Assessment #1 case-set #4 case #2 vanderbilt

There is increased consolidative opacities most pronounced in the mid to lower lung zone with obscuration of the right heart border. likely representing right lower lobe collapse with associated atelectasis. There is right greater than left pulmonary edema bilaterally.

No evidence of pneumothorax.

Endotracheal tube and NG tube are in proper position.

hazy opacification of the bilateral mid to lower lungs which likely represents bilateral pleural effusions with superimposed bibasilar atelectasis. however, superimposed infection/ aspiration cannot be excluded.

Status post intubation, appropriately positioned ET tube. NG tube side hole should be advanced 2-3 cm (side hole near GE junction). Bibasilar opacity, possible contusions. Opacity at right lung base obscures the diaphragm with suggestion of airfield structure above the diaphragm, consider traumatic diaphragmatic rupture.

Poor conspicuity of bilateral diaphragms, with a patchy opacity obscuring the right heart border. Overall concerning for bilateral layering pleural effusions and lung contusion.

Right greater than left lower lobe hazy opacities. The bilateral costophrenic angles are obscured, pleural effusions cannot be ruled out.

rml pna

Layering pleural fluid collections bilaterally in the setting of trauma concerning for hemothoraces.

Hazy right greater than left bibasilar airspace opacities, which may be secondary to pulmonary hemorrhage given trauma.

Right pleural effusion.

f

r eff

Esophagogastric side port projects over the gastric cardia with tip extending inferiorly out of view. Endotracheal tube tip projects approximately 2cm above the clavicles.

Cardiomediastinal silhouette is within normal limits but obscured inferiorly. Marked pulmonary edema with moderate right and small left pleural effusions, likely contusions with possible hemothoraces, although without identifiable fracture.

Right upper lobe atelectasis.

Lucency throughout the upper abdomen, concerning for pneumoperitoneum. Recommend left-down decubitus or upright radiograph versus CT abdomen according to clinical concern.

Patchy opacities of the lower lung bases with dense retrocardiac opacity which could represent aspiration and/or contusion. Limekly small bilateral pleural effusions.
ETT with tip *** cm from the carina.
Gastric tube with side port projecting over the GE jxn. Consider advancing for more optimal intra-gastric positioning.

Effusion
Confusion
Ett NGOG

Endotracheal tube with tip above the level of the clavicles. Enteric tube in the stomach with the tip excluded from field of view.

There is a right pleural effusion with associated atelectasis. There is no focal consolidation or sizeable pleural effusion in the left lung. No pneumothorax; however, not evaluated well on supine film. Cardiomediastinal silhouette is somewhat obscured by overlying opacity but appears within normal limits. No definite acute bony abnormality.

B/l R>L pleural effusion with adjacent compressive atelectasis. Please also correlate for signs of infectin.

bilateral effusions likely hemothorax in the setting of trauma. At least acute left 8th rib fx.
upper lungs are clear.
ETT and gastric suction tube in expected position.

Veil-like opacification of bilateral lower lungs, likely layering effusions. Associated opacification may reflect contusion or aspiration.

Bibasilar hazy opacities which may represent pulmonary contusion in the setting of traua. Smally right greater than left pleural fluid collections.

NG tube with side port at GE junction, advance 10 cm.
Layering right greater than left effusions, moderate in volume.
Bibasilar atelectasis. Obscured R heart border, partial.
Cardiomediastinal silhouette except R heart normal.

RLL pna, b/l pleural effusions

Bilateral lower lung opacities likely reflecting a combination of layering pleural fluid, aspiration and pulmonary contusion in the setting of trauma.

ETT in mid trachea. Left PTX with deep sulcus sign. Opacification of the ling bases bilaterally. The heart size is normal. No osseous findings.

pleural effusion, increased right paratracheal stripe

Right greater than left bibasilar hazy opacities, favoring pulmonary contusions vs. atelectasis. R>L pleural effusions .

ETT distal tip over thoracic inlet. Gastric suction tube coursing below the diaphragm.

