I really enjoy when some of the blogs I read post medical challenges for their readers, and I think I’m ready to start doing it from time to time here on my own. Because I’m currently rotating through radiology, I think it’s appropriate to begin with the interpretation of a radiograph.
You are the radiologist on call and are asked to interpret this chest x-ray of a 56 year old male who presented to the trauma bay after being struck by a motor vehicle while riding his bike home from work.
What’s the diagnosis?
A) Massive left hemothorax (blood in the chest)
B) Right pneumothorax (collapsed lung/air in the chest)
C) Right pneumothorax & left hemothorax
D) Left pneumonectomy (lung removed)
E) Ruptured left diaphragm
The answer will be posted in 24-48 hours, good luck!
Abnormal Facies 
Tak
July 14, 2011
I had it between Left pneumonectomy and Left hemidiaphragm rupture but I think I will have to choose the left pneumonectomy for a couple of reasons. For the benefits of others I will keep my reasonings private (however right or wrong they might be !)
Pranab
July 14, 2011
IMO C) Right pneumothorax & left hemothorax especially keeping n mind the history of the case…
Petulant Skeptic
July 15, 2011
Just getting on record what I tweeted earlier… D.
Sherry
July 15, 2011
I would like to say c) right pneumothorax and left hemothorax though ruptured left diaphragm could also be a possibility given the mechanism of injury. In which case, can I create my own choice f) Need more information…?
If not, then at least I tried. I’ll be a PT in a year — not a physician!
Keith
July 15, 2011
gonna go with C) on this one. I’m not too sure about it, but I would’ve thought that the blood would push the diaphragm down on the left
Pranab
July 16, 2011
a tension pneumothorax would cause the shift of mediastinal contents to the right more pronounced than the pressure effect caused by the hemothorax if there was a diaphragmatic rupture or a small hemothorax. 😛
Faiza
July 15, 2011
I think it’s C
Keval
July 15, 2011
C. Due to blunt abdo trauma
Jay Phu
July 21, 2011
looks like answer C is convincing..mediastinal shift to left is also seen.
Jim
July 21, 2011
Please note that the answer has been posted (see trackback below) – if you would like to discuss anything please do so by commenting on the follow-up post so that people can continue to participate in this challenge.
Chest X Ray Interpretation
May 4, 2012
Chest x-rays may provide important information regarding the size, shape, contour, and anatomic
location of the heart, lungs, bronchi, great vessels (aorta, aortic arch, pulmonary arteries),
mediastinum (an area in the middle of the chest separating the lungs), and the bones (cervical
and dorsal spine, clavicles, shoulder girdle, and ribs).
aikibooz
January 24, 2014
Im not sure at all
In the picture i ve seen that left lung increase opacity and it seem like silhouette with the heart boarder and also the pleural line was seen so the first answer goes to massive left hemothorax .and the second one if there is a right lung pneumothorax we could see the pleral line with no lung marking at the periphery , maybe deep sulcus sign was seen. I m sure that the periphery is radiolucent.