Imaging
Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.
The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.
Medical Image of the Week: Wide Mediastinum Due to Lung Infiltrates
Figure 1. Panel A: Admission chest x-ray showing an apparent widened mediastinum. Panels B & C: CT scan showing consolidation in the posterior lungs bilaterally. Panel D: Chest x-ray showing resolution of his widened mediastinum with an increase in positive end-expiratory pressure.
The patient is a 65-year-old man patient with a past medical history of poorly controlled hypertension and coronary artery disease who was admitted after a witnessed code arrest. He was found down, and paramedics arrived within 5 minutes and started chest compressions. His initial CXR showed a wide mediastinum (Figure 1A) that was concerning for possible aortic dissection especially with his history of poorly controlled hypertension. Due to his hemodynamic instability a chest CT scan couldn’t be done initially, but the patient underwent a trans-esophageal echo that was negative for aortic dissection.
When the patient became more stable a chest CT scan with contrast was done and showed consolidation of the medial parts of both lungs with 7 bilateral rib fractures (Figure 1 B & C). The impression was either lung contusion from the aggressive chest compression as evidenced by the bilateral 7 rib fractures or aspiration in the dependent parts of the lung. His apparent widened mediastinum resolved with increasing the positive end-expiratory pressure (PEEP) on the ventilator within 48 hours (Figure 1D).
Huthayfa Ateeli MBBS, Laila Abu Zaid MD
Department of Medicine
University of Arizona
Tucson, AZ.
References
- Cohn SM. Pulmonary contusion: review of the clinical entity. J Trauma. 1997;42(5):973-9. [CrossRef] [PubMed]
- Lai CC, Wang CY, Lin HI, Wang JY. Pulmonary contusion associated with chest compressions. Resuscitation. 2010;81(1):133. [CrossRef] [PubMed]
Reference as: Ateeli H, Zaid LA. Medical image of the week: widen mediastinum due to lung infiltrates. Southwest J Pulm Crit Care. 2015;10(2):77-8. doi: http://dx.doi.org/10.13175/swjpcc007-15 PDF