|
 
 |
| QUIZ |
|
| Year : 2023 | Volume
: 6
| Issue : 2 | Page : 87-89 |
|
Radiology quiz
Aarthi Narasimhan, Vyshnavi Rajeev, Riha Mehrin
Department of Respiratory Medicine, Apollo Main Hospital, Chennai, Tamil Nadu, India
| Date of Submission | 23-May-2023 |
| Date of Decision | 14-Jun-2023 |
| Date of Acceptance | 16-Jun-2023 |
| Date of Web Publication | 13-Jul-2023 |
Correspondence Address:
Dr. Aarthi Narasimhan
Department of Respiratory Medicine, Apollo Main Hospital, Greams Road, Chennai - 600 006, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/japt.japt_20_23
How to cite this article:
Narasimhan A, Rajeev V, Mehrin R. Radiology quiz. J Assoc Pulmonologist Tamilnadu 2023;6:87-9 |
A 59-year-old man presented to the outpatient department with a history of shortness of breath and change in voice for the past 1 month. He also had a history of cough and occasional blood-tinged sputum in the past 1 month. He lost almost 15 kg in the past 3 months.
He was a chronic smoker for more than 20 years, and he used 4–5 packets of cigarettes per day. He was on regular treatment for diabetes and hypertension.
On physical examination, he was moderately built, afebrile, and maintained optimal saturation with room air. On auscultation, breath sounds were absent on the left hemithorax.
Routine blood investigations showed elevated HbA1c.
[Figure 1] shows chest X-ray and [Figure 2], [Figure 3], [Figure 4] show computed tomography of this patient. The patient was evaluated further with bronchoscopy. [Figure 5] shows the bronchoscopic finding of this patient. | Figure 1: Chest X-ray showing left upper, mid, and lower zone homogenous opacity with mediastinal shift toward the same side
Click here to view |
 | Figure 2: Computed tomography chest axial view showing narrowed left main bronchi
Click here to view |
 | Figure 3: Computed tomography chest axial view showing atelectasis of the left upper lobe
Click here to view |
 | Figure 4: Computed tomography chest axial view showing atelectasis of the left lower lobe
Click here to view |
 | Figure 5: Bronchoscopy showing endobronchial growth occluding the left main bronchus
Click here to view |
| Questions | |  |
- Identify the radiological findings in chest X-ray and computed tomography
- Enumerate the differential diagnosis from the chest X-ray
- Identify the lesion in bronchoscopy image
- Enumerate the differential diagnosis from the bronchoscopy image.
| Answers | | |
- Chest X-ray [Figure 1] shows left upper, mid, and lower zone homogenous opacity with mediastinal shift toward the same side. Computed tomography chest axial view [Figure 2], [Figure 3], [Figure 4] shows narrowed left main bronchi with atelectasis of the left upper and lower lobes
- The differential diagnosis of an opaque hemithorax with ipsilateral mediastinal shift includes pulmonary agenesis, pneumonectomy, and atelectasis
- Bronchoscopy shows endobronchial growth occluding the left main bronchus [Figure 5]
- Differential diagnosis of this lesion is endobronchial tumor most likely bronchogenic carcinoma.
| Final Diagnosis | | |
Endobronchial ultrasound needle aspiration was taken from the growth [Figure 6] and [Figure 7] and cytology showed atypical cells in a background of subacute inflammation. | Figure 6: EBUS needle aspiration from the growth. EBUS: Endobronchial ultrasound
Click here to view |
 | Figure 7: Cytology sample collected using EBUS needle aspiration technique. EBUS: Endobronchial ultrasound
Click here to view |
Needle biopsy histopathological examination revealed poorly differentiated tumor.
| Discussion | | |
Whiteout long is one of the most important radiological findings that one comes across in pulmonology clinics. The differential diagnosis for a whiteout lung is varied and also depends on the position of the trachea and diaphragm. Whiteout lung should be differentiated with the position of the trachea and diaphragm. While a pulled trachea suggests a mass lesion causing total lung atelectasis, a massive pleural effusion causes pushing away of the trachea. In our case, we describe a massive tumor completely obstructing the left main bronchus causing atelectasis but associated with pleural effusion causing the central trachea. This scenario should be considered in an elderly male presenting with breathlessness and dry cough.
A differential diagnosis of a whiteout lung can be analyzed by the following features:
- Trachea pulled to the same side includes
- Lesion obstructing the main bronchus causing total lung atelectasis
- Pneumonectomy (associated crowding of ribs)
- Pulmonary agenesis/hypoplasia.
- Trachea in the center includes
- Large consolidation
- Large pleural lesion with endobronchial mass
- Large chest wall mass.
- Trachea pushed away to the other side includes:
- Large pleural effusion
- Diaphragmatic hernia
- Large pulmonary mass.
Other features to look out for while diagnosing a whiteout lung include the position of the diaphragm – whether pulled up or pushed down, the position of the ribs – whether overcrowded or spaced out, and the presence of any other features like the bones or cardiac lesions that can add on to the differential diagnosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Acknowledgment
We would like to thank the Department of Pulmonology, Apollo Hospitals, Chennai, Tamil Nadu, India.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
|
Search Pubmed for