Discussion
The portable film reveals almost total opacification of the left lung, with loss of the left hemidiaphragm and the left cardiac border. Only a small bit of aerating lung is seen in the central portion of the lung. There is a mild shift of the mediastinum to the left, indicating loss of volume. We can see the obstruction of the left main bronchus, with a cutoff sign. This patient had a large mucus plug, causing collapse.
Did you notice the position of the left internal jugular central line? Note its low descent and crossing over to the right, indicating a persistent left superior vena cava, with the vessel rejoining the superior vena cava just above the region of the right atrium.
This patient came to the emergency department with dyspnea and shortness of breath. A portable film raised questions.
Discussion
The portable film reveals a density in the right lower lung field. Note that the cardiac border is easily seen, and the horizontal fissure is somewhat depressed. The right diaphragmatic border is not seen, indicating this is a large consolidation of the right lower lobe. The differential diagnosis is between atelectasis and pneumonia of the right lower lobe. The question of fluid can be completely eliminated by the visualization of the right cardiac border.
A newborn developed marked shortness of breath and a portable film was obtained.
Discussion
The portable film establishes the diagnosis in this newborn. Note that there is no gas in the abdomen. The left hemithorax has a peculiar configuration, with both gas- and solid-contained structures. There is some shift of the mediastinum to the right. The findings are all characteristic of the absence of the left hemidiaphragm, with herniation of the GI tract into the left lung. This is almost always associated with hypoplasia of the left pulmonary artery.
This 54-year-old alcoholic was found unconscious late one Saturday night and brought to the emergency department.
Discussion
The portable film reveals total opacification of the left hemithorax. What do you think is the etiology of this opacification? Can this be fluid? Clearly there is shift of the mediastinum to the left, indicating that there is loss of volume in the left lung. It cannot be fluid because the left chest is opacified; if this were fluid there would be a shift of the mediastinum to the right. The patient had aspirated while lying on his left side, with a piece of food stuck in his left mainstem bronchus, causing collapse of the left lung.
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