Respiratory Pathology Flashcards
What is shown in this coronal CT?
Rhinosinusitis.
Yellow arrows: Bilateral maxillary sinusitis
Red arrow: Nasal septal deviation (unrelated to rhinosinusitis)
Rhinosinusitis pathology:
Obstruction of sinus drainage into nasal cavity –> inflammation and pain over affected area
Typically maxillary sinuses in adults
Rhinosinusitis - most common causes?
Most common acute cause: viral URI
May cause superimposed bacterial infection, most commonly: S. pneumoniae, H. influenzae, and M. catarrhalis
Epistaxis
Nose bleed
Epistaxis most common occurs in…
Anterior segment of nostril (Kiesselbach plexus)
Epistaxis in posterior segment of nostril can lead to…
Life threatening hemorrhage
Sphenopalatine artery is located in which segment of the nostril?
Posterior
(Sphenopalatine a. is branch of maxillary a.)
Deep Vein Thrombosis:
Blood clot within deep vein which leads to swelling, redness, warmth, pain
Virchow’s Triad:
SHE
Stasis
Hypercoagability (defect in coagulation cascade proteins, most commonly factor V Leiden)
Endothelial damage (exposed collagen triggers clotting cascade)
People with ____?____ are predisposed to DVT.
Virchow’s Triad (SHE)
Stasis
Hypercoaguability
Endothelial damage
95% of pulmonary emboli arise from where?
Deep leg veins
Homan Sign
Dorsiflex foot –> calf pain
Prevention and acute management of DVT?
Heparin
(unfractionated or low-molecular weight,
ex. enoxaparin)
Long term prevention of DVT recurrence?
Warfarin (oral anticoagulant)
Can also use Rivaroxaban, another oral anticoagulant
Name this study and disease it is test of choice for.
CT pulmonary angiography
Test of choice for PE
Pulmonary Emboli lead to what physiological defects?
V/Q mismatch –> hypoxemia –> respiratory alkalosis
Pulmonary Embolism causes what symptoms?
Sudden-onset dyspnea, chest pain, tachypnea.
May present as sudden death.
Types of Pulmonary Emboli:
An embolus moves like a FAT BAT
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor
Fat Emboli are associated with…
Long bone fractures and liposuction
Was this pathology formed pre or post mortem?
Formed before death!
Lines of Zahn are interdigitating areas of pink (platelets, fibrin) and red(RBCs) found only in thrmobi formed before death.
What is this an image of?
Pulmonary thromboembolus
Classic triad of hypoxemia, neurologic abnormalities, and petechial rash is associated with what?
Fat emboli (PE)
Amniotic fluid emboli can lead to…
DIC, especially postpartum
Air (Gas) Emboli are caused by…
Nitrogen bubbles that precipitate in ascending divers
Treat with hyperbaric O2
Patient likely presents with what symptoms?
Sudden-onset dyspnea, chest pain, tachpnea.
May present with sudden death.
pic: Pulmonary Embolism
Obstructive lung disease:
Obstruction of air flow resulting in air trapping in the lungs.
Hallmark Pulmonary Function Test in Obstructive Lung Disease:
FEV1 (Forced Expiratory Volume in 1 sec) decreased a LOT
FVC (Forced Vital Capacity) decreased some
Leads to DECREASED FEV1/FVC ratio
FEV1/FVC ratio in healthy adults
75-80%
Chronic Bronchitis pathology:
Bronchitis = Blue Bloater
Hyperplasia of mucus-secreting glands in the bronchi
Reid index >50%
Disease of small airways
A form of COPD along with Emphysema
What is the Reid Index?
Thickness of gland layer/total thickness of bronchial wall
Bronchitis: >50%
Chronic Bronichitis: Diagnostic criteria
Productive cough for > 3 months per year (not necessarily consecutive) for >2 years.
Chronic Bronchitis: Findings
Wheezing, crackles, cyanosis (early-onset hypoxemia due to shunting), late-onset dyspnea, CO2 retention
Emphysema pathology:
Enlargement of air spaces, decreased recoil, increased compliance, decreased DLCO
Increased elastase activity –> loss of elastic fibers –> increased lung compliance
What is DLCO?
Diffusion capacity of the Lung for CO
Measures the partial pressure difference between COinspired<strong> </strong>and COexpired
Determines the extent to which O2 passes from air sacs to blood.
What are the two types of Emphysema and what causes them?
Centriacinar - associated with smoking
Panacinar - associated with α1-antitrypsin deficiency
Emphysema signs and symptoms:
Emphysema “ Pink Puffer”
Exhalation through pursed lips (to increase airway pressure and prevent airway collapse during respiration)
Barrel-shaped chest
Pathological microscopy shown on left shows what pathological feature of what disease?
(Microscopy is relatively normal on right)
Destruction of alveolar walls (arrow)
Emphysema
Name specific type of disease shown in gross specimen
Centriacinar Emphysema
(Associated with smoking)
Specimen shows multiple air-space cavities lined by heavy black carbon deposits
This disease is associated with what?
Smoking
(Centriacinar Emphysema)
X-Ray of what disease?
Emphysema
barrel-shaped chest (Increased A-P Diameter)
Asthma
Bronchial hyperresponsiveness causes reversible bronchoconstriction.
Asthma pathology:
Smooth muscle hypertrophy, Curschmann sprials (shed epithelium forms mucus plugs), and Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum)
Curschmann spirals:
shed epithelium which forms mucus plugs
seen in Asthma on microscopy!
Charcot-Leyden Crystals:
Formed from breakdown of eosinophils in sputum
Name the feature and disease
Curschmann spirals
Asthma
Common triggers for asthma:
Viral URIs, allergens, stress
How do you test for asthma?
Methacholine challenge
Methacholine challenge test:
Methacholine is a non-selective muscarinic receptor agonist (M3)
Pt inhales aerosolized methacholine, leading to bronchoconstriction
Degree of narrowing can be quantified by spirometry.
Pt with asthma will react to lower doses of drug.
Contraindicated: in ppl with severe airway obstruction
Asthma Findings:
Cough, wheezing, tachypnea, dyspnea, hypoxemia, decreased I/E ratio, pulsus paradoxis, mucus plugging
I/E ratio: time of inspiration/expiration
Pulsus Paradoxus:
Abnormally large decrease in systolic pressure during INSPIRATION (>10mmHg)
Sign that is indicative of several conditions: obstructive lung disease, cardiac tamponade, pericarditis, etc.
Normally: decrease in BP (<10mmHg) on inhalation and increase in BP on exhalation
This image is indicative of what finding in what disease process?
Mucus plugging
Asthma
Bronchiectasis pathology:
Chronic necrotizing infection of bronchi which leads to PERMANENTLY dilated airways, PURULENT (foul smelling) sputum, recurrent infections, and hemoptysis.
Bronchial obstruction, poor ciliary motility (smoking), Kartagener syndrome, cystic fibrosis, allergic bronchopulmonary aspergillosis is associated with what disease?
Bronchiectasis
What disease process is shown in this patient with Cystic Fibrosis?
Bronchiectasis
Restrictive Lung Disease
Restricted lung expansion causes DECREASED lung volumes (FVC and TLC).
FEV1/FVC ration INCREASED >80%
Restrictive Lung Diseases with Poor breathing mechanics:
Poor muscular effort - Polio, Myasthenia Gravis
Poor structural apparatus - Scoliosis, Morbid Obesity
Interstitial Lung Disease is ….. and causes what physiologic changes ?
a group of lung diseases that affect the interstitium (tissue and space around the air sacs of the lungs)
Causes DECREASED diffusing capacity, INCREASED A-a gradient
This image shows what characteristic finding in what interstitial lung disease?
“Honeycomb Lung”
Idiopathic pulmonary fibrosis (repeated cycles of lung injury and wound healing with increased collagen deposition)
Another name for Neonatal Respiratory Distress Syndrome, and type of lung disease
Hyaline Membrane Disease
Interstitial Lung Disease
Examples of Pneumoconioses, and type of lung disease.
Anthracosis, Silicosis, Asbestosis
Interstitial Lung Disease
Drug toxicities that can cause Interstitial Lung Disease:
Bleomycin, Busulfan, Amiodarone, Methotrexate
Hypersensitivity Pneumonitis: pathology, symptoms, and epidemiology
Mixed type III/IV hypersensitivity rxn to environmental antigen
Causes dyspnea, cough, chest tightness, headache.
Often seen in farmers and those exposed to birds.
Pneumoconioses: examples, what they lead to, type of lung disease
Coal workers’ pnumoconiosis (anthracosis), silicosis, and asbestosis
Lead to increased risk of cor pulmonale and Caplan Syndrome
Interstitial Lung Disease (Restrictive)
Caplan Syndrome
Rheumatoid Arthritis and Pneumoconiosis with intrapulmonary nodules
Name feature and disease
Asbestos (ferruginous) bodies - golden-brown fusiform rods resembling dumbbells.
Asbestosis (Pneumoconiosis, Interstitial Lung Disease)
This image is pathognomonic for what disease?
Asbestosis
See “Ivory white” calcified pleural plaques (arrows)
Asbestosis is associated with what professions?
Shipbuilding, roofing, and plumbing.
Asbestosis is associated with an increased risk for what?
Increase incidence of bronchogenic carcinoma and mesothelioma.
BUT Bronchogenic carcinoma >> mesothelioma
Which lobes are affected in Asbestosis?
Lower lobes
Asbestos is from the roof, but affects the base (lower lobes)
This image is pathognomonic for what disease?
Asbestosis
Shown is a diaphragm specimen with “ivory white” calcified supradiaphragmatic plaques
Coal Workers’ Pneumoconiosis
“Black Lung Disease”
Prolonged coal exposure –> macrophages laden with carbon –> inflammation and fibrosis
What lobes are affected in Coal Workers’ Pneumoconiosis?
Upper lobes
Silica and coal are from the base (earth), but affect the roof (upper lobes)
Anthracosis
asymptomatic condition found in many urban dwellers exposed to pollution
Silicosis is associated with what occupations?
Foundries (factories producing metal castings), sandblasting, and mining.
Silicosis pathology:
Macrophages respond to silica and release fibrogenic factors, leading to fibrosis.
May disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB.
Silicosis patients are at increased risk for….
bronchogenic carcinoma, and possibly TB
What lobes are affected in Silicosis?
Upper lobes
White arrows point to what feature of what disease?
“Eggshell” calcification of hilar lymph nodes
Silicosis
Neonatal respiratory distress syndrome: Cause
Prematurity - get surfactant deficiency which leads to INCREASED surface tension and alveolar collapse.
Lecithin:sphyngomyelin ratio predictive of neonatal respiratory distress syndrome:
<1.5 in amniotic fluid
<2 is abnormal
Persistently low O2 tension in Neonatal respiratory distress syndrome leads to risk of….
Patent ductus arteriosus
Therapeutic supplemental O2 in Neonatal Respiratory Distress Syndrome can result in
Retinopathy of Prematurity (ROP) and bronchopulmonary dysplasia
Risk factors for Neonatal Respiratory Distress Syndrome:
Prematurity
Maternal Diabetes (due to increased fetal insulin)
C-section delivery (decreased release of fetal glucocorticoids)
Treatment for Neonatal Respiratory Distress Syndrome
Maternal steroids (glucocorticoids) before birth: (speeds up production of surfactant)
Artificial surfactant (synthetic or derived from cow) through endotracheal tube
Acute Respiratory Distress Syndrome (ARDS) cause
trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism
ARDS pathology:
Diffuse alveolar damage leads to increased alveolar capillary permeability –> protein-rich leakage into alveoli and noncardiogenic pulmonary edema
Formation of intra-alveolar hyaline membrane
This “ground-glass” appearance of lung fields is seen in what disease?
Neonatal Respiratory Distress Syndrome
ARDS is characterized by:
Acute onset respiratory failure, bilateral lung opacities, decreased PaO2/FiO2 (normal 300-500 mmHg), and no HF.
ARDS Management:
Mechanical ventilation with low tidal volumes
Address underlying cause
Near-complete opacification of the lungs with obscured cardiomediastinal silhouette is seen in what disease?
ARDS
Name the pathology and disease.
Thickened hyaline membranes (pink), and alveolar fluid (clear frothy)
ARDS
The initial damage in ARDS is due to ?
Release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade, and oxygen-derived free radicals.
Normal FEV1/FVC Ratio = 80%
Obstructive Lung Disease
FEV1/FVC <80%
In both obstructive and restrictive, FEV1 and FVC are reduced. In obstructive, however, FEV1 is more dramatically reduced compared to FVC, resulting in a decreased ratio.
Restrictive Lung Disease
FEV1/FVC >/= 80%
In both obstructive and restrictive, FEV1 and FVC are reduced.
Pulmonary Hypertension =
>/= 25mmHg at rest
Normal pulmonary artery pressure =
10-14 mmHg
Pulmonary Hypertension results in…
arteriosclerosis, medial hypertrophy, and intimal fibrosis of pulmonary arteries
Primary (Idiopathic) Pulmonary Hypertension is caused by what?
Inactivating mutation in BMPR2 gene, which normally functions to inhibit proliferation of vascular smooth muscle.
Heritable
Poor Prognosis
Secondary Pulmonary Hypertension can be due to…
COPD, mitral stenosis, recurrent thromboemboli, autoimmune disease, left-to-right shunt, sleep apnea, certain drugs, HIV infection, Congenital Heart Disease, Schistosomiasis, or living at high altitude
Why would a left-to-right shunt cause PAH?
Increases shear stress which leads to endothelial injury
Why would living at high altitude cause Pulmonary HTN?
Causes hypoxic vasoconstriction
What drugs can cause Pulmonary HTN?
Cocaine, Amphetamines
Sleep apnea is defined by
Repeated cessation of breating > 10 seconds during sleep.
Leads to disrupted sleep, and daytime somnolence.
How is PaO2 affected during the day in someone who suffers from sleep apnea?
Normal
How is PaO2 affected at night in someone with sleep apnea?
Nocturnal hypoxia, which leads to systemic/pulmonary hypertension, arrhythmias (A-Fib/A-flutter), and sudden death.
Central sleep apnea is due to? Outcome?
CNS injury / toxicity
no respiratory effort
Obstructive sleep apnea is due to? Result?
Airway obstruction caused by excess parapharyngeal tissue in adults, adenotonsillar hypertrophy in children.
Respiratory effort against airway obstruction
Obstructive sleep apnea is associated with
obesity, lound snoring
Sleep apnea treatment:
weight loss, CPAP, surgery
Sleep apnea can cause polycethmia becauase…
hypoxia leads to increase EPO release which leads to erythropoiesis
Obesity hypoventilation syndrome:
BMI >/= 30 which leads to hypoventilation during sleep, decreased PaO2 and Increased PaCO2 during waking hours
Breath sounds, percussion, and fremitus in pleural effusion:
Breath sounds: decreased
Percussion: Dull
Fremitus: decreased
No tracheal deviation
Breath sounds, percussion, fremitus, and tracheal deviation in atelectasis
Breath sounds: decreased
Percussion: dull
Fremitus: decreased
Deviation: toward side of lesion
Breath sounds, percussion, fremitus, and tracheal deviation in spontaneous pneumothorax:
breath sounds: decreased
Percussion: hyperresonant
Fremitus: decreased
No tracheal deviation
Breath sounds, percussion, fremitus, and tracheal deviation in tension pneumothorax
breath sounds: decreased
percussion: hyperresonant
fremitus; decreased
tracheal deviation: AWAY from side of lesion
Percussion to normal lung:
resonance
Breath sounds, percussion, fremitus, and tracheal deviation in lung consolidation (lobar pnumonia, pulmonary edema)
breath sounds: bronchial breath sounds; late inspiratory crackles
Percussion: dull
Fremitus: INCREASED
tracheal deviation: none
Leading cause of cancer death
Lung cancer
Lung cancer often presents with:
cough, hemoptysis, bronchial obtruction, wheezing, pneumonic “coin” lesion on xray or noncalcified nodule on CT
Most common type of lung cancer
Secondary (metastases) from other areas
Lung metastases are more common than primary neoplasms. Most often from:
breast, colon, prostate, and bladder
Lung cancer often metastasizes to these areas:
adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)
Lung cancer complications:
SPHERE
Superior vena cava syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal symptoms (hoarseness)
Effusions (pleural or pericardial)
Risk factors of lung cancer:
smoking, second hand smoke, radon, asbestos, family history
Adenocarcinoma location
peripheral
Most common lung cancer in nonsmokers
Adenocarcinoma
Most common lung cancer overall (except for metastases)
Adenocarcinoma
k-ras, EGFR, and ALK are activating mutations in what cancer?
Adenocarcinoma
Clubbing is associated with what lung cancer?
Adenocarcinoma
Clubbing = hypertrophic osteoarthropathy
Lung cancer in which chest x-ray shows hazy infiltrates similar to pneumonia:
Bronchioalveolar subtype of Adenocarcinoma
What lung cancer grows along alveolar septa and leads to apparent “thickening” of alveolar walls?
Bronchioloalveolar subtype of Adenocarcinoma
What lung cancer has a glandular pattern on histology, and often stains mucin + ?
Adenocarcinoma
This is an image of what type of lung pathology?
Adenocarcinoma: Glandular pattern on histology, often stains mucin +
Squamous cell carcinoma is located where?
Centrally
(Squamous and Small cell carcinomas are Sentral (central))
Hilar mass arising from bronchus is indicative of what lung cancer?
Squamous cell carcinoma
Cavitation, Cigarettes, hyperCalcemia (produces PTHrP) are characeteristics of what lung cancer?
Squamous cell carcinoma
Keratin pearls and intercellular bridges are indicative of what lung pathology?
Squamous cell carcinoma
Name lung pathology and histological charactersitics:
Squamous cell carcinoma
Keratin pearls and intracellular bridges
Note sheets of large, dysplastic squamous cells (arrows) surrounding dark pink keratin pearls (lower right)
Small cell (oat cell) carcinoma is located where?
Centrally
Undifferentiated and very aggressive form of lung cancer:
small cell (oat cell) carcinoma
ACTH, ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome) are often produced in this lung cancer:
small cell (oat cell) carcinoma
Amplification of myc oncogenes is common in this type of lung cancer
small cell (oat cell) carcinoma
How is small cell (oat cell) carcinoma treated?
Chemotherapy. Inoperable
This image is characteristic finding in what lung pathology?
small cell (oat cell) carcinoma
Neoplasm of neuroendocrine or Kulchitsky cells -> small cark blue cells
Sheets of dark purple tumor cells with nuclear molding, high mitotic rate, necrosis, and “salt and pepper” neuroendocrine-type chrmatin
Large cell carcinoma is located where?
Periphery
This lung cancer characteristically has anaplastic undifferentiated tumors
Large cell carcinoma
How do you treat large cell carcinoma?
Surgical removal. Less responsive to chemotherapy
Histologically, this lung cancer has pleomorphic giant cells and can secrete beta-hCG
large cell carcinoma
This lung cancer has an excellent prognosis
Bronchial carcinoid tumor (metastasis is rare)
Symptoms in bronchial carcinoid tumor are usually due to
mass effect; occasionally carcinoid syndrome (5-HT secretion, flushing, diarrhea, wheezing)
What is carcinoid syndrome?
Seen in bronchial carcinoid tumor
5-HT secretion –> flushing, diarrhea, wheezing
What is shown in this xray?
Hilar mass arising from bronchus (squamous cell carcinoma)
Nests of neuroendocrine cells are indicative of what type of lung pathology?
Bronchial carcinoid tumor
These lung cancers are chromogranin A +:
bronchial carcinoid tumor
small cell (oat cell) carcinoma
Why? Both consist of neuroendocrine cells, and chromogranin A is located in the secretory granules of neurons and endocrine cells
Malignancy of the pleura associated with asbestosis:
Mesothelioma
Mesothelioma results in …
hemorrhagic pleural effusions and pleural thickening
What characteristic finding is seen on histology of mesothelioma?
Psammoma bodies
Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus
Pancoast Tumor
Pancoast tumor that impinges on cervical sympathetic plexus may result in:
Horner syndrome (ispilateral ptosis, miosis, and anhidrosis)
SVC syndrome
Sensorimotor deficits
Hoarseness
Superior Vena Cava Syndrome
An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”), neck (jugular venous distention), and upper extremities (edema).
What causes SVC syndrome?
Commonly caused by malignancy (Pancoast Tumor) and thrombosis from indwelling catheters.
Is SVC syndrome a serious problem?
It is a medical emergency. Can raise intracranial pressure (severe obstruction) which can lead to headaches, dizziness, and increased risk of aneurysm/rupture of intracranial arteries
This MRI shows what lung pathology?
Pancoast tumor. See mass at Right lung apex.
What are these characteristic structures, and in what lung pathology are they found in?
Psammoma bodies
Mesothelioma
Most common organism to cause lobar pneumonia?
S. pneumoniae
Legionella and Klebsiella are also common
Characteristics of lobar pneumonia:
intra-alveolar exudate –> consolidation; may involve entire lung
Typical organisms in bronchopneumonia:
S. pneumoniae, S. aureus, H. influenzae, Klebsiella
Characteristics of Bronchopneumonia:
Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving >/= 1 lobe
This Xray shows what?
Lobar pneumonia. Dense right upper lobe consolidation with branching air-bronchograms; sharp inferior margin represents the horizontal fissure.
This gross specimen shows what lung pathology?
Lobar pneumonia
What cells are whinin the alveolar spaces, and what lung pathology is this indicative of?
Neutrophilic infiltrate
Bronchopneumonia
Name consolidation pattern and lung pathology:
Patchy distribution involving >1 lobe
Bronchopneumonia
Interstitial (atypical) pneumonia is most commonly caused by what organisms?
Viruses (influenza, RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia
Interstitial pneumonia is characterized by:
diffuse patchy inflammation localized to interstitial areas at alveolar walls
Distribution >/= 1 lobe
Follows more indolent course
This xray shows what characteristics and what lung pathology?
Course bilateral reticular opacities, worse on right
Interstitial pneumonia (diffuse, patchy interstitial inflammation)
Localized collection of pus within parenchyma:
lung abscess
Lung absesses are caused by:
bronchial obstruction (cancer) or aspiration of oropharyngeal contents (especially in pts predisposed to loss of consciousness [alcoholics or epileptics])
This specimen shows what lung pathology?
lung abscess
This xray shows what characteristics and what lung pathology?
Air fluid levels and cavitation.
Lung abscess
Lung abscesses are often caused by what organisms?
Anaerobes (Bacteroides, Fusobacterium, Peptostreptococcus) or S. aureus
Treatment for Lung Abscess
Clindamycin
Pleural Effusion:
Excess accumulation of fluid between the two pleural layers –> restricted lung expansion during inspiration
Transudate:
Decreased protein content.
Due to CHF (increased hydrostatic pressure), nephrotic syndrome (proteinuria -> decreased colloid oncotic pressure), or hepatic cirrhosis (decreased colloid oncotic pressure)
Exudate:
Increased protein content, cloudy.
Due to malignancy, pneumonia, collagen vascular disease, trauma
Occurs in states of Increased vascular permeability
Must be drained in light of risk of infection:
Exudate
Lymphatic/Chylothorax:
Due to thoracic injury from trauma, malignancy.
Milky-white appearing fluid; Increased triglycerides
Xray shows what pathology?
Pleural effusion (excess accumulation of fluid between the 2 pleural layers)
CT shows what pathology?
Pleural Effusion
What is seen on Xray and CT after treatment of pleural effusion?
Almost complete resolution after therapy.
Pneumothorax:
Accumulation of air in the pleural space
Pneumothorax signs and symptoms:
Unilateral chest pain and dyspnea, unilateral chest expansion, decreased tactile fremitus, hyperresonance, diminished breath sounds, all on the affected side.
Spontaneous pneumothorax:
Accumulation of air in the pleural space.
Occurs most frequently in tall, thin, young males because of rupture of apical blebs.
Tension pneumothorax:
Usually occurs in setting of trauma or lung infection. Air is capable of entering pleural space but not exiting. Trachea deviates away from affected lung.
What is shown on this CT?
Pneumothorax (collapsed lung)
What is shown on the xray?
Tension pneumothorax.
Deviation of trachea away from hyperlucent left lung. Low left hemidiaphragm.
