Sunday, December 19, 2010

what's wrong here?

This x-ray has been everywhere to get here so sorry for the poor image. I gave you this view because it shows the problem and the cross sections would require multiple views.

This patient had a chest surgery about two months prior to this CT. He was sob but not severe. He complained of abdomen fullness which I ignored.

What surgery did he have?
What part of that surgery caused the finding on CT?
What was done to relieve his symptoms?


posted by joe @ 12/19/2010 05:21:00 PM   6 comments


At 8:54 AM, Blogger Clay said...

I am guessing he had a aortic aneurysm repair, complicated by hemothorax, resolved by chest tube placement.

At 11:15 AM, Blogger joe said...

close but no cigar.

At 4:35 AM, Blogger Clay said...

I don't see any organs missing unless there is part of a lung gone and I don't see any hardware or clips so I don't plan on getting the surgery right without any other clues. Was the hemothorax part right?

At 5:48 AM, Blogger joe said...

hemothorax is right and right system --clue you will not be able to see the cause of the problem but must think about a surgery that could cause it. That is the key to the whole exercise.

At 5:16 AM, Blogger Clay said...

So this individual had a CABG and subsequently developed a hemothorax. Great case. Did he require a chest tube or was thoracentesis sufficient?

At 6:01 AM, Blogger joe said...

1st thoracentesis 4 liters of old liquid blood! And much improvement of his symptoms. Another 3 liters removed 2 weeks later. The plan is to continue to monitor his symptoms. Now looking at cxr and old fashion auscultation and percussion. As you will see in the subsequent post many CABG pts have pleural effusions not many have large effusions but most are managed by observation and thoracentesis.


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