Chest Pathology

Take a look at the image. See if you can identify the pathology. The answer is at the bottom.

Here's a portable cxr image I took the other day. It has been stripped of any pt info. I thought it would be a good education tool.

First let's critique the image itself: the clavicles are some what high, I could have shot more caudally. The pt seems some what rotated - the distance in the sternoclavicular joints is a little asymmetrical. The heart is under penetrated - I could have brought up the mAs by 50%. While it true that you can window images that are done with computed radiography, film is a different story.

You're always fighting a battle between too much exposure time or not enough penetration. High mAs with a large pt or high density pathology and you might get motion on the film. In-pt's tend toward involuntary motion. So then you might end up shooting high Kvp and low mAs. Two things happen, you contribute to higher dose if you use a grid. I have nothing against grids. They're necessary. But if I can, especially in the ER with young pt's, I don't use a grid. The other thing that happens is you risk quantum mottle, which is happening more with faster systems.

Now for the pathology: a large subcutaneous pneumothorax can be seen on the pt's right side. There is ample tissue affected with neoplasm (cancer) in the lungs. I'm sure other pathology is evident.