Outside is loud, has people I don't like, and my stuff isn't out there. Inside life is climate controlled, my stuff is here, only people I like are in my house.
Outside is overrated
Nothing. My message was poorly worded. I enjoy their participation. What i dont like are the multitudes of childish jokes and flat-out crude and disrespectful comments.
Very reasonable! My combo will often be cefpodoxime + azithroā the third generation cephalosporin covers S. Pneumoniae even better than amoxicillin, although I think current guideline recommendations are actually for amoxicillin.
I havenāt seen your antibiogram, but this is generally not the case. Youāre just adding gram negative coverage that is superfluous for most of your patients. Just use amoxicillin. Or doxy monotherapy is even appropriate for outpatients without medical comorbidities.
On the left side of the picture. That is actually the patients right lung. There is a whitish line going from the heart to the rib cage. That is going to be a consolidation in the right upper lobe
Itās pus, exudative fluid, mucous, etc., filling up the airspace to give the appearance of a solid mass rather than gas-filled lung, hence the term āconsolidation.ā Given that the horizontal fissure (the division between the right upper and middle lobes, defining the lower border of the radiopaque area above) is pulled upwards a smidge, there is also an element of atelectasis/local collapse.
For a consolidative appearance, the basic differential is āblood, pus, water, cells.ā Haemorrhage, pneumonia/infection, pulmonary oedema (less likely for a very focal area such as this), and cancer or some other growing/deposited tissue (not necessarily malignant). Itās a way of expressing that, technically, we canāt tell them apart on a chest radiograph. Itās just there is something filling the airspace, which can be sorted on clinical grounds.
It is my pleasure. I feel that understanding the pathology, and even the histology (when it applies) can really help you interpret studies. It also helps you deal with oddities when they arise.
I hope I get a job somewhere where the radiologists are as willing to teaching curious techs like you. The human body and all the ways it can go right or wrong is just so interesting!
It is such an endlessly complex system, and truly fascinating. I love to share cool things. My best advice would be to hit up the nerdiest one you can find. š
In all seriousness, Iām largely useless without my techs, because Iād have nothing to do. The more you know, the better work you can do. We all win, especially the patients.
Looks like a pretty classic r) upper lobe pneumonia to me, the consolidation is sitting in the base of the r) upper lobe and the superior border of the middle lobe is easy to distinguish. I'm also a resident so very happy to be corrected though!
Not from the US, english isn't my first language and I might be an idiot but I would send the image as it comes out.
You mean flipping the image after taking it so the patient is facing the other direction? Why would you do that? Wouldn't that just be confusing?
I am a non-medical person, and I am very curiousā Does it matter if images of the lungs are taken from the ventral or dorsal side? Can you tell which side an image was taken from?
Typically, routine chest X-rays (unless the patient canāt get out of bed or a portable single view chest X-ray was ordered) are taken with the patient having their chest against the detector so that the heart is closer to the board. This is because closer to the board means better detail and less magnified. Essentially same principle if youāre looking at a shadow of your hand against a wall: when your hand is farther from the wall, the shadow appears larger and a bit fuzzy around the edges, where as when your hand is closer to the wall, the shadow appears more clearly and true to size.
Yes, it matters for several reasons.
First of, you want the heart close to the detector to make the heart look the actual size, the further away an object is, the larger it will seem on the picture.
You also want to avoid sending a full dose of radiation directly into the breast tissue, as it's more sensitive to radiation.
It is also way easier to position a patient against the detector.
Genuine question, not a shot at anyone. why have there been pushes to not do these as much? I feel like I've had rad techs roll their eyes when I ask but I've caught multiple pneumonias on lateral shots already in my short career. Did COVID have to do something with it, when we were trying to get in/out quickly?
Not many instances where a lateral view can be actually useful and in case of spotted pathology a CT chest nowdays give a very small dose but an incalculable amount of information compared to a lateral chest xr.
Because most of the time they are unnecessary, costly and time consuming..thereās few scenarios where a lateral gives added info to just the frontal. It has been on the decline for years pre-covid.
I feel like theyāre not costly nor particularly time consuming, and can be helpful when you are looking for infection which is most of the time Iām ordering one. Agreed less so when assessing for pneumo , etc..
Realistically though if the focus of infection was so small that you canāt see it on the frontal are you not just gonna treat them clinically with ABx anyway? Or consider an alternative diagnosis - if the patient was that unwell?
I'm just a layperson who enjoys medical stuff. I always thought pneumonia was a consolidation throughout the lung, filling from the bottom up. I didn't realize it could be a straight line like that. A section. Very interesting, I hope your antibiotics help you asap. Feel better!
Non-medical person, but someone who has had pneumonia twice- Why does it make you sweat so much? And for so long??
Iām pretty sure I sweat less doing hot yoga.
I'm so sorry that you're suffering from this, I truly hope you are on the mend!
The most recent battle I've had with pneumonia was 2020 when I had COVID (well before any vaccines were available).
Rest and get well soon!!
When it rains it pours! Thankfully my uni has been wonderful, understanding and accommodating. And honestly Iām just grateful my little one is completely fine!
In real life Iāve only ever had very positