EMQs in Clinical Medicine.pdf - Peshawar Medical College

Chest radiograph pathology – answers 41
is the term used to describe widespread TB through haematological
dissemination. It carries a poor prognosis.
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A 35-year-old businessman returns from a trip abroad and collapses
at the airport with haemoptysis and pleuritic chest pain. He has a
sinus tachycardia and his ECG shows right axis deviation.
This is a classic history of pulmonary embolus (PE), although in many
cases not all these features may be present. Diagnosis relies on a high
index of clinical suspicion together with tests such as ventilation–
perfusion scanning and pulmonary angiography (now commonly
performed using spiral computed tomography). Other risk factors for
PE include previous thromboembolic events, oral contraceptive pill,
surgery (especially pelvic surgery), immobility and inherited
thrombophilias.
14 Chest radiograph pathology
Answers: J M C F A
J
M
C
Multiple bilateral nodules between 0.5 and 5 cm in a former miner
with rheumatoid arthritis.
Caplan’s syndrome is a pulmonary manifestation of rheumatoid arthritis
(RA) which is characterized by the presence of pulmonary nodules. It
typically occurs in patients with RA who are exposed to coal dust,
although the granulomas can also appear in workers exposed to other
dusts, e.g. silicosis and asbestos. Symptoms include cough, shortness of
breath and haemoptysis.
RA has several other respiratory manifestations/associations including
fibrosing alveolitis, pleural effusions and, very rarely, obliterative
bronchiolitis. RA can also affect the cricoarytenoid joints leading to
upper respiratory tract obstruction.
Kerley B lines, bat-wing shadowing, prominent upper lobe vessels,
cardiomegaly.
These findings are suggestive of acute left ventricular failure leading to
pulmonary oedema. Kerley B lines are often difficult to see in real life.
Although right ventricular failure may present with cardiomegaly,
pulmonary oedema does not occur.
Trachea deviated to right, horizontal fissure and right hilum displaced
upwards.
These chest radiograph findings are characteristic of right upper lobe
collapse. Try to find the horizontal fissure because its position is a good
clue to the presence of volume loss. The horizontal fissure on the right
lung should run from the middle of the right hilum and can be traced to