ET tube with distal tip above the level of the clavicles, recommend advancing. Opacities at the right lower lung which may relate to contusion or aspiration in this patient with history of trauma. L PTX as evidenced by the deep sulcus sign.

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ET tube tip projects over the mid-thoracic trachea. Enteric tube with side-port projecting over the distal esophagus. Recommend further advancement.

Moderate bilateral pleural effusions with adjacent patchy airspace opacities suggestive of mild pulmonary edema versus atelectasis. Query deep left sulcus sign which may be indicative of a pneumothorax. Decubitus films could be obtained if there is clinical concern.

Endotracheal tube tip projects above the thoracic inlet. Recommend advancing by x cm. Bilateral mid and lower lung opacities could reflect contusions vs atalectasis. Right greater than left pleural effusions.

Globular, enlarged, and radio dense appearance of the cardiac silhouette concerning for pericardial effusion.

Small bilateral layering pleural effusions.

Moderate bilateral pleural effusions. No discernible pneumothorax. Hazy bibasilar airspace opacities which likely reflects layering pleural fluid, atelectasis and contusion. Recommend CT for further eval. ETT Tube terminates above the clavicular heads, recommend advancement by x cm. Gastric decompression tube with side port projecting over the GE junction, recommend advancement by approx 10 cm for more optimal positioning.

Hemoperitoneum

Increased opacity in right lung base, concerning for diaphragmatic rupture with volume loss or infection/contusion.

-Endotracheal tube is above clavicular heads, recommend advancing
-Bilateral moderate to large pleural effusions (possible hemothorax) with bibasilar air space disease that could represent contusion in the setting of trauma, difficult to exclude superimposed aspiration or infection.

Traumatic diaphragmatic rupture

FINDINGS:

ET tube is within the mid trachea. Enteric tube courses below the diaphragm and appears to continue below the stomach bubble.

There are hazy opacities overlying the lower lungs bilaterally, likely pleural effusions or hemothorax in the setting of trauma. No pneumothorax.

The cardiac silhouette is normal. No acute osseous abnormalities are seen radiographically.

IMPRESSION:

1. Enteric tube coursing below the diaphragm and out of the field-of-view below the expected location of the stomach bubble. Recommend KUB to ensure appropriate positioning.
2. Bilateral hazy opacities in the lungs bases which likely represent effusions or hemothorax in the setting of trauma.

Cardiomegaly with a ‘waterbottle’ shaped heart, concerning for pericardial effusion. Recommend ultrasound for further evaluation. Prominent pulmonary vasculature with interstitial coarsening, consistent with pulmonary edema. Probable right sided pleural effusion vs contusion. CT chest could be considered for further evaluation.
ET tube terminates above the thoracic inlet, recommend advancement.
Evaluation is severely limited due to poor penetration.

Multiple acute minimally displaced right posterior rib fractures.

Moderate bilateral pleural effusions with dense opacification of the right midlung and right lower lung, likely due to layering blood/fluid, pulmonary contusion, and atelectasis. No discernable ptx. Recommend CT for further evaluation.

Hyperexpanded lungs with flattening of the diaphragms.

Partially obscured right heart border which appears normal in size.

ET tube projects over the thoracic inlet. Consider advancement. Gastric decompression tube courses below the diaphragm with sideport projecting just distal to the GE junction. Consider advancement.

mediastinal deviation, tension pneumo vs lobar collapse

ETT and enteric tubes in appropriate position. low lung volumes with hazy opacities in bilateral bases, may represent pulmonary contusion. obscuration of the right hemidiaphragm with moderate pleural effusion. cardiac silhouette appears mildly enlarged. lucency over LUQ, suspicous for pneumoperitoneum

PTX

lucency of the left lung base with deep sulcus and sharp outline of the left heart border concerning for moderate to large pneumothorax.

Right basilar opacities may represent aspiration, atelectasis, or contusion in the setting of trauma.

rec 3-4 cm adv of endotrach tube

ETT terminating in the mid trachea. Enteric tube with the tip not captured.
The left costodiaphragmatic recess appears more pronounced, concerning for a left-sided pneumothorax. The right hemidiaphragm is not well visualized. Recommend CT chest for further assessment.
Hazy opacification of the lower lung zones bilaterally, right greater than left with partial obscuration of the heart border likely due to pulmonary contusions in setting of trauma.

ET too high. Bilateral pleural effusions. Edema.

possible deep sulcus?

Questionable left deep sulcus sign which may be pneumothorax or artifact/positional. CT could further evaluate.

Bibasilar gradient opacities with loss of costophrenic angle consistent with R>L pleural effusion or hemothorax in setting of trauma. Bibasilar airspace opacities may reflect combination of contusion, edema, aspiration, and/or atelectasis. CT could also evaluate.

ETT above the clavicles. Consider slight advancement. Gastric decompression through GE with tip outo f view.

lucencies in right lung base may reflect ptx

left hemopneumothorax

ETT above the clavicles, consider advancing.
Deep left sulcus which could reflect pneumothorax, as well as layering gradient opacities at the bases could reflect pleural effusions/hemothorax in this setting.

Hazy bibasilar opacities, may represent a combination of pulmonary contusion, atelectasis, aspiration.
Moderate b/l pleural effusions. Loculated air within the right lung base may represent right hydropneumothorax.
ET tube terminates x cm above the carina.
Enteric tube with side port within the gastric cardia and tip terminating beyond field of view. Consider advancement.

Indistinct right heart border. Right pleural effusion. Acute rib fractures.

PTX

Lucency along the left hemidiaphgram which extends ifneriorly over the splenic silhouette. Associated left sided rib fractures, concenring for supine evidence of pneumothorax. Minimal associated rightward deviation of the cardiac silhouette.

right basilar dense opacification, likely represents atlectasis

support lines in expected positions.

1. Bilateral right greater than left lower lobe abnormalities concerning pulmonary contusion/laceration with likely hemothorax in the setting of trauma.
2. Questionable lucency at the left costephrenic sulcus concerning for pneumothorax and/or hemopneumothorax in the supine patient. Concern CT chest or upright for further evaluation. No mediastinal shift.
3. No evidence of osseous injury within the thorax.
4. ETT projecting over the midthoracic trachea.
5. Gastric tube with tip not imaged, sideport projecting over the midgastric body.

flattening of the left hemidiaphragm concerning for left basilar ptx.

bilateral R>L hazy opacities may represent layering effusions.

right basilar opacities with obscuration of right heart boarder and r hemidiaphragm may represent collapse vs consolidation.

ETT above thoracic inlet, recommend advancing xx cm.

Deep sulcus sign on the left concerning for pneumothorax.
Right lower lung opacification with internal lucencies concerning for loculated pleural effusion. Superimposed hemothoraax or pulmonary contusion in setting of trauma.
Gastric decompression tube side port projects over the GE junction. Reccomend advancement by aproximately 5-10cm.

acute rib fractures, pulmonary opacities bilaterally at the bases. ET tube and NG tube appropriately positioned.

lucences basilar regions with pleural effusions suggestive of hydropneumothorax.

query continuous diaphragm sign concerning for pneumomediastinum

bilat pleural effusions

rll airspace dz-could be pna vs aspiration vs contusion

ett midtrachea
ngt beyond field of view

Bilateral middle and lower lung hazy airspace opacities with obscuration of the right hemidiaphragm and right heart border, favored to reflect atelectasis, aspiration, infection or pulmonary contusion in the setting of trauma.
B/l pleural effusions. Left deep sulcus sign concerning for PTX.

Right basilar hydropneumothorax.

Moderately enlarged cardiopericardial silhouette with a globular configuration, most suggestive of the presence of a pericardial effusion. consider echocardiogram for further eval. Obscuration of the right hemidiaphragm suspicious for pulmonary contusion. Pneumothroax.

Opacification of the right greater than left lung bases and lucency at the left lower lung. ISO trauma, findings are concerning for moderate right hemopneumothorax and moderate left hemothorax. No acute displaced fractures.

ET tube projects in the upper thoracic trachea. Gastric decompression tube courses over midline, terminates outside the field of view, and side port projects in the expected region of the gastric body.

misplaced ETT