDIASTINUM <ul><li>Mediastinal emphysema appears as a thin line of radiolucency that outlines the c...
CXR FINDINGS <ul><li>Inner margin that is concave than convex </li></ul><ul><li>They  should not conform to the costophren...
BULLAE Inner margin that is concave
PNEUMOTHORAX DEEP SULCUS Curvilear convex line Absent lung markings
<ul><li>Thank you </li></ul>
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Imaging: Pneumomediastinum/pneumothorax/bullae

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Imaging: Pneumomediastinum/pneumothorax/bullae

  1. 1. IMAGE OF THE WEEK <ul><li>Prof .Dr. P. Vijayaragavan’s Unit. </li></ul><ul><li>Dr. A. Karthick Ramalingam. </li></ul>
  2. 2. CLINICAL SUMMARY <ul><li>58 year old Mrs.Samundeswari was admitted with </li></ul><ul><li>C/o sudden onset breathlessness and facial swelling. </li></ul><ul><li>H/o cough with expectoration present </li></ul><ul><li>Initially drug allergy was suspected </li></ul><ul><li>O/E the facial swelling was found to be due to subcutaneous emphysema. </li></ul>
  3. 3. CXR PA VIEW
  4. 4. FINDINGS <ul><li>Bony cage is normal. </li></ul><ul><li>Soft tissue: Subcutaneous emphysema. </li></ul><ul><li>Trachea in midline. </li></ul><ul><li>Slight mediastinal shift towards left. </li></ul><ul><li>Emphysematous change seen in right lung field . 8 ribs can be counted posteriorly. </li></ul><ul><li>Flat diaphragm and air can be seen below heart </li></ul><ul><li>Left upper zone shows a ellipsoidal translusent area devoid of lung markings surrounded by thin wall .A septa is seen within that area. </li></ul><ul><li>Fibrotic changes are present in left mid and lower zone and right lower zone. </li></ul><ul><li>Pneumomediastinum present. </li></ul>
  5. 5. Bullae with a septa within it Pneumomediastinum Air under heart
  6. 6. CT CHEST <ul><li>PNEUMOMEDIASTINUM </li></ul><ul><li>PNEUMOTHORAX </li></ul><ul><li>EMPHYSEMATOUS BULLAE </li></ul><ul><li>BRONCHIECTASIS </li></ul>
  7. 7. CXR FINDINGS IN PNEUMOMEDIASTINUM <ul><li>Mediastinal emphysema appears as a thin line of radiolucency that outlines the cardiac silhoutte, as well as thin lucent vertically oriented streaks of air within the mediastinum </li></ul><ul><li>Aorta and other posterior mediastinal structures may be highlighted, and well defined lucency around the right pulmonary artery may be seen ( ring around the artery sign ) </li></ul><ul><li>Unlike in pneumothorax or pneumoperitoneum, the air remains fixed and does not rise to the highest point </li></ul><ul><li>An unbroken line may extend from one hemidiaphragm to other beneath the heart – the continuous diaphragm sign </li></ul>
  8. 8. CXR FINDINGS <ul><li>Inner margin that is concave than convex </li></ul><ul><li>They should not conform to the costophrenic angle when they are at lung base </li></ul><ul><li>A bullae is limited to one lobe </li></ul><ul><li>Thin curvilinear line that is convex </li></ul><ul><li>Costophrenic angle will be free of vascular markings </li></ul><ul><li>Not limited to one lobe </li></ul><ul><li>In a small pneumothorax costophrenic angle blunting due to small amount of pleural fluid that collects </li></ul><ul><li>Deep sulcus sign positive </li></ul><ul><li>BULLAE </li></ul><ul><li>PNEUMOTHORAX </li></ul>
  9. 9. BULLAE Inner margin that is concave
  10. 10. PNEUMOTHORAX DEEP SULCUS Curvilear convex line Absent lung markings
  11. 11. <ul><li>Thank you </li></ul>

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