Sunday, April 17, 2016
This is a chest radiograph of a 50 year old male who started having pain with deep breathing and coughing following returning from a trip to Italy. Reports pain began after lifting heavy luggage at Eisenhower International Airport upon return home. View radiographs and describe what you feel like you may see and also add one differential diagnosis pathology that you may need to rule out with his history.
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There are rib fractures on the posterolateral aspects of the 4th and 5th ribs on the L side. Differential diagnosis would include bronchitis.
ReplyDeleteJessica Stoddard
I see excess space at the R sternoclavicular joint as compared to the left showing possible dislocation at that joint. Differential diagnosis should include intercostal muscular sprain.
ReplyDeleteA pulmonary embolism would be a good factor to rule out after a long flight in which the patient was sitting and could have developed a deep vein thrombosis. The trachea seems to be deviated slightly to the right, possibly indicating pathology that decreases lung volume on the right, thus "pulling" the trachea to the right, or pathology on the left that increases lung volume/pressure thus "pushing" the trachea to the right.
ReplyDeleteMaKayla McPhail
I feel like there is more space at the right sternoclavicular joint compared to the left. This could indicate a possible dislocation or malalignment of the joint. A differential diagnosis that needs to be ruled out is active tuberculosis due to the patient traveling to a foreign country and having pain with breathing and coughing. - Chricket Short Niehues
ReplyDeleteThere is an obvious increase in space at the R SC joint when compared to the left. Although it is rare at this joint, a dislocation or subluxation may be present. A differential diagnosis would include a strained chest wall muscle which can occur following heavy lifting and cause pain with deep breathing, coughing, and movement.
ReplyDeleteI also feel that there is an increased amount of space at the right sternoclavicular joint as compared to the left side. A differential diagnosis would be pulmonary edema of unknown origin (TBD). This patient could have had a pre-existing condition which was exacerbated by travel and remaining stationary for an extended period of time during which fluid accumulated within the lungs.
ReplyDeleteJennifer Cox
Given his recent history of traveling, I think an important differential diagnosis to rule out would be tuberculosis since he is reporting difficulty with deep breathing and coughing.
ReplyDeleteIt appears that there is an increased strenoclavicular space on the right which could be indicative of dislocation due to straining/pulling on the clavicle with heavy lifting.
Rachelle Fisher
The trachea appears slightly deviated to the right, therefore I would rule out a pneumothorax as this could be indicated when the left side of the chest cavity has an increase in pressure.
ReplyDeleteUpon looking at this image, I think there are some fractured ribs and (if facing me in anatomical position) the L side top few ribs looks to be slightly elevated. There is also a deviation of the trachea and patches in the lungs indicating possible infection or other debris. The R sternoclavicular joint seems to be separated at least compared to the other side.
ReplyDeleteI would want the Patient screened for fluid build up in the pericardium due to the increased pain with deep breathing which would increase pericardial friction.
The patient appears to have fractured ribs on the left side. A differential diagnosis that I would like to rule out is pneumothorax due to his pain with breathing and coughing.
ReplyDeleteIt looks as if the trachea is deviated to the right causing increased sternoclavicular space on the right. He likely could have strained the ligaments in the sternoclavicular joint while lifting his heavy luggage. Due to patient reporting pain with deep breathing and coughing and having a deviated trachea, I would want to rule out pneumothorax.
ReplyDeleteI see increased space at the SC joint indicating either a severely sprained or dislocated joint resulting from his heavy lifting. After the overseas travelling, I would want to rule out tuberculosis due to his report of pain with coughing and breathing. -Ashley Kelsey
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ReplyDeleteThere is increased space on the right sternoclavicular joint when compared to the left. Also there appears to be a decreased right costophrenic angle versus the left so differential diagnosis might include pleural effusion due to possible infection from traveling out of the country. -Amber Padgett
ReplyDeleteIncreased space on R versus L sternoclavicular joint indicating a dislocation, possible due to his heavy lifting. The xray appears to have multiple small radiodense nodules of varying size with differential diagnosis including miliary tuberculosis infection post his international trip.
