X-ray of Very cool case

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Ken

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thanks

Norman
 
Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Saturday, June 27, 2009 10:50 AM
To: trauma-list at trauma.org
Subject: X-ray of Very cool case

Several people stated that they had been unable to visualize this supine

chest X-ray, so I have reproduced it here:   
 

 
This is classic for what Dr. Matthew Wall published in J Trauma about
two  
years ago.   There are some subtile clues to lead you to know that  this
is 
NOT a dextrocardia.      Although I was never  able to get a copy of the

chest X-ray of Princess Diana, I am led to believe  that two chest
X-rays of 
her were almost identical to this one, and read as a R  loculated
hemothorax, 
and that apparently the right diaphragm could be  visualized as can be
seen 
here.     Note the relative  curvalinear left mediastinal line, which
would 
NOT be present if there was a  dextrocardia.     Note that a LEFT aortic

knob can be  seen.    This patient needs a thoracotomy, and the
management of  
the torn Right pericardium has at least 3 separate acceptable  options.

Had there been a R pneumonectomy (post pneumonectomy  cardiac herniation
is 
the most common cause), the options would have been  decreased by one.  
 
k mattox
**************Make your summer sizzle with fast and easy recipes for the

grill. (http://food.aol.com/grilling?ncid=emlcntusfood00000005)
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