Active learning

This is an active learning session of the chest Xray of a patient presented with AKI.

[16/06/20, 8:49:17 AM] Vaishnavi: Sir in this case the chest xray shows consolidation

Can this be attributed to pulmonary edema caused by AKI?

[16/06/20, 9:21:37 AM] Dr.Rakesh Biswas Sir: Where exactly is the consolidation? What else does it show?

[16/06/20, 9:24:38 AM] Vaishnavi: Consolidation is like it look more solidified

[16/06/20, 9:27:44 AM] Dr.Rakesh Biswas Sir: What are the radiological pointers to consolidation?

[16/06/20, 9:29:27 AM] Dr.Rakesh Biswas Sir: Which side?

[16/06/20, 9:30:13 AM] Vaishnavi: Increased lung density sir

[16/06/20, 9:30:20 AM] Vaishnavi: Left

[16/06/20, 9:31:16 AM] Dr.Rakesh Biswas Sir: The lung is black. In fact there is lot less lung on the left compared to right?

[16/06/20, 9:31:47 AM] Vaishnavi: Yes sir

There is increased density on left

[16/06/20, 9:33:21 AM] Dr.Rakesh Biswas Sir: When does the lung become less visible and almost merges with the heart shadow?

[16/06/20, 9:33:57 AM] Dr.Rakesh Biswas Sir: What is lung density? It's normally supposed to look black

[16/06/20, 9:37:01 AM] Vaishnavi: Fibrosis?

[16/06/20, 9:37:09 AM] Vaishnavi: It becomes lighter sir

[16/06/20, 9:40:08 AM] Dr.Rakesh Biswas Sir: 👍

[16/06/20, 9:40:29 AM] Dr.Rakesh Biswas Sir: Right. 

The hallmark of consolidation is Air bronchograms

[16/06/20, 9:41:02 AM] Dr.Rakesh Biswas Sir: Check out how air bronchograms or consolidation looks like from Google Images

[16/06/20, 9:42:03 AM] Vaishnavi: Yes sir

[16/06/20, 9:47:15 AM] Dr.Rakesh Biswas Sir: So you see there is no volume loss of the lung (black area)

[16/06/20, 9:47:34 AM] Vaishnavi: Yes sir

[16/06/20, 9:47:52 AM] Vaishnavi: How do we read it then sir?

[16/06/20, 9:47:52 AM] Dr.Rakesh Biswas Sir: Notice the assymetry here?

[16/06/20, 9:48:21 AM] Dr.Rakesh Biswas Sir: Why the volume loss in the left upper zone?

[16/06/20, 9:48:45 AM] Vaishnavi: Yes

[16/06/20, 9:49:37 AM] Vaishnavi: Pleural fluid might cause it sir

[18/06/20, 9:55:05 AM] Dr.Rakesh Biswas Sir: Would pleural fluid cause volume loss that is apparent in the left hemithorax? 

Google Image features of left upper and lower lobe collapse separately and share what you learn

[18/06/20, 10:21:26 AM] Vaishnavi: Upper lobe - 

Slight increase in radiographic density

Obscured heart border and anterior aortic arch

Hyperexpaned lower segment comes in between upper lobe and superior mediastinum silhouetting the aortic arch - LUFTSCHIZEL SIGN. This might be mild forming a cap which looks like a tumor.

Left hilum is drawn upwards making left main bronchus horizontal.

[18/06/20, 10:22:18 AM] Vaishnavi: Luftschizel sign

[18/06/20, 10:22:44 AM] Vaishnavi: Lower lobe -

Triangular opacity in posterior mediastinum - RETRO CARDIAC SAIL SIGN

Double cardiac contour

Inferior displacemnet of left hilum

Flattening of left heart border - FLAT WAIST SIGN

[18/06/20, 10:23:16 AM] Vaishnavi: Double heart contour

[18/06/20, 10:24:16 AM] Vaishnavi: In this there are air bronchograms also sir

[18/06/20, 10:24:48 AM] Vaishnavi: Triangular density

[18/06/20, 4:44:09 PM] Dr.Rakesh Biswas Sir: Where?

[18/06/20, 4:45:07 PM] Dr.Rakesh Biswas Sir: Excellent. So what does our patient's chest X-ray look like? Could it be a collapse?

[18/06/20, 5:04:57 PM] Vaishnavi: Yes sir lower lobe collapse

[18/06/20, 6:54:59 PM] Dr.Rakesh Biswas Sir: Check out normal chest X-ray in Google Images as this could even be a normal finding