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Thu Mar 19 18:50:13 GMT 2009

Well done, Sal. If you can manipulate the Xray, turn it upside down and see
if you get any more clues.

Best Wishes,

Rowley. 
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of sjasmd at aol.com
Sent: 18 March 2009 05:21
To: trauma-list at trauma.org
Subject: Re: Unique chest X-ray

i am suspecting artefact, like a double of exposure of some sort
i would repeat the xray

sal

-----Original Message-----
From: Blueflightmedic <trauma at emergencyunit.com>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Mon, 16 Mar 2009 2:56 pm
Subject: Unique chest X-ray

I thought you would enjoy this one. A elderly male patient presented the
night before I reviewed him with severe left arm pain. The pain does not
sound cardiac and has no associated features. He has no throat discomfort or
difficulty swallowing. He is presently resident in a rehabilitation facility
awaiting surgery for a pseudocyst following pancreatitis secondary to a
gallstone once he is fit enough. 20 years ago he had a severe bout of
pneumonia after a viral URTI and he has residual lung scarring and has been
under review by a chest physician since. He has a normal ECG(EKG). Apart
from mild evidence of continuing hepatic inflammation his blood results are
normal - in particular his amylase is not elevated.

On the ward round he appears fit and ready to go home. His pain has lysed.
His overnight chest Xray is appended. What does it show and what do you do
now?

Best Wishes,

Rowley. 

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Unique chest X-ray