60 year old man • SOB • COPD • Sudden onset • High HR • Raised JVP • Reduced breath sounds • Scattered wheeze and creps on right
Most likely?
Pneumothorax
no risk factors for PE (immobility, surgery, malignancy), but that is next most likely
Treatment for a primary pneumothorax and under 50?
< 2cm - discharge, repeat CXR
> 2cm/SOB - aspiration, if unsuccessful: chest drain
Treatment for secondary pneumothorax or over 50?
< 2cm - aspiration
> 2cm - chest drain
Pneumothorax improves after chest drain insertion, but recurrent SOB after 2 hours. Cause?
Re-expansion pulmonary oedema
- Acute SOB
- Pleuritic chest pain
- PMHx: DVT
- High HR
- Raised JVP
What deviation and heart block would you see on ECG?
Appropriate next step in management?
Right axis deviation and RBBB
LMWH
How to determine axis?
- If I + II is negative - axis devitation
2. If avL is positive - left axis, negative - right axis
- Smoker
- Chronic SOB
- Chest pain
- Cough
- Reduced breath sounds
- Hyperresonant on both sides
- Absent lung markings with fluid levels
What is this?
What do you not do with this?
Bullae - can get in smokers and COPD
Don’t use chest drain
- Progressive SOB
- Dry cough
- Clubbing
- FEV1/FVC ration > 70%
- CXR: reticulo-nodular shadowing
DDx?
Fibrosis e.g. idiopathic fibrosing alveolitis
Causes of cavitating lesion?
Infection, inflammation, malignancy
TB/S. aureus, rheumatoid arthritis, squamous cell carcinoma
- SOB
- Keeps pidgeons
- CXR: reticulo-nodular shadowing
Diagnosis?
Hypersensitivity pneumonitis => pulmonary fibrosis
Tracheal deviation direction with respect to opacity in pleural effusion and lung collapse?
- Pleural effusion - away
* Lung collapse - towards
Causes of bilateral hilar lymphadenopathy?
Infection, inflammation, malignancy
TB, sarcoidosis, lymphoma
What does asbestosis need for diagnosis on CXR?
Fibrosis
Asbestos plaques is not asbestosis
What does pulmonary oedema look like on CXR?
BILATERAL fluffy shadowing
