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Solution to Unknown Case #23 – Empyema (loculated pleural effusion)

History: Child with cough.  This is the appearance of an empyema on a lateral decubitus chest radiograph. Pleural effusions are classified as either transudative (simple fluid) or exudative (complex fluid containing pus, blood, or protein). On ultrasound, transudative pleural effusions are anechoic and simple appearing, whereas exudative pleural effusions are complex appearing with echogenic debris and … Continue reading

Multiple Pleural Masses Mnemonic – MALLETS

This mnemonic has commonly bean used to recall the differential diagnosis of multiple pleural masses: M – Mesothelioma  A – Adenocarcinoma L – Lymphoma L – Leukemia E – Empyema T – Thymoma S – Splenosis See pleural cases here.

Asbestos Related Pleural Disease – Pleural Plaques and The Holly Leaf Sign

History: 60 year old male with shortness of breath.  Pleural plaques can be seen in numerous disease entities, and are most commonly seen in cases of prior asbestos exposure, as in this case. Other possibilities include prior empyema, hemothorax, or pleural effusion. Plaques can be mimicked by extrapleural fat. Pleural malignancies are an additional consideration, … Continue reading

Unilateral Pleural Effusion – Differential Diagnosis

History: 70 year old male with shortness of breath and cough.  The differential diagnosis for unilateral pleural effusion includes parapneumonic effusion, neoplasms such as mesothelioma, primary lung cancer, pleural metastases, lymphoma, other entities such as cirrhosis, pancreatitis, and trauma. This patient had a parapneumonic effusion.

Bronchopleural Fistula – CT

History: 65 year old male with a chronic right sided hydropneumothorax for 3 years after spontaneous pneumothorax.    This patient had a chronic, non-remitting hydropneumothorax, which did not resolve even after the placement of the bronchial valve. This is concerning for a bronchopleural fistula. A bronchopleural fistula is simply defined as an abnormal connection between … Continue reading

Unilateral Hyperlucent Hemithorax Mnemonic – CRAWLS

This mnemonic is commonly used to recall the differential diagnosis of a unilateral hyperlucent hemithorax: C – contralateral lung has increased density or opacity (such as posterior layering of a pleural effusion in the supine patient) R – rotation of the patient causing less attenuation of the x-ray beam A – air (pneumothorax) W – … Continue reading

Bronchiectasis – Differential Diagnosis

History: 65 year old male with shortness of breath.  This is the appearance of bronchiectasis. Bronchiectasis is defined as abnormal widening or dilatation of the airways. It can be diagnosed by a bronchoarterial ratio (B/A) of greater than 1.5. Other ways to diagnose bronchiectasis include lack of bronchial tapering after airway bifurcations and visualization of … Continue reading

Penetrating Chest Trauma – Knife in Chest

History: 50 year old male with self inflicted chest stab wound. Important findings to look for in the case of penetrating trauma to the chest include pneumothorax, pleural effusion (which indicates hemothorax), widened mediastinum indicating injury to the vascular pedicle, enlarged cardiac silhouette indicating hemopericardium, diaphragmatic injury, and pneumoperitoneum. Surprisingly, this patient did not have … Continue reading

Lung Mass – Differential Diagnosis

History: 60 year old male with cough.  A lung mass is a focal opacity that measures greater than 3 cm. If it measures less than 3 cm and is the only lesion, it is classified as a solitary pulmonary nodule. Read this post for the differential diagnosis for a solitary pulmonary nodule. The differential diagnosis … Continue reading

Unilateral Opaque or “White Out” Hemithorax – Differential Diagnosis

History: 60 year old male with shortness of breath. The differntial diagnosis for unilateral opaque hemithorax is broad, and includes large pleural effusion, empyema, hemothorax, complete lung collapse, pneumonectomy, community acquired pneumonia, bronchogenic carcinoma, pleural masses such as mesothelioma, and finally pulmonary agenesis. This patient had complete collapse of the left lung secondary to a … Continue reading