ReplyDeleteI feel this patient demonstrates elevated ribs on the left side. I also notice on the left a small space between several of the ribs and costal cartilage; possibly resulting from dislocation or inflammation causing malalignment of the ribs and related structures. A differential diagnosis that needs to be ruled out is costochondritis. This condition is an inflammation of the cartilage that connects the ribs to the sternum. Costochondritis is a sharp pain in the chest with deep breathing or with trunk motions effecting multiple ribs. There is no certain cause, however, it may be caused by lifting heavy objects such as a suitcase, stress such as traveling abroad, excessive coughing, or joint infections, for example tuberculosis. – Elissa Westbrook
ReplyDeleteThe increased joint spaced at the R SC joint and R scapular protraction indicates SC joint sprain or dislocation. Differential diagnosis that would be important to rule out is pleurisy that could be caused by a viral infection, tuberculosis or pneumonia from his travels. Pleurisy is inflammation of the pleura that causes chest pain with breathing or coughing.
ReplyDeleteI see an increase in joint space at the R SC joint, it could be a sprain from the heavy lifting. Also, since he his having pain with deep breathing and coughing I would want to see a view from the back to assess possible disc issues.
ReplyDeleteI see increased space in the sc joint on the right but this may not be pathological but the individuals norm. The pain is most likely due to the rib fractures of the 4th and 5th left side ribs.
ReplyDeleteA differential diagnosis could be abdominal wall muscle strain. -Teresa Kirby
There is an increased space on R versus L sternoclavicular joint possible due to his heavy lifting.The pain looks like it is due from the rib fracture at 4 & 5 on left side. A differential diagnosis to rule out the possibility of being pleuritic pain. Pleurisy is inflammation of the parietal pleura that typically results in characteristic pleuritic pain and has a variety of possible causes. The term “pleurisy” is often used to refer to a symptom and a condition. This could go with his pain with deep breathing and pain with coughing. -Amber Buckles
ReplyDeleteIt appears that the patient has multiple left rib fractures and the trachea is deviated to the right. I would like to rule out a pneuthorax due to pain with breathing and coughing and the deviation of the trachea away from the injured side.
ReplyDeleteThere is an increase in the right SC joint space, and his trachea looks deviated to the right. You would need to determine if the cough and pain with deep breathing is due to bacterial, viral, or infection from another type of micro organism. Also, perform physical examination techniques to see if the right SC joint is sprained or dislocated.
ReplyDeleteThe patient presents with left sided rib fractures on the posterolateral aspects of ribs 4 and 5. It seems unlikely that the patient would suffer fractured ribs from lifting a bag, but this is what the radiograph shows. With the patient's history, you would want to rule out a pulmonary embolism from the flight, or some sort of an infection that was acquired overseas.
ReplyDeleteNick Johansen
This individual appears to have increased joint space of the R sternocostal joint. The trachea also appears to deviate slightly to the right. And there appears to be possible fractures of the ribs on the right. A possible differential diagnosis would be to rule out a pnuemothorax.
ReplyDeleteJake Snodgrass
Increased R SC joint space. It may be good to rule out intercostal muscle strain, which could have been torn when lifting the heavy luggage and affecting deep breathing and the forced expiration necessary for a cough.
ReplyDelete~John Babb
I see increased R SC joint space indicative of clavicle dislocation. I also see a depressed 2nd rib on the R which might be from a stuck costovertebral joint. I think it would be important to rule out an intercostal muscle strain.
ReplyDeletePt. demonstrates increased R SC space this could indicate a dislocation when lifting the heavy luggage. Differential diagnosis could be abdominal trauma. The pain the pt experiences when breathing and coughing is more than likely due to the L side rib fractures but to be safe I would Like to rule out a pneumothorax.
ReplyDeleteThe x-ray demonstrates increased right SC joint space secondary to heavy lifting. Slight left side rib elevations compared to the right. Upper rib fractures on the left along with the increased SC joint separation on the right could potentially cause the pain with coughing and deep breathing. A differential diagnosis could be potential pneumonia or cancer. The pain from the bony abnormalities could be masking something more dangerous.
