Upload
kong-kong-kong
View
240
Download
0
Embed Size (px)
Citation preview
8/10/2019 Osce Chest
1/23
OSCE Chest
8/10/2019 Osce Chest
2/23
8/10/2019 Osce Chest
3/23
8/10/2019 Osce Chest
4/23
THEN, Look at the key!
A well-defined, metallic density, sharp edge,triangular shaped, 0.5 x 0.3 cm in size at rightmain bronchus
Decreased right lung volume compared withthe left
Diagnosis : a tooth in right main bronchuscausing partial right lung collapse
8/10/2019 Osce Chest
5/23
8/10/2019 Osce Chest
6/23
See sharpmargin
above clavicle
Click for lateral view
8/10/2019 Osce Chest
7/23
8/10/2019 Osce Chest
8/23
8/10/2019 Osce Chest
9/23
Cervicothoracic sign
Which compartment do you think this mass isin?
8/10/2019 Osce Chest
10/23
Massdisappears
at clavicle
Click for answer
8/10/2019 Osce Chest
11/23
Cervicothoracic sign
Answer: mass lies in anterior mediastinum.We know this because it disappears at thelevel of the clavicle where it extends into theneck.
This particular example is Non-Hodgkinslymphoma
8/10/2019 Osce Chest
12/23
Thoracoabdominal sign
A sharply marginated mediastinal mass seen throughthe diaphragm must lie entirely within the chest. The posterior costophrenic sulcus extends far more
caudally than the anterior aspect of the lung Therefore
Any mass that extends below the dome of the diaphragmand remains sharply outlined must be in the posteriorcompartments and surrounded by lung, and Any massthat terminates at dome of diaphragm must be anterior
8/10/2019 Osce Chest
13/23
Can yousee the
outline of themass below
the diaphragm?
Click for answer
8/10/2019 Osce Chest
14/23
Thoracoabdominal sign
Answer: margin of mass is apparent andbelow diaphragm, therefore this must be inthe middle or posterior compartments whereit is surrounded by lung
This example is a lipoma
8/10/2019 Osce Chest
15/23
Hilum overlay and convergence signs
Principle of hilum overlay the proximal segments of the
R and L main pulmonaryarteries lie lateral to thecardiac silhouette on PA film
With pericardial effusion orcardiac enlargement , thisrelationship is unchanged
Conversely, an anteriormediastinal mass will
overlap the mainpulmonary arteries,therefore they will be seenwithin the margins of themass
Hilum convergence To distinguish between
enlarged pulmonary arteryand mediastinal mass
If branches of thepulmonary artery convergetoward a central mass enlarged PA
If branches of PA convergetoward the heart ratherthan the central mass mediastinal tumor
8/10/2019 Osce Chest
16/23
Hilum canbe seenthrough
mass
Click for answer
8/10/2019 Osce Chest
17/23
Hilum overlay sign
Answer: this must be an anterior mediastinalmass because it overlaps rather than pushesout the main pulmonary arteries
This particular example is a thymoma
8/10/2019 Osce Chest
18/23
Yes!!
Click for more info
8/10/2019 Osce Chest
19/23
Hilum overlay sign
Heart is enlarged, but hilar vessels still visiblelateral to the cardiac silhouette
This case is pericardial effusion
8/10/2019 Osce Chest
20/23
8/10/2019 Osce Chest
21/23
Lesions Fluid Fat Vascular
Anterior ThymicLymphoma
Germ cellGoiter
Thymic CThymoma
Pericardial CGerm cellLymphoma
Germ cell bThymolipoma
Fat pad
ThyroidCardiac
Coronary
Middle Lymph nodes
Duplication C Arch anomaly
Duplication C
Necrotic nodesPericard recess
Lipoma
Esophageal FVpolyp
Arch anomaly
Azygous veinVascular nodes
Posterior NeurogenicBone andmarrow
Neuroenteric CSchwannomaMeningocele
Extramedullaryhematopoiesis
Desc aorta
> 1 comp InfectionHemorrhageLung cancer
LymphangiomaMediastinitis
Liposarcoma Hemangioma
8/10/2019 Osce Chest
22/23
Imaging Findings
Bilateral paraspinal masses with round, lobulated margins
Medullary expansion of the bony structures with widening of the ribsbeing the most pronounced bony finding
Resorption of trabeculae produces coarsened appearance to bonesSplenomegaly (or absent spleen )Masses do not calcify and do not usually cause bone erosionThe lesions are usually of low -attenuation on non -contrast CT and
may mildly enhance after contrast
8/10/2019 Osce Chest
23/23