what`s your diagnosis? Why?

The patient shown below most likely has:



a. A large right pleural effusion

b. A large left pneumothorax

c. Atelectasis of the right lung

d. Pneumonia in the right lung

e. Unilateral pulmonary edem

Correct Answer:in 23 April 10
A large right pleural effusion

Explanation
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There is opacification of the right hemithorax. There is a shift of the heart and mediastinal structures (i.e. the trachea) away from the side of opacification. This eliminates atelectasis, pneumonia and pulmonary edema as possibilities. There is never a shift of the heart or mediastinal structures toward the side of a pneumothorax. In addition, there should be no lung markings visible in the hemithorax which contains the pneumothorax. This is a large effusion which produces a mass-like effect and pushes the mediastinal structures away from the opacified side.

Answer this cases about Esophagus.

1-What is the most likely diagnosis in the patient shown below?

a. Esophageal varices
b. Esophageal carcinoma
c. Reflux esophagitis
d. Lye stricture
e. Fibrovascular polyp



2-What is the most likely diagnosis in the patient shown below?

a. Esophageal varices

b. Esophageal carcinoma
c. Reflux esophagitis
d. Lye stricture
e. Fibrovascular polyp


3-What is the most likely diagnosis in the patient shown below?

a. Esophageal varices
b. Esophageal carcinoma
c. Reflux esophagitis
d. Lye stricture
e. Fibrovascular polyp
















THE RIGHT ANSEWR : in 22April 10
1.b
There is a rapid change in the caliber of the lumen of the esophagus in the mid-esophagus. There is a segment with irregular margins and apparent destruction of the normal smooth mucosal pattern. The findings are most suggestive of a carcinoma of the esophagus. Most carcinomas of the esophagus are of the squamous cell variety. They frequently spread longitudinally along the esophageal wall in part because of the lack of a serosal lining to the esophagus.

2.a
There are long, serpiginous filling defects seen longitudinally in the esophagus. While their full extent can not be determined in this image, they started at the EG junction and continues to the level of the carina. These findings are characteristic of esophageal varices of the so-called "uphill" variety. These are almost always caused by portal hypertension and they characteristically at the level of the carina, where the esophageal plexus of veins drains into the azygous system.

3.d
There is very long segment of smoothly narrowed esophagus from just below the level of the clavicles to the EG junction. This appearance is characteristic of a stricture caused by the ingestion of a caustic material such as lye. Lye, which became component of some drain cleaners in the late ?60s, is so highly toxic that only a few drops can cause this full-thickness liquefaction necrosis of the esophagus. The acute ulcerative phase is invariably followed in several weeks by this fibrotic stage. There is a significantly higher incidence of carcinoma of the esophagus in patients with lye strictures than in the normal population.