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ferretpants
Joined: 21 Nov 2006
Posts: 22
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 Posted: Tue Nov 21, 2006 3:28 pm Post subject: Can you guess this one? |
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64yr old male post RSLTx (Right Single Lung Transplant) presents to the department for a routine post op CXR and complains of a frozen Rt shoulder.
CXR and AP Rt Shoulder (routine view for our hospital) were taken (below).
What diagnosis can you make from these films?
What views/further modalities would you suggest next for this patient?
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He/she who asks a stupid question is a fool for 5 mins, he/she who never asks that question is a fool forever........... |
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MurphyMobile
Moderator
Joined: 26 Aug 2006
Posts: 148
Location: WNC
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| Posted: Tue Nov 21, 2006 10:29 pm Post subject: |
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ferretpants-
If I was a radiologist, I would not even consider reading these images.
The history would have to explain the plastic tubing along side the right
side of the neck.
The chest needs repeating to include a lateral with the right side against chest upright bucky.
The right shoulder is actually A-C jt. Two if not three views would be needed
to evaluate completely.
I would suspect he has a pnuemothorax and subcutaneous air from what
the shoulder shows.
To further study for pnuemo, I would do a left lateral decubitus of the chest
and a lordotic view.
The A-C Jt. looks irregular and would suspect a avulsion fx. where the subcutaneous air look suspicious.
Also, I question the glenoid fossa at the distal region. I would question
a fx. A true AP that shows the fossa and space would be helpful.
Finally, on the AP erect chest, superimposed over the scapula looks like
questionable density that could be fluid or a consolidated mass. Also, it looks like there is fluid at the base of the lung.
This would require a rt. lateral decubitus for fluid or mass.
MM
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ferretpants
Joined: 21 Nov 2006
Posts: 22
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| Posted: Sun Nov 26, 2006 6:04 am Post subject: |
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| MurphyMobile wrote: | ferretpants-
1) If I was a radiologist, I would not even consider reading these images.
2)The history would have to explain the plastic tubing along side the right
side of the neck.
3)The chest needs repeating to include a lateral with the right side against chest upright bucky.
4)The right shoulder is actually A-C jt. Two if not three views would be needed
to evaluate completely.
5)I would suspect he has a pnuemothorax and subcutaneous air from what
the shoulder shows.
6)To further study for pnuemo, I would do a left lateral decubitus of the chest
and a lordotic view.
7)The A-C Jt. looks irregular and would suspect a avulsion fx. where the subcutaneous air look suspicious.
8)Also, I question the glenoid fossa at the distal region. I would question
a fx. A true AP that shows the fossa and space would be helpful.
9)Finally, on the AP erect chest, superimposed over the scapula looks like
questionable density that could be fluid or a consolidated mass. Also, it looks like there is fluid at the base of the lung.
This would require a rt. lateral decubitus for fluid or mass.
MM |
Great to get a response like this! I am going to number and answer each of your questions above separately (see the quote box above).
1) Why not, they are perfectly good images? I am asking you to think as a radiographer, in other country's outside the big US of A, the radiographers report is highly regarded.
2) What plastic tubing?
3) Yes, this would be good.
4) Yes there is an A/C joint present, and you do not need any more views. Or put it this way, if you did take some more views they do not show anything.
5)No
6)No pneumo
7)No
8)No, the patient is now starting to complain that he is glowing in the dark.
9)Fantastic, good observation concerning the scapula.
Qu.
What do you think of the ribs?
What other modalities would you use?
_________________
He/she who asks a stupid question is a fool for 5 mins, he/she who never asks that question is a fool forever...........
Last edited by ferretpants on Tue Dec 19, 2006 8:51 am; edited 1 time in total |
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MurphyMobile
Moderator
Joined: 26 Aug 2006
Posts: 148
Location: WNC
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| Posted: Tue Nov 28, 2006 4:48 am Post subject: |
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I have dial-up internet. Takes ten years to get the images.
Just above the scapula is a radiolucent tubing like structure. Does that
belong there?
At least you are receiving comments.
I have worked at a trauma II hospital and the techs would go bonkers
even trying to decide what is wrong.
I had to do this on a mobile radiology job and loved it. But we did 2 views
of each part. (as the radiologists would state and instructors would insist
90 deg views)
If the patient is complaining of "glowing in the dark" he has yet to find out
what exams entail. Did someone explain to him?
MM 
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MurphyMobile
Moderator
Joined: 26 Aug 2006
Posts: 148
Location: WNC
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| Posted: Tue Nov 28, 2006 4:58 am Post subject: |
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| Quote: | | ) Why not, they are perfectly good images? I am asking you to think as a radiographer, in other country's outside the big US of A, the radiographers report is highly regarded. |
The images are great. But for evauluation purposes I would want laterals.
| Quote: | | What views/further modalities would you suggest next for this patient? |
If this patient is concerned about radiation, ultrasound and MRI is the
only answer I would suggest. Although he may be claustaphobic, or have
internal metal for the MRI.
Sounds like you are making fun of the US. So why use the word frozen
shoulder? Surely there is a better word.
Maybe one of the ligaments is attached to the wrong area when the drs.
did the lung transplant. Maybe the lung is too big.
MM
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