Case 59

21 y/o male with hx of previous PTX presents to the ED for evaluation of L sided chest pain x 3 days that developed while lifting a heavy box.  Pt was seen by PMD then next day diagnosed w/musculoskeletal pain and given NSAIDS. The CP has not improved since initial presentation. The CP is made worse moving around, deep inspiration and laying down. Associated with a non-productive cough.

ROS
Constitutional: no fever, chills, trauma or generalized weakness
ENT: no URI sxs, no throat pain, no change in voice, no excessive drooling, no ear pain/discharge, no hearing changes.
Cardiovascular: See HPI. + no syncope , no palpitations, no peripheral edema
Respiratory: See HPI. no h/o asthma or COPD.
Gastrointestinal: No nausea, vomiting or diarrhea. no abdominal pain.
Musculoskeletal: No chest wall trauma. No neck pain, no back pain, no joint pain.
Integumentary: No rash or skin changes. no edema
Neurological: No headache, no dizziness, no visual changes, no focal weakness

Vitals: T 98.6F, HR 62 bpm, BP 114/56, RR 18, SpO2: 100%

PE
General:  well appearing, non-toxic male in no acute distress
Skin: skin warm, pink and dry. MMM. No rash to chest.no crepitus.
Neck: Neck supple.
Pulm: CTAB. Normal respiratory effort. No respiratory distress. No wheezes, stridor, rales or rhonchi. No retractions
CV: RRR, no M/R/G.
Abd: Soft, non-tender, non-distended. No rebound or guarding.
MSK: FROM of all extremities.  No chest wall tenderness. No edema, erythema, cyanosis. Radial pulses equal and intact bilaterally.

 IMAGE 1 - R1 is the right lung.  L1 is the left lung.

IMAGE 1 - R1 is the right lung.  L1 is the left lung.

QUESTIONS:

  1. Based off of the images and videos seen above, what is your diagnosis?  What are the various categories within this diagnosis?
  2. In image 1, how can you differentiate between normal and abnormal lung?  What are these signs called?
  3. How do you obtain image 1?  (Mode, Probe, Technique)
  4. In video 1, what is the name of this sign and what does this indicate if found during your scan?
  5. In video 2, what is the name of this sign and what does this indicate if found during your scan?