A common scenario of asymptomatic patients

This house wife, middle age came to the hospital because of right lower lung field single nodule. (I hope you see it!)

From how you feel, do you think it looks malignant? Why? and then ... what's next? (give reasons)

A study of solitary pulmonary nodule

This is a picture of a lung cancer patient. Please look at the nodule... you can see irregular border and...take a closer look ---> you can also see some "sun ray" like lines around the nodule. This is malignant look. 

What if the patient came to see you about counselling (or second opinion); he came with uncertainty in diagnosis.

What else can you see from this film? Your plan? Why? Any alternatives?

NOTE: THIS IS NOT A ROUTINE CHEST X-RAY. THIS IS CORONAL VIEW OF CT SCAN WITH CONTRAST. THIS IS FOR EDUCATIONAL PURPOSES.

Lung metastasis

She is supposed to have advanced stage lung cancer. Obviously you can see opaquecity in her left chest. It is an unexpandible left lung. The chest tube was placed because of massive pleural effusion that she has had.

For the right lung, you can see multiple foci of round lesions all over the lung. They are supposed to be Metastatic lesions.

Pleural effusion

Describe how it looks.

How much would you like to take it out? (As much as possible or just 50 mL)

What would you like to send for labs?

Lung blebs

The lung clamp is holding the lung. This picture reveals multiple subpleural blebs.

pneumonectomy specimen (en bloc with a piece of chest wall substance)

 These 2 pictures show a mass in the left lower lobe (bulging area under the resected chest wall). When open, the mass (whitish area) is very close to the superior segmental bronchus. This is the reason why resection only the left lower lobe may not have oncological benefit.

Emphysematous lungs/ Pneumothorax/ Subcutaneous emphysema

 These 2 pictures are chest films of a patient who came to the hospital with a problem of progressive dyspnea for 2 years.

The upper one, it shows how big the 2 lungs are (many rib spaces detected). Both lungs reveal generalized patchy infiltration. The heart is also bigger than normal.

The lower one is the film of the same patient that has pneumothorax at the apex. It is more obvious to look at subcutaneous emphysema at the right chest wall an the neck.

Leakage aorta

It is obviously seen the contrast is leaking from the Aortic arch.

SVC obstruction

Malignant pleural effusion

If this pleural fluid is malignant pleural effusion, can you tell about the plans (options) to the patient? Discuss about these aspects.

   1. recurrence
   2. morbidity of the interventions
   3. role of medical/ surgical pleurodesis

Possible emergency???

If the patient has sudden onset of dyspnea and the films look like these two pictures, what is a set of your orders? Does surgery have some roles in this situation?

Spot Diagnosis

This is a picture of fenestrated diaphragm and a small dark nodule on the diaphragm. If the patient came to the hospital with a problem of recurrent pneumothorax, what is the clinical diagnosis? What is the classical presentation/ natural history of the disease?

Traumatic hemothorax

If there is large amount of traumatic clotted hemothorax without any symptom. Do you think if the patient needs drainage procedure?

What if the amount of the hemothorax is small? Is your plan the same of the large amount one?

If the clotted hemothorax is just moderate degree without any symptom, what do you think?

VSD

According to the patients who have VSD, weather or not we should suggest VSD closure in all cases?

If Yes, give the underlying reasons?
If No, name the special conditions that the defect should or should not be closed?

A Common pitfall

After insertion of the new chest tube in a 27 year-old man who had traumatic pneumothorax (unexpanded lung) and has been treated for 3 weeks with a chest tube, he had markedly cough and loose pink sputum.

1. What was the problem?
2. How can we treated the problems?
3. Does furosemide help?

haziness of hemithorax

Is this showing total lung atelectasis or massive pleural effusion?