EMQs in Clinical Medicine.pdf - Peshawar Medical College

42 Respiratory medicine
the level of the sixth rib in the axillary line. In right upper lobe collapse,
the horizontal fissure will be elevated.
Chest radiograph findings of a left upper lobe collapse are somewhat different.
There is no left middle lobe and hence no horizontal fissure. The
upper lobe is anterior to a greater proportion of the lower lobe. Hence,
left upper lobe collapse can give rise to a hazy white appearance over a
large part of the left lung field. This should not be confused with a
pleural effusion because in collapse there will be tracheal deviation to
the side of the lesion, elevation of the hilum and preservation of the
costophrenic angle.
F
A
Numerous calcified nodules sized less than 5 mm located predominantly
in the lower zones of the lungs.
Multiple, small, calcified nodules may occur after varicella pneumonitis.
Other causes of numerous calcified nodules include TB, histoplasmosis
and chronic renal failure.
Double shadow right heart border, prominent left atrial appendage,
left main bronchus elevation.
Advanced mitral stenosis is associated with characteristic findings caused
by left atrial enlargement. These include elevation of the left main
bronchus, widening of the carina, double right heart border and a prominent
left atrial appendage. Calcification of the mitral valve may also be
seen, as may pulmonary oedema. Left ventricular enlargement is not a
feature despite the presence of pulmonary oedema.
15 Chest radiograph pathology
Answers: K C E F G
K
C
A 28-year-old African–Caribbean man presents with dry cough and
progressive shortness of breath. His chest radiograph shows bilateral
hilar lymphadenopathy.
This constellation of symptoms and radiological findings is highly suggestive
of sarcoidosis which is more common in black patients. Other
causes of bilateral hilar lymphadenopathy include TB, malignancy
(although symmetrical lymphadenopathy is rare), organic dust diseases
and extrinsic allergic alveolitis.
The chest radiograph of a 13-year-old boy with cystic fibrosis has
tramline and ring shadows.
Ring shadows and tramlining are a characteristic radiological finding in
bronchiectasis, which is a common early complication of cystic fibrosis.
Patients present with a cough productive of large amounts of purulent
sputum and there can be haemoptysis. On examination the patient may