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Thread: what you see?

  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    what you see?

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    A 72-year-old woman presents to the emergency department with cough, fever, and shortness of breath. The woman lives alone at home, but
    spends part of each day shopping and riding public buses. Approximately 4 days previously she had developed an upper respiratory infection.
    Approximately 2 days ago, she abruptly became much more ilI, and her symptoms started worsening, beginning with a single, Iong, shaking
    chilI. Since that time, she has had fever, pain with breathing, cough, and dyspnea. She decided to come to the emergency department when
    her temperature at home was 103.4 F. In the emergency department, her temperature is 39.9 C (103.8 F), blood pressure is 90/50 mm Hg,
    pulse is 120/min, and respirations are 30/min. No breath sounds are heard over her lower left lung field, but they can be heard at other sites.


    A chest x-ray film would be most likely to demonstrate which of the following:
    / A. A single roughly ovoid white area
    / B. Complete whitening over one lobe of her lungs
    / C. Marked dilation and elongation of bronchial spaces
    / D. Multiple small spotty areas of white found primarily near the bronchi
    / E. No obvious radiologic changes
    Last edited by IMG SURVIVOR; 10-19-2008 at 10:54 PM.
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    why even bother with the obvious. Just know where you are need it and where you can help the most.

  2. #2
    smu05 is offline Permanently Banned 510 points
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    Apparantely she has pneumonia and most likely consolidation of her left lower lung field. Therefore, i don't think you would see complete whitening over one lobe of lungs. I think you would see single roughly ovoid white area in the left lower lung base.

    lemme know if i am thinking along right track.

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    LqdPls is offline Senior Member
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    This woman is hemodynamically unstable, she's bleeding. Hemorrhage possibly secondary to an abscess formation. I think you would see:

    B. Complete whitening over one lobe of her lungs
    Last edited by LqdPls; 10-19-2008 at 04:35 PM.

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    Statia Graduate is offline Junior Member 510 points
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    Quote Originally Posted by IMG SURVIVOR View Post
    A 72-year-old woman presents to the emergency department with cough, fever, and shortness of breath. The woman lives alone at home, but
    spends part of each day shopping and riding public buses. Approximately 4 days previously she had developed an upper respiratory infection.
    Approximately 2 days ago, she abruptly became much more ilI, and her symptoms started worsening, beginning with a single, Iong, shaking
    chilI. Since that time, she has had fever, pain with breathing, cough, and dyspnea. She decided to come to the emergency department when
    her temperature at home was 103.4 F. In the emergency department, her temperature is 39.9 C (103.8 F), blood pressure is 90/50 mm Hg,
    pulse is 120/min, and respirations are 30/min. No breath sounds are heard over her lower left lung field, but they can be heard at other sites.


    A chest x-ray film would be most likely to demonstrate which of the following:
    / A. A single roughly ovoid white area
    / B. Complete whitening over one lobe of her lungs
    / C. Marked dilation and elongation of bronchial spaces
    / D. Multiple small spotty areas of white found primarily near the bronchi
    / E. No obvious radiologic changes
    B. Complete whitening over one lobe.

    Lobar consolidation is classic for pneumococcal pneumonia.
    Also, her vitals tell you more of the story. She is hemodynamically unstable. She also has pneumococcal sepsis as well, common with pneumococcal pneumonia.

  5. #5
    Chopdoc's Avatar
    Chopdoc is offline Senior Member 528 points
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    Quote Originally Posted by LqdPls View Post
    This woman is hemodynamically unstable, she's bleeding. Hemorrhage possibly secondary to an abscess formation. I think you would see:

    B. Complete whitening over one lobe of her lungs
    Good eyes on the vitals.....but I would call this septic shock.

    Recognition of shock, the different causes, and the stages, is especially important on the Steps.

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    RussianJoo's Avatar
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    Quote Originally Posted by LqdPls View Post
    This woman is hemodynamically unstable, she's bleeding. Hemorrhage possibly secondary to an abscess formation. I think you would see:

    B. Complete whitening over one lobe of her lungs

    she's not bleeding.. low BP can be caused by many things not only blood loss.
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    Statia Graduate is offline Junior Member 510 points
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    Quote Originally Posted by Chopdoc View Post
    Good eyes on the vitals.....but I would call this septic shock.

    Recognition of shock, the different causes, and the stages, is especially important on the Steps.
    It is also important to know the SIRS criteria.

  8. #8
    Statia Graduate is offline Junior Member 510 points
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    Quote Originally Posted by RussianJoo View Post
    she's not bleeding.. low BP can be caused by many things not only blood loss.
    And a pulmonary abscess usually does not cause pulmonary hemorrhage.

    Causes of pulmonary hemorrhage include destructive/infiltrating processes. Such as TB, cancer, and invasive aspergillosis. Many will present with mild hemoptysis. A rare few will have arterial bleeding. This is life-threatening, and requires urgent intervention. Usually requires intubation for airway protection, resuscitation with IVF and blood products, and urgent surgical intervention or IR for arterial embolization.

  9. #9
    Dr. X's Avatar
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    whitening.. hmm.. what happened to "opacity", "hypodensity" etc.. im jus playing img.. good q.

    b it is and septic shock has set in.
    pic: pneumococcal pneumonia.
    Attached Images Attached Images
    • File Type: jpg 3.jpg (8.7 KB, 31 views)
    Last edited by Dr. X; 05-05-2009 at 09:21 PM.
    SJSM.

  10. #10
    Statia Graduate is offline Junior Member 510 points
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    Ugh, I've seen those, it is never good. Note the placement of the central line and possible ETT on the film (sort of hard to see).

    Agree about the "whitening term". This film would be considered complete "white-out" of the left lung. Easier to say than "dense consolidation of the left upper and left lower lobes and likely the lingula."
    Last edited by Statia Graduate; 05-06-2009 at 01:24 PM.

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