Lt lower lobecomy.

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous white opacity occupying the lower and middle zones of the Rt hemithorax + Meniscus sign + Obliteration of both Rt costophrenic and cardiophrenic angles.

🟨DD
1_ Mild pleural effusion
2_ hydropneumothorax
3_ Lobar pneumonia
4_ Lobe collapse
5_ Lobecomy

🟨Most likely DX
Rt Mild pleural effusion
(B/C of 👉 Meniscus sign + Obliteration of both lt costophrenic and cardiophrenic angles ).💡💬

🟨Next step
Chest CT scan
Thoracocetesis

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous white opacity occupying the lower zone of the Rt hemithorax with air fluid level

🟨DD
1_ Hydro_pneumothorax
2_ Hemo_pneumothorax
3_ Mild pleural effusion

🟨Most likely DX
Rt Hydro_pneumothorax OR Rt Hemo_pneumothorax
(B/C of👉 Air fluid level )💡💭

🟨Next step
Chest CT scan
Thoracocetesis

🟨TTT
Chest tube under water seal.

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous black opacity occupying both lungs + Flat diaphragm + tubular heart + widening of all intercostal spaces.

🟨DD
1_ Hyperinflated chest 👉 Emphysema, Br.asthma
2_ Pneumothorax

🟨Most likely DX
Hyperinflated chest
(B/C of 👉 flat diaphragm + tubular heart + widening of all intercostal spaces)💬💡💭

🟨Next step
PFT
Reversibility test
ABG

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous black opacity occupying the Rt hemithorax with deviation of Thracea to the opposite side.

🟨DD
1_ Rt Tension Pneumothorax
2_ Hyperinflated chest 👉 Emphysema, Br.asthma


🟨Most likely DX
Rt tension Pneumothorax
(B/C of 👉 Deviation of Trachea to the opposite side)💡💬

🟨Next step
1_ Start O2
2_ Insert canula in 2nd ICS midclvicular line
3_ Insert chest tube under water seal

🟨Description
◽Plain chest x ray
◽PA view
◽Showing heterogenous white opacity occupying Rt and lt hemithorax

🟨DD
1_ Bronchpneumonia
2_ ILD
3_ Pulmonary edema
4_ Miliary TB

🟨Most likely DX
Bronchpneumonia

🟨Next step
CBS
ESR
CRP
Sputum culture
Blood culture
Urine culture
ABG

LFT , RFT (لانهم بينحطوا على Antibiotics 💬💡)

🟨Description
◽Plain chest x ray
◽PA view
◽Showing heterogenous white opacity occupying Rt and lt hemithorax (reticulonodular appearance ) + Both costophrenic angles are not clear

🟨DD
1_ILD
2_Pulmonary edema
3_ Bronchpneumonia
4_ Miliary TB

🟨Most likely DX
ILD
علاش ؟؟
لان البياض متعه يتميز بانه يبدا من تحت باتجاه ال hilum و ال costophrenic angles تكون مش واضحة (مدخدشة / ما تبانش كويس)💬💡

🟨Next step
PFT
ABG
HRCT
BAL
Lung biopsy

🟨Description
◽Plain chest x ray
◽PA view
◽Showing heterogenous white opacity occupying Rt and lt hemithorax (Glass ground appearance ) + Both costophrenic angles are clear

🟨DD
1_ Pulmonary edema
2_ ILD
3_ Bronchpneumonia
4_ Miliary TB

🟨Most likely DX
Pulmonary edema
علاش ؟؟
لان البياض متعه يتميز بانه يبدا من فوق من ال hilum و ينزل تحت ، و ال costophrenic angles تكون واضحة (تبان كويس)💬💡
🟨Next step
ABG
Measure pulmonary artery pressure
➡️if > 25 mm hg 👉 indicates Cardiogenic
ف تطلب على طول
ECG
Echo

➡️if < 18 mm hg 👉 indicates Non cardiogenic
(Sepsis, Truma , Burns , Pneumonia, Pancreatitis )
ف تطلب
CBC
ESR
CRP
Blood culture
Sputum culture
Urine culture
RFT
LFT

🟨Description
◽Plain chest x ray
◽PA view
◽Showing single homogenous white mass occupying the upper zone of the Rt hemithorax

🟨DD
1_Cancer 👉 Bronchogenic ca , lymphoma
2_ Infection 👉 Hydatid cyst , Aspergilloma
3_ Inflammation 👉 Wegner granulomatosis , Polyartritis nodosa

🟨Most likely Dx
Pancots tumer (Bronchogenic ca)

🟨Next step
Bronchoscopy and biopsy
CT scan (Chest + abdomen ) with contrast
Dexa scan
CBC
ESR
CRP
LFT
RFT

🟨Description
◽Plain chest x ray
◽PA view
◽Showing single cavitary mass occupying the lower zone of the Rt hemithorax with water lilly appearance (camalote sign)

🟨DD
1_ Infection 👉Hydatid cyst , TB , Fungal infection
2_ Cancer

🟨Most likely DX
Hydatid cyst
(B/C of 👉 Water lilly appearance )

🟨Next step
Chest CT scan

🟨Description
◽Plain chest x ray
◽PA view
◽Showing single liquifactive cavitary mass with air fluid level occupying the upper zone of the Rt hemithorax

🟨DD
1_ Infection 👉 Abscess, TB , Hydatid cyst,
Fungal infection
2_ Cancer

🟨Most likely DX
Abscess
(B/C of 👉 Air fluid level )💡💬

🟨Next step
Chest CT scan
Sputum C/S

مرات يسألك سوال تاني ، بال Examination شن ممكن تلقى عنده ؟
1_ Finger clubbing
2_ Halitosis

🟨Description
◽Plain chest x ray
◽PA view
◽Showing air under diaphragm

🟨DD
1_ Perforated viscus
2_ Post_surgery
3_ Post_Truma (Stab wound)

🟨Most likely DX
Perforated viscus

🟨Next step
➡️Stabilize the pt 👉 ABC / IV fluids , Antibiotics
➡️Send investigations
CBC
ESR
CRP
RFT
Blood group, Cross match
➡️Imaging
Abdominal CT scan with contrast