Case Images

View Images / Launch Visage

Case Notes

History

62 yo male with AML and fever

Exam

2 view chest

Prior Study

multiple prior exams

Dicom

Findings

You scored: 0 / 34

Technique	Correct Answer	Your Answer
The exam is expiratory, rotated, over or under penetrated, or limited by overlying structures or soft tissues, body habitus, patient positioning, or motion.	No	NA

Support Devices	Correct Answer	Your Answer
There is a vascular line or lines present in an abnormal location or otherwise abnormal.	Yes	NA
There are other devices such as a chest tube or pleural drain, feeding, NG, or gastrostomy tube, LVAD or pacemaker, vascular stents, cardiac valves, anesthesia catheter, VP shunt, neurostimulator, or other drains or tubes present that are in an abnormal position or are otherwise abnormal.	No	NA

Cardiomediastinum	Correct Answer	Your Answer
The superior mediastinum is abnormally widened considering the technique.	No	NA
There is abnormal shift of the mediastinum.	No	NA
There is a mass or other abnormal density in or overlying the mediastinum.	Yes	NA
There is an abnormality in the retrosternal, retrotracheal, or retrocardiac space on the lateral view.	Yes	NA
There is abnormal tracheal deviation or narrowing on the frontal and/or lateral view.	No	NA
There is pneumomediastinum and/or pneumopericardium.	No	NA
There is enlargement of the cardiac silhouette.	No	NA
The heart borders are abnormal.	No	NA
The right paratracheal stripe is thickened or enlarged.	No	NA
The azygoesophageal recess is displaced or otherwise obscured.	Yes	NA

Vasculature and Hila	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
The aorto-pulmonary window is convex or obscured by a mass, adenopathy, or vasculature.	No	NA
There is cephalization or haziness of the pulmonary vessels or congestion of the central pulmonary vasculature.	No	NA

Lungs	Correct Answer	Your Answer
The lungs are hyperinflated or underinflated generally or segmentally.	No	NA
There is focal, multifocal, or diffuse airspace disease, mass, opacity, or nodularity.	Yes	NA
There is focal or diffuse interstitial disease.	No	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.	Yes	NA
The right or left hemidiaphragm is focally or diffusely obscured on the frontal and/or lateral view.	Yes	NA
There is elevation, depression, or contour abnormality of the right or left hemidiaphragm.	No	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, blunting of the costophrenic angle, or posterior sulci.	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.	No	NA

Impression

Expert Answer

The left upper extremity PICC is in the azygous vein and needs to be retracted. There is a small to moderate right pleural effusion and parenchymal disease which could be from pneumonia in this patient with fever.

Your Answer

Recommendations & Acuity

Recommendations

Expert Answer

Verbally notify the clinical team about the malpositioned PICC in the azygous vein and need for retraction, and findings of pneumonia in this patient with fever.

Your Answer

Acuity

Expert Answer

Urgent (Action Necessary in a few hours)

Your Answer

Section 2 Case313

Findings Results

You scored: 0 / 34

Technique	Correct Answer	Your Answer
No, the exam is technically correct.	No	NA

Support Devices	Correct Answer	Your Answer
There is a left upper extremity PICC. The PICC enters the azygous vein and should be repositioned.	Yes	NA
There are no other devices present.	No	NA

Cardiomediastinum	Correct Answer	Your Answer
The superior mediastinum is not abnormally widened.	No	NA
There is no abnormal shift of the mediastinum.	No	NA
The posterior opacity on the lateral view is from the right pleural and parenchymal disease.	Yes	NA
There is abnormality in the retrocardiac space on the lateral view from the right pleural and parenchymal disease.	Yes	NA
There is no abnormal tracheal deviation or narrowing on the frontal or lateral view.	No	NA
There is no pneumomediastinum or pneumopericardium.	No	NA
There is no enlargement of the cardiac silhouette.	No	NA
The visualized heart borders are normal. The lower right heart border is obscured.	No	NA
The right paratracheal stripe is not thickened or enlarged.	No	NA
The azygoesophageal recess is obscured.	Yes	NA

Vasculature and Hila	Correct Answer	Your Answer
The aorta is not dilated, tortuous, ectatic, calcified, and there is no focal contour abnormality.	No	NA
The central pulmonary arteries and hila are not enlarged. There are calcified left hilar lymph nodes and a calcified granuloma just lateral to the right hilum.	No	NA
The aorto-pulmonary window is not convex or obscured by a mass, adenopathy, or vasculature.	No	NA
There is no cephalization or haziness of the pulmonary vessels or congestion of the central pulmonary vasculature.	No	NA

Lungs	Correct Answer	Your Answer
The lungs are not hyperinflated or underinflated generally or segmentally.	No	NA
There is airspace disease and/or atelectasis in the right lower lobe. There is calcified granulomatous disease in the left upper lobe.	Yes	NA
There is no focal or diffuse interstitial disease.	No	NA
There likely is compressive atelectasis in the right lower lobe from the pleural effusion.	Yes	NA
There is no cavitary or cystic disease.	No	NA
The position of the minor fissure may be slightly depressed on the lateral view.	Yes	NA
The right hemidiaphragm is obscured by the pleural effusion.	Yes	NA
There is no elevation, depression, or contour abnormality of the left hemidiaphragm.	No	NA

Pleura	Correct Answer	Your Answer
There is no focal or diffuse abnormality of the pleura or chest wall.	No	NA
There is a mild to moderate right pleural effusion and blunting of the left costophrenic angle and posterior sulci.	Yes	NA
There is fluid in the right major fissure and likely the minor fissure.	Yes	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
The ribs, clavicles, shoulders, spine, and other visualized bones are normal.	No	NA
There is no free air beneath the diaphragm.	No	NA
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