ReplyDeletePt displays what looks like rib fracture on the L around the 5th rib and enlarged space at the R SC jt revealing possible dislocation. I would want to rule out potential pneumothorax from the rib fractures as well as any lung infections acquired during the flight or overseas, but since pain started after the lifting it is highly unlikely he has some sort of lung infection/pathology but TB is always a concern.
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ReplyDeleteI agree with the above comments that there is increased joint space in the R SC joint and it would be good to look for rib fractures. It also appears that the L scapula is elevated compared to the R, which may just be due to positioning. Differential diagnosis could include an intercostal muscle strain due to his pain immediately after lifting.
ReplyDeleteAmanda Rudd
I feel the patient has an increased space at the R SC joint as well. The patient has a mechanism that could have created irritation or pathology of the SC joint with the heavy lifting of bags. Also, the R clavicle does not have the same angle of inclination as the left, the left has a steeper angle. This could just be due to the fact that the patient is right handed, or that the patient is protecting/guarding the R upper extremity to attempt to prevent pain. A differential diagnosis could be costochondritis of the R upper costochondral junctions due to the location of pain and pain with coughing.
ReplyDeleteKerby Rice
I feel the patient has an increased space at the R SC joint as well. The patient has a mechanism that could have created irritation or pathology of the SC joint with the heavy lifting of bags. Also, the R clavicle does not have the same angle of inclination as the left, the left has a steeper angle. This could just be due to the fact that the patient is right handed, or that the patient is protecting/guarding the R upper extremity to attempt to prevent pain. A differential diagnosis could be costochondritis of the R upper costochondral junctions due to the location of pain and pain with coughing.
ReplyDeleteKerby Rice
As others have said I see the increased joint space in the R SC joint, which could be causing his pain. It is important to rule out some for of pericarditis as this can be caused by multiple factors, many of which could be acquired while traveling. This often comes about acutely and the pt presents with pain on coughing, inspiration, and it is worse with lying down.
ReplyDeleteThere appears to be greater joint space within the R SC joint which may be indicative of joint separation secondary to the traction forces applied through repetitive lifting and carrying heavy luggage while on vacation. The patient's pain with deep breathing and coughing may be indicative of inflammation of the pleural tissue, so I would rule out viral infection, pneumonia, and/or tuberculosis.
ReplyDeleteChelsey Claassen
I see what appears to be increased space at the R SC joint, possibly due to dislocation. CT scan may be indicated to determine the direction of dislocation. Pain with deep breathing and coughing may indicative of mediastinal or subclavian compression secondary to SC dislocation. -Rebecca Montgomery
ReplyDeleteThere seems to be increased space at the R sternoclavicular joint when compared to the left which could indicate possible dislocation at that joint. It would be important to rule out an intercostal muscular sprain as well as any infection that could be contracted during traveling. - Bri Fisher
ReplyDeleteYou all posted some fantastic comments. Plenty of great differentials.
ReplyDeleteSeveral of you were right on. Fractured ribs and pneumothorax causing pain with deep breath and coughing. More than likely fractured rib during lifting of heavy luggage, or so that was what was reported as cause.
Great job!
Better late than never. Upon close examination, I believe I see the fracture lines in the left 4th, 5th, and maybe 6th ribs. These fractures are likely to lead to pneumothorax which would explain the patient's subjective complaints.
ReplyDeleteLAST! I feel the differential diagnoses have been covered thoroughly. If there are fractured ribs due to lifting luggage, a strengthening program will definitely be needed upon healing and resolution of his acute symptoms, specifically internal and external intercostals and transverse abdominals to provide the "binder" support for the core.
ReplyDeleteI agree with all comments above. Rib fractures seem to be present on the L side at 5th and 6th rib. I would also look into tuberculosis and rule out thoracic pathology following healing of fractures.
ReplyDelete