RADIOLOGY CASE REPORT
University of Ottawa 3rd year clerk
Patient ID: OH#___3306717-4______Date of Study: ____June 10/08______
Type of Study: __PA and Lateral CXR______
1. Clinical Indication: __63 year old female with exposure to ammonia. Requisition gave no indication of any symptomology (ie. Chest pain, dyspnea).
2. Picture:
2. Describe the radiological findings:
__Lungs are clears, with no evidence of airspace or interstitial disease. There is no evidence of pulmonary edema, pleural effusions, pneumomediastinum or pneumothorax. However, there is an asymmetric opacification in the medial RUL. In comparison to a previous CXR (Feb 12/2008), this opacification has become more radio-opaque.
3. Provide possible diagnosis(es):
___Lung tumor, granuloma (eg. TB), pneumonia______
4. What would you recommend next for this patient?
____The patient should have a Chest CT to better image the lung consolidation.__
5. Is the use of this test/procedure appropriate?
___Yes, this is the appropriate test (CXR) to look for chest pathology from chemical exposure. The consolidation is a incidental finding which is best re-examined using CT.__
6. Is(are) there any alternate test(s)?
___At the moment, CT chest is the best test. If it turns out to be a nodule, then FNA could be done. Alternately, a PET scan is a possibility in order to see if the area is metabolically active (ie. An active tumor).
7. How would you explain to the patient about the possible risks and benefits of this test?
____The risks of CXR are low, as they use minimal amounts of radiation. If this patient was younger (and therefore at risk of pregnancy), I would explain that radiation can be harmful to the fetus and the ovaries, however, that precautions (shielding) will be used that are quite effective at protecting the pelvic area. There is, of course, always a slight risk of cancer from the radiation, but the benefits of accurate diagnosis far outweigh the risk. Other benefits of the xray is that no radiation remains in the patient’s body after the test, there are generally no side effects, it’s quick, and it is relatively inexpensive for the health care system.
8. What is the cost of this test?
___A CXR is in the range of 20-30 dollars, plus the cost of the technician and radiologist (to perform the test and read/report it).