RADIOLOGY CASE REPORT

September 25th, 2008

Patient ID: OH# 34872598 Date of Study: September 21, 2008

Type of Study: Portable AP Erect Chest Xray

1. Clinical Indication: 75 year old man seen in emergency because of increasing shortness of breath and pitting edema. The attending physician wanted to rule-out a possible pneumonia.

2. Picture:

2. Describe the radiological findings:

There is increased haziness and fullness bilaterally at the hila. Vascular redistribution is noted. Increased interstitial markings are seen. The cardiac width is increased. This finding is in keeping with cardiomegaly. A mild pleural effusion is suspected as there is blunting of the left costophrenic angle. However, the latter finding can not be confirmed as there is no LAT view to compare with.

3. Provide possible diagnosis(es):

The combination of the many findings above suggests that Congestive Heart Failure is the most likely diagnosis with this patient. However, a DDx exists for each individual finding.

DDx of hazy hila:CHF,sarcoidosis, lung cancer, pulmonary HTN,metastasis, lymphoma

DDx of interstitial markings: interstitial lung disease (ie: pulmonary fibrosis), edema

DDx of increased cardiac width: CHF, incompetent cardiac valves, cardiomyopathy

4. What would you recommend next for this patient?

Based upon the findings, the patient has advancing congestive heart disease. I would admit the patient to the hospital until they are stable. Start with 100% O2 administration. Also restrict fluid and sodium intake as patient is already volume overloaded. I would give the patient a diuretic (ie: a loop diuretic like Lasix) and nitrates to help stabilize. I would also give my patient analgesics if needed and consider starting him on an ACEI and/or digoxin if he is not already taking them.

5. Is the use of this test/procedure appropriate?

The use of a CXR to R/O a pneumonia and also to look for findings of CHF is a very appropriate and useful tool.

6. Is(are) there any alternate test(s)?

In terms of R/O a pneumonia, the CXR is a very useful tool and there exists few other means by which you can confirm a pneumonia. In terms of CHF, perhaps an ECHO and/or ECG can help with the diagnosis.

7. How would you explain to the patient about the possible risks and benefits of this test?

Benefits of this test include: (1) relatively inexpensive and widely available (2) It’s painless and fast (3) will allow the physicians to correctly treat the pt based upon the findings of CXR.

Possible risks of this test include: (1) involves exposure to radiation (though minimal) (2) may not be able to accurately diagnose everything

8. What is the cost of this test?

The cost of this test is relatively inexpensive, with PA and LAT views being just under $100 (ie: approximately $80). This is substantially lower than other diagnostic imaging techniques.