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pleural effusion

1st case study

noor alani

on 9 December 2012

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Transcript of pleural effusion

Pleural Effusion College of Health Sciences
Medical Diagnostic Imaging Department Fall semester 2012-2013
Student Name :- Noor Adnan Al Ani – U00022819
Supervisor Name:- Dr.Mohamed Abuzaid.
Course Instructor :- Dr.Mohamed Abuzaid. A 47-year old, male patient came to the emergency department by a wheelchair after having an accident (hit by a crane). The physician in the ER department requested chest, ribs, shoulder and elbow x-rays. CT scan was also done for the patient. Anatomy & physiology chest sternum 12 pairs of ribs 12 thoracic vertebrae pericardial cavity Thoracic
cage Thoracic cavity 2 pleural cavities parietal pleura visceral pleura Radiographic Anatomy PA chest x-ray Pleural Effusion Pathology a collection of fluid in the pleural cavity. It could be transudative(caused by loss of albumin and reduced osmotic pressure), or exudative(due to inflammation). Symptoms Shortness of breath (SOB).Tachypnea (rapid breathing).
Chest pain.
Hiccups. Examinations Radiology: xrays, CT scan, ultrasound.
Other tests can be conducted for getting specific diagnosis, like lung test and thoracentesis followed by a lab test Treatment Minor pleural effusion
Severe pleural effusion observation invasive thoracenticec Clinician's assessment The patient came to the emergency department by a wheelchair after being hit by crane. The patient was in pain especially during respiration, and had difficulty breathing. Assessment & diagnosis of physician The physician suspected rib fracture, that could be a cause of some complications like pleural effusion and partial lung collapse, which can be the reason of shortness of breath that the patient was suffering from. Investigations required The physician requested a lab test, which reveals nothing significant.
The physician also requested a PA chest x-ray and PA ribs x-ray exams, to check for any rib fracture and lung pathology.
CT scan with contrast was requested after the x-ray examinations were conducted. CT scan emphasizes lung pathology and shows its severity. Radiographic procedure Diagnostic Imaging examinations PA chest x-ray showing rib fractures, pleural effusion and partial collapse of the left lung PA upper ribs x-ray showing fractures in the 1st, 2nd and 3rd left ribs anteriorly. CT scan results radiologist physician oFracture in the 1st, 2nd and 3rd left ribs.
oPleural effusion in the left pleura. The patient had fractures in the first three left ribs on their anterior portion with flail segments. Fractured ribs are affecting the lungs and causing pleural effusion in the left pleural cavity. comparison The radiologist and the physician had the same opinion about the patient through x-ray and CT scan results. Patient's prognosis PA chest x-rays with the patient in a standing position. The image was taken one week after the first examination. Notice the fluid level. PA ribs x-rays with the patient standing position. The image was taken two weeks after the first examination. Full recovery is almost achieved. MDI role in this case Respiratory disorders have approximately the same symptoms, and even the patient can't describe the pain sufficiently. That's why, seeing inside the patient gives the exact diagnosis. Radiology helps in diagnosis, which is the first step toward treatment and recovery. Conclusion A 47-year old, male patient entered the emergency department after being hit by a crane. The physician requested chest, ribs, shoulder and elbow x-ray examinations. The patient was transferred to the ICU for continuous observation. CT scan was done before transferring the patient to the surgical ward for treatment. The patient was discharged after one month with no signs of the initial symptoms, and full recovery is expected. References Books:
1.Clinical anatomy by regions, Richard S.Snell, eighth edition.
2.Merrill's Atlas of radiographic positioning & procedures, Elsevier Mosby, twelfth edition, volume one.
5.http://www.patient.co.uk/health/Pleural-Effusion.htm L feel free to ask any question! Clinical Practice ( 0502357 )
General x-ray gas exchange patient position Initial examinations were done using x-rays and then CT scan. Radiology also was the only way to check for treatment progress and then recovery. patient standing with back of hands on hips. part position center the midsagittal plane with chin extended and eyes straight ahead.
have patient roll shoulders forward.
place top of IR 1.5 to 2 inches above shoulders.
respiration: suspend at the end of the 2nd inspiration. CR & CP perpendicular at the level of T7 SID 72inches KVp 125 mAs 2.5 IR size 14 x 17
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