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Case Notes

History

75 year old male with heart disease; PICC placement

Exam

AP portable chest

Prior Study

Multiple prior portable chest exams.

Dicom

Findings

You scored: 0 / 36

Technique	Correct Answer	Your Answer
The exam is technically correct, and is not expiratory, is not rotated, nor over or under penetrated, nor limited by overlying structures or soft tissues, body habitus, patient positioning, or motion.	yes	NA

Support Devices	Correct Answer	Your Answer
There is an ETT or tracheostomy tube presentand the ETT is less than 2cm from the carina or the ETT or tracheostomy tube is otherwise in abnormal position.	no	NA
There is a venous line or lines present and in an improper location or other abnormality.	no	NA
There is a PAC in place that is not in a main pulmonary artery or is otherwise abnormal.	no	NA
There is an NG tube and/or feeding tube in place and the NG or feeding tube does not go below the GE junction or has other abnormality.	no	NA
There is a cardiac pacemaker/AICD or temporary transvenous pacemaker the leads are fractured or in an abnormal location, not in the RA, RV, or coronary sinus.	no	NA
There is a chest tube in place and the side port of the chest tube is outside of the bony thorax or the tube is abnormally positioned.	no	NA
There are other devices such as an IABP, LVAD, vascular stents, cardiac valves, gastrostomy tube, other drains or tubes, anesthesia catheter, VP shunt, or neurostimulator present and improperly positioned.	no	NA

Cardiomediastinum	Correct Answer	Your Answer
The mediastinum is abnormally widened considering the technique.	No	NA
There is abnormal shift of the mediastinum.	No	NA
There is air in the soft tissues of the mediastinum.	No	NA
There is abnormal tracheal deviation or narrowing.	No	NA
There is enlargement of the cardiac silhouette.	Yes	NA
The heart borders are abnormal.	No	NA
There is pneumopericardium.	No	NA
The right paratracheal stripe is thickened or enlarged.	No	NA

Vasculature	Correct Answer	Your Answer
The aorta is dilated, tortuous, ectatic, calcified, or there is a focal contour abnormality.	no	NA
The central pulmonary arteries or hila are enlarged.	No	NA
There is cephalization or haziness of the pulmonary vessels or congestion of the central pulmonary vasculature.	Yes	NA

Lungs	Correct Answer	Your Answer
The lungs are hyperinflated or underinflated.	no	NA
There is focal, multifocal, or diffuse airspace disease.	yes	NA
There is focal or diffuse interstitial disease.	yes	NA
There is focal or lobar atelectasis or total collapse of the lung.	yes	NA
There is cavitary or cystic disease with or without air fluid levels or soft tissue nodularity.	no	NA
The position of the major and minor fissures is abnormal.	No	NA
There is elevation, depression, or contour abnormality of the right or left hemidiaphragm.	no	NA
The right or left hemidiaphragm is focally or diffusely obscured.	Yes	NA

Pleura	Correct Answer	Your Answer
There is focal or diffuse abnormality of the pleura or chest wall.	no	NA
There is a pleural effusion or blunting of the costophrenic angle.	Yes	NA
There is focal fluid in the fissures.	Yes	NA
There is asymmetric pleural thickening or capping of the apices.	No	NA
There is a pneumothorax, hydro/pneumothorax, or hemo/pneumothorax.	no	NA

Bones, Soft Tissues, Upper Abdomen	Correct Answer	Your Answer
The ribs, clavicles, shoulder, spine, or other visualized bones are abnormal.	no	NA
There is free air beneath the diaphragm.	No	NA
The bowel or organs of the upper abdomen are abnormal.	no	NA
There is subcutaneous emphysema, focal or diffuse soft tissue abnormality, radiopaque foreign body, or post-surgical change or hardware.	yes	NA