A 49-year-old COPD patient arrives to the ER complaining of ...

[madam-professor]

A 49-year-old COPD patient arrives to the ER complaining of shortness of breath (SOB) and difficulty breathing. The physical examination reveals bilateral coarse crackles throughout the lung fields, pedal edema, and hepatomegaly.
 
  The chest x-ray shows bilateral fluffy infiltrates with a bat's wing configuration. What clinical condition you may suspect on this patient?
  a. Acute coronary syndrome
  b. COPD exacerbation
  c. Hypertensive crisis
  d. Left heart failure

Question 2

Which of the following are common radiographic findings seen in patients with volume loss due to atelectasis?
 
  1. Elevation of the hemidiaphragm
  2. Narrowing of the space between the ribs
  3. Increase in the retrosternal airspace
  4. Shift of the mediastinum
  a. 1 only
  b. 3 only
  c. 1, 2, and 4 only
  d. 3 and 4 only

[vkodali]

Answer to Question 1

ANS: D
The term bat's wing appearance is applied to the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs. Left heart failure and CHF will cause congestion of the pulmonary vessels leading to pulmonary edema throughout the lung fields.

Answer to Question 2

ANS: C
This can be seen by elevation of the diaphragm on the side of the atelectasis, a shift of the medi-astinum toward the atelectasis, and poor expansion of the chest causing narrowing of the space between the ribs. If the collapsed segment of the lung is in the upper lobe, the hilum will be dis-placed upward and the minor fissure on the right will be displaced upward.

[madam-professor]

Gracias!

[bulacsom]

TYSM