Short case reporting sample content

Case 1 (CXR)

History: An 18-year-old male referred from Emergency Department with pleuritic chest pain

Findings:

• Small right apical pneumothorax

• Lung apex at level of posterior 2nd/3rd posterior intercostal space

• No pneumomediastinum

• No signs of tension

• Lungs appear normal

• No rib fracture

Diagnosis:

Small right apical pneumothorax

Management:

• Inform ED team of finding

• If patient stable, pneumothorax may resolve with conservative management

Case 2 (CXR)

History: A 38-year-old female referred from GP with several months of tiredness and lethargy.

Findings:

• Lobulated, non-calcified soft tissue mass projected over left side of mediastinum, inseparable from left heart border

• Separate from left hilum (hilum overlay sign)

• Mediastinum otherwise normal

• Lungs and pleural spaces clear

• No evidence of splenomegaly

• Bones normal

Diagnosis:

• Anterior mediastinal mass. Could be lymphadenopathy, thymic neoplasm or mediastinal germ cell tumour (teratoma)

• Thymoma most likely, given history and lack of calcification or fat

Management:

• Inform GP + 2WW referral to chest clinic

• Requires CT thorax, abdomen and pelvis for further evaluation

• Myaesthenia gravis screen (blood tests to identify antibody subtype)

• Lung MDT discussion with view to image guided mediastinal biopsy

Case 3 (CXR)

History: An 81-year-old male referred from GP with cough and weight loss

Findings:

• Left lower lobe collapse with no visible hilar mass

• Numerous calcified pleural plaques indicating previous asbestos exposure

• No mediastinal lymphadenopathy

• No pleural effusion

• No bone metastases

Diagnosis:

• Left lower lobe collapse – likely due to small central lung cancer obstructing left lower lobe bronchus in a patient with prior asbestos exposure

• Mucus plugging, inhaled foreign body or endobronchial carcinoid less likely in this case

Management:

• Lung MDT referral

• CT chest and abdomen with IV contrast agent

• Bronchoscopic biopsy likely to provide diagnosis unless CT reveals other target such as supraclavicular lymph node or liver/bone metastases

Case 4 (XR Right Elbow)

History: A 3-year-old female referred from Emergency Department with painful right elbow after fall from swing

Findings:

• Fracture dislocation of right proximal radius

• Displaced (avulsed) medial humeral epicondyle

• No other injury seen

Management:

• Inform ED staff and advise referral to fracture clinic

Case 5 (CXR)

History: A 20-year-old female referred from Emergency Department with acute asthma exacerbation

Findings:

• Rounded area of consolidation in left upper zone

• Lungs otherwise clear

• No pneumothorax or pneumomediastinum

• No pleural effusion

Diagnosis:

• Likely round pneumonia left upper lobe

• Differential diagnosis pulmonary infarct but less likely

Management:

• Inform ED staff

• Suggest repeat CXR after antibiotic treatment to ensure resolution (although may not be necessary as patient is young)

Case 6 (CXR)

History: A 25-year-old male referred from Emergency Department with painful left shoulder after rugby injury

Findings:

• Anterior dislocation of left humeral head

• Bony defect in posterior humeral head (Hill Sachs impaction fracture)

• Left glenoid appears intact

• Acromioclavicular joint intact

• No rib fracture or pneumothorax

Diagnosis:

• Likely round pneumonia left upper lobe

• Differential diagnosis pulmonary infarct but less likely

Management:

• Suggest orthopaedic referral

• May require CT or MRI shoulder after reduction for surgical planning