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• • • DRIPEE ABCDE • • • • • • • • • • •• • • • •Case courtesy of Usman Bashir, Radiopaedia.org, rID: 18394• A 52 YEAR OLD MAN IS BROUGHT TO A & E HYPOTENSIVE AND TACHYCARDIC .THERE IS A PRECEDING HISTORY OF SUDDEN -ONSET LEFT SIDED PLEURITIC CHEST PAIN FOLLOWING BLUNT TRAUMA TO THE CHEST .THE PATIENT IS RUSHED THROUGH TO X -RAY FOR AN URGENT CHEST X-RAY AS PART OF HIS ASSESSMENT . Case courtesy of Jeremy Jones, Radiopaedia.org, rID: 32564 A 48 YEAR OLD FEMALE PRESENTING WITH A FEVER AND A COUGH PRODUCTIVE OF GREEN SPUTUM Case courtesy of Ian Bickle, Radiopaedia.org, rID: 55316Case courtesy of Sarah AlJahdali, Radiopaedia.org, rID: 7763440 YEAR OLD FEMALE WITH A SUDDEN HISTORY OF SHORTNESS OF BREATH Case courtesy of Ian Bickle, Radiopaedia.org, rID: 87417 In the erect position, this meniscus is the characteristic feature of a pleural effusion. The straight air-fluid level as seen in case 4 is the typical appearance of a hydropneumothorax, as opposed to a meniscus observed in a pleural effusion. Case courtesy of Ian Bickle, Radiopaedia.org, rID: 50364 AC40 YEAR OLD FEMALE PRESENTS WITH SEVERE, ACUTE ABDOMINAL PAIN. ON EXAMINATION, SHE IS PYREXIAL, TACHYCARDIC, AND PERITONITIC. Case courtesy of Sajoscha A. Sorrentino, Radiopaedia.org, rID: 14866The appearance of this erect chest x-ray is consistent with a large volume of free subdiaphragmatic gas highly suspicious for a perforated viscus, and an urgent surgical review is required. Case 6 An 80 year old male presents to the Emergency Department with a 1-week history of worsening shortness of breath and cough. On examination, he is hypoxic with reduced air entry on the left.Findings are suggestive of left lower lobe collapse: • Tracheal deviation to the left. This is due to the trachea/mediastinum moving towards the side with less air pressure. • Triangular opacity in medial left mid-to- lower zone can be seen – sail sign • Double left heart border • Lung hyperinflation with flattened right hemidiaphragm and coarsening of lung markings Differential diagnoses include proximal obstructing mass (tumour or hilar lymph node), mucous plug, inhaled foreign body Initial Mx should include oxygen, bloods, CT chest and abdomen with contrast Case 7 A 60 year old presents to the cliniic for her routine appointment 3 months after surgery. On examination, there is reduced chest expansion on the right dullness to percussion and absence of breath sounds. Case courtesy of Ian Bickle, Radiopaedia.org, rID: 62444Findings: • Right hemithorax complete opacification • Trachea pulled to the right due to ipsilateral volume loss • Surgical clips at right hilum • Compensatory hyperinflation of the left lung Differentials for white-outs: Trachea pulled Trachea central Trachea pushed towards the white-out away from the white-out • Pneumonectomy • Consolidation • Pleural effusion • Lung collapse – • Pulmonary • Diaphragmatic e.g endotracheal oedema hernia intubation, • Mesothelioma • Large thoracic mucous plugging, mass inhaled foreign body • Pulmonary hypoplasia Case 8 A 50 year old female presents to the clinic for a routine appointment post-surgery. She is complaining of mild left chest tenderness relieved by paracetamol but is otherwise well. Case courtesy of Ian Bickle, Radiopaedia.org, rID: 50354Findings: • Absent left breast outline with resultant left hypertranslucent hemithorax suggestive of left mastectomy • Surgical clips in left axilla suggestive of axillary node clearance Besides the risks common to all surgical procedures (e.g. infection, post-operative pain, bleeding), axillary node clearance is associated with a 14% risk of lymphedema which can cause functional arm impairment. Learning point: • Do not mistake soft tissue asymmetry for lung disease Case 9 A 75 year old male presents to the emergency department with arm and chest and pain after falling from a ladder. On examination, there is tenderness over the right shoulder and chest with a palpable deformity over the right shoulder. Movements are limited on the right side. His observations are stable with oxygen saturations of 96% on room airFindings: • Right clavicle fracture • Subtle rib fracture Learning point: • Always check for other injuries Initial management includes analgesia, use of a sling and referral to orthopaedics. Surgical management can be considered depending on type of injury and patient choice. Most clavicle fractures take 4-6 weeks to heal. Always look out for complications such as neurovascular injury, pneumothorax, haemothorax, surgical emphysema. Case 10 A 50 year old is taken to the emergency department by paramedics after a road traffic collision at a combined speed of 80km/h. On examination, there is decreased air entry on the left with reduced chest expansion and hyper-resonance on percussion. The patient is in severe pain with oxygen saturations of 88% on room air.Findings: • Left apical pneumothorax • 8th posterior rib fracture with minimal displacement • Left-sided surgical emphysema • Haemothorax in left base with fluid meniscus Advanced trauma life support (ATLS) guidelines should be followed. Initial management includes oxygen, bloods including G&S, and clotting, arterial blood gas, CT whole-body (given the nature of the presentation), intravenous fluids +- blood transfusion and referral to the surgeons and respiratory team for further input. A chest drain is typically inserted to manage the haemopneumothorax. Surgical intervention may be required if there is haemodynamic or respiratory compromise.Radiology Interest Group Aims: • Raise the profile of radiology in the UK and Cyprus and improve accessibility for medical students and doctors to get involved • Will be hosting sessions such as how to improve your portfolio in radiology, audits, research opportunities and more• •