Clinical cases
A chance to apply some of your new knowledge
to real clinical scenarios
Case 1
• A 60 year old non-smoking woman
complained of cough, dyspnoea and right
sided pleuritic chest pain for 3 days. She
was pyrexial (39.3 C) and a pleural rub was
audible at the right lung base. Her white cell
count was raised.
• What are the notable observations ?
Case 1
• A 60 year old non-smoking woman
complained of cough, dyspnoea and right
sided pleuritic chest pain for 3 days. She
was pyrexial (39.3 C) and a pleural rub was
audible at the right lung base. Her white cell
count was raised.
Case 1 diagnosis
• Right lower lobe pneumonia
Case 2
• This 25 year old woman, visiting Scotland
on a hen weekend, was admitted with
central chest pain which began during an
episode of vomiting. She complained that
her neck had become swollen. On
examination he had a tachycardia and mild
pyrexia (38.1 C). Palpation of her neck and
chest wall gave rise to a ‘crackling’
sensation
Case 2
• This 25 year old woman, visiting Scotland
on a hen weekend, was admitted with
central chest pain which began during an
episode of vomiting. She complained that
her neck had become swollen. On
examination he had a tachycardia and mild
pyrexia (38.1 C). Palpation of her neck and
chest wall gave rise to a ‘crackling’
sensation.
Case 2 diagnosis
• Pneumomediastinum from oesophageal
perforation
Case 3
• This 55 year old man collapsed whilst out
shopping with his wife. The paramedics
noted his breathing to be laboured and
intubated him at the scene. This CXR was
obtained on admission to hospital
Case 3
• This 55 year old man collapsed whilst out
shopping with his wife. The paramedics
noted his breathing to be laboured and
intubated him at the scene. This CXR was
obtained on admission to hospital
Case 3 diagnosis
• Endotracheal tube inserted too far into right
main bronchus.
Correctly sited endotracheal tube
Case 4
• This 22 year old woman complained of sudden
onset right sided chest pain, followed by
progressive dyspnoea. By admission, she was in
distress and appeared cyanosed. Her pulse was
140, with respiratory rate 40. On chest
auscultation, breath sounds were noted to be quiet,
especially on the right
Case 4
• This 22 year old woman complained of sudden
onset right sided chest pain, followed by
progressive dyspnoea. By admission, she was in
distress and appeared cyanosed. Her pulse was
140, with respiratory rate 40. On chest
auscultation, breath sounds were noted to be quiet,
especially on the right.
Case 4 diagnosis
• Tension pneumothorax
Case 5
• This 67 year old man, a lifelong smoker,
complained of several weeks of reduced
exercise tolerance due to dyspnoea. He had
a chronic cough productive of white sputum
but recently it had been blood stained. He
had lost 10kg in weight.
Case 5
• This 67 year old man, a lifelong smoker,
complained of several weeks of reduced
exercise tolerance due to dyspnoea. He had
a chronic cough productive of white sputum
but recently it had been blood stained. He
had lost 10kg in weight.
Case 5 diagnosis
• Right middle and lower lobe collapse
Case 6
• This 68 year old man was admitted with a
myocardial infarct 5 days ago. He became
acutely breathless at 3am. On examination
he was sitting up in bed and sweating. His
respiratory rate was 40 and pulse 130. His
chest was dull to percussion at the bases and
crackles were heard there on auscultation.
Case 6
• This 68 year old man was admitted with a
myocardial infarct 5 days ago. He became
acutely breathless at 3am. On examination
he was sitting up in bed and sweating. His
respiratory rate was 40 and pulse 130. His
chest was dull to percussion at the bases and
crackles were heard there on auscultation.
Case 6 diagnosis
• Acute pulmonary oedema due to congestive
cardiac failure.
QUIZ TIME
Is this CXR normal or abnormal ?
(correct answer = 1 point)
If you think it is abnormal, what is the
diagnosis ?
(correct answer = 1 bonus point)
QUIZ TIME
• This is a chance to see if you’ve acquired any
CXR interpretation skills
• 8 normal CXR (correctly sited lines = normal)
• 8 abnormal CXR
• maximum score = 24 points
• additional points may be given for entertaining
incorrect answers, at the discretion of the
moderator
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
ANSWERS
1
• Normal
2
• Left lower lobe consolidation/pneumonia
3
• Normal right internal jugularbrachiocephalic and left subclavianbrachiocephalic vein catheters
4
• Normal
5
• Right middle lobe consolidation/pneumonia
6
• Left pneumothorax
7
• Right upper lobe collapse
8
• Normal
9
• Normal
10
• Right midzone consolidation/pneumonia
11
• Normal
12
• Misplaced NG tube in right main bronchus
13
• Normal
14
• Left lower lobe collapse
15
• Normal
16
• Right lower zone consolidation