WIDI - Case123-Congestive Heart Failure with Cephalization and Pulmonary Venous Congestion

Case Notes

History

65 year old female with increasing oxygen requirement

Exam

AP portable chest

Prior Study

Multiple prior portable chest exams.

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.	No	NA

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.

Support Devices	Correct Answer	Your Answer
There is an ETT or tracheostomy tube present and the ETT is less than 2cm from the carina or the ETT or tracheostomy tube is otherwise in an abnormal position.	No	NA
There is a venous line or lines present and in an improper location or otherwise abnormal.	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 that does not go below the GE junction or has other abnormality.	No	NA
There is a cardiac pacemaker/AICD or temporary transvenous pacemaker and 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 otherwise 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

Support Devices

Correct Answer

Your Answer

There is an ETT or tracheostomy tube present and the ETT is less than 2cm from the carina or the ETT or tracheostomy tube is otherwise in an abnormal position.

There is a venous line or lines present and in an improper location or otherwise abnormal.

There is a PAC in place that is not in a main pulmonary artery or is otherwise abnormal.

There is an NG tube and/or feeding tube in place that does not go below the GE junction or has other abnormality.

There is a cardiac pacemaker/AICD or temporary transvenous pacemaker and the leads are fractured or in an abnormal location, not in the RA, RV, or coronary sinus.

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 otherwise abnormally positioned.

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.

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

Cardiomediastinum

Correct Answer

Your Answer

The mediastinum is abnormally widened considering the technique.

There is abnormal shift of the mediastinum.

There is air in the soft tissues of the mediastinum.

There is abnormal tracheal deviation or narrowing.

There is enlargement of the cardiac silhouette.

Yes

The heart borders are abnormal.

There is pneumopericardium.

The right paratracheal stripe is thickened or enlarged.

Vasculature	Correct Answer	Your Answer
The aorta is dilated, tortuous, ectatic, calcified, or there is a focal contour abnormality.	Yes	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

Vasculature

Correct Answer

Your Answer

The aorta is dilated, tortuous, ectatic, calcified, or there is a focal contour abnormality.

Yes

The central pulmonary arteries or hila are enlarged.

There is cephalization or haziness of the pulmonary vessels or congestion of the central pulmonary vasculature.

Yes

Lungs	Correct Answer	Your Answer
The lungs are hyperinflated or underinflated.	No	NA
There is focal, multifocal, or diffuse airspace disease.	No	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

Lungs

Correct Answer

Your Answer

The lungs are hyperinflated or underinflated.

There is focal, multifocal, or diffuse airspace disease.

There is focal or diffuse interstitial disease.

Yes

There is focal or lobar atelectasis or total collapse of the lung.

Yes

There is cavitary or cystic disease with or without air fluid levels or soft tissue nodularity.

The position of the major and minor fissures is abnormal.

There is elevation, depression, or contour abnormality of the right or left hemidiaphragm.

The right or left hemidiaphragm is focally or diffusely obscured.

Yes

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.	No	NA
There is asymmetric pleural thickening or capping of the apices.	No	NA
There is a pneumothorax, hydro/pneumothorax, or hemo/pneumothorax.	No	NA

Pleura

Correct Answer

Your Answer

There is focal or diffuse abnormality of the pleura or chest wall.

There is a pleural effusion or blunting of the costophrenic angle.

Yes

There is focal fluid in the fissures.

There is asymmetric pleural thickening or capping of the apices.

There is a pneumothorax, hydro/pneumothorax, or hemo/pneumothorax.

Bones, Soft Tissues, Upper Abdomen	Correct Answer	Your Answer
The ribs, clavicles, shoulder, spine, or other visualized bones are abnormal.	Yes	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.	No	NA

Bones, Soft Tissues, Upper Abdomen

Correct Answer

Your Answer

The ribs, clavicles, shoulder, spine, or other visualized bones are abnormal.

Yes

There is free air beneath the diaphragm.

The bowel or organs of the upper abdomen are abnormal.

There is subcutaneous emphysema, focal or diffuse soft tissue abnormality, radiopaque foreign body, or post-surgical change or hardware.

Section 2 Case123

Findings Results

You scored: 0 / 36

Technique	Correct Answer	Your Answer
The exam is slightly rotated to the left.	No	NA

Support Devices	Correct Answer	Your Answer
There is an ETT present in the lower trachea.	No	NA
There is a right IJ venous line present with the tip at the SVC right atrial junction.	No	NA
There is no PAC	No	NA
There is no NG tube or feeding tube.	No	NA
There is no pacemaker.	No	NA
There is no chest tube.	No	NA
There are no other devices.	No	NA

Cardiomediastinum	Correct Answer	Your Answer
The mediastinum is not abnormally widened.	No	NA
There is no abnormal shift of the mediastinum.	No	NA
There is no air in the soft tissues of the mediastinum.	No	NA
There is no abnormal tracheal deviation or narrowing.	No	NA
There is mild enlargement of the cardiac silhouette.	Yes	NA
No. The heart borders are normal.	No	NA
There is no pneumopericardium.	No	NA
The right paratracheal stripe is not thickened or enlarged.	No	NA

Vasculature	Correct Answer	Your Answer
There is calcification of the aortic arch.	Yes	NA
The central pulmonary arteries or hila are not enlarged.	No	NA
There is cephalization and haziness of the pulmonary vessels and congestion of the central pulmonary vasculature from pulmonary edema.	Yes	NA

Lungs	Correct Answer	Your Answer
The lungs are not hyperinflated or underinflated.	No	NA
No. Retrocardiac opacity is likely from atelectasis rather than airspace disease.	No	NA
There is mild interstitial disease from edema.	Yes	NA
There is atelectasis of the left lower lobe and subsegmental atelectasis in the right lower lobe.	Yes	NA
There is no cavitary or cystic disease.	No	NA
No. The position of the major and minor fissures is not well seen but appears normal.	No	NA
There is no elevation, depression, or contour abnormality of the right hemidiaphragm.	No	NA
The left hemidiaphragm is diffusely obscured by left lower lobe atelectasis and pleural effusion.	Yes	NA

Pleura	Correct Answer	Your Answer
There is no focal or diffuse abnormality of the pleura or chest wall.	No	NA
There are small bilateral pleural effusions.	Yes	NA
There is no focal fluid in the fissures.	No	NA
There is no asymmetric pleural thickening or capping of the apices.	No	NA
There is no pneumothorax, hydro/pneumothorax, or hemo/pneumothorax.	No	NA

Bones, Soft Tissues, Upper Abdomen	Correct Answer	Your Answer
There is an old fracture deformity of the proximal left humerus.	Yes	NA
There is no free air beneath the diaphragm.	No	NA
No. The bowel and organs of the upper abdomen are normal.	No	NA
There is no subcutaneous emphysema, focal or diffuse soft tissue abnormality, radiopaque foreign body, or post-surgical change or hardware.	No	NA

Case123

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