Examine this patient's chest.

SALIENT FEATURES

History

· History of TB, ankylosing spondylitis, radiation.

· History of phrenic nerve crush, plombage, thoracotomy.

Examination

· The fibrosis is usually apical.

· Flattening of the chest on the affected side.

· Tracheal deviation to the affected side.

· Reduced expansion on the affected side.

· Dull percussion note.

· Presence of localized crackles; bronchial breathing may be present.

Proceed as follows:

Look for the following signs:

· Scars of phrenic nerve crush, plombage, thoracotomy.

· Radiation scars.

DIAGNOSIS

This patient has flattening of the R/L side of the chest with diminished movements on that side, tracheal deviation and localized

crackles (lesion) due to pulmonary fibrosis secondary to tuberculosis (aetiology), and is comfortable at rest (functional status).

QUESTIONS

Mention a few causes of upper lobe fibrosis.

* Tuberculosis.

· Ankylosing spondylitis.

· Radiation-induced fibrosis.

ADVANCED-LEVEL QUESTIONS

Which is the best imaging procedure for the upper lobe lesions?

MRI is better for upper lobe lesions than CT of the chest.

What is the role of MRI of the thorax?

MRI of the thorax is less useful than CT scanning because of poorer imaging of the pulmonary parenchyma and inferior spatial

resolution. However, MRI can provide images in multiple planes (e.g. sagittal, coronal as well as transverse) which CT can not. MRI

is excellent for evaluating processes near the lung apex, spine and thoraco-abdominal junction.

On 8 November 1895 R6ntgen discovered what he called X-rays. In the subsequent

7 weeks he meticulously performed experiments, and an X-ray picture of his wife's hand convinced him about the potential role of the new ray. In 1901 he was awarded the

Nobel Prize for physics.

Hounsfield's work on CT in the EMI laboratories at Hounslow made it possible to obtain detailed cross-sectional views of the soft tissues, particularly the brain.

Sir Godfrey N. Hounsfield (1919-) and Alan M. Cormack (1924-), the latter of Tufts University, Boston, were jointly awarded the 1979 Nobel Prize for Medicine for the

development of computer-assisted tomography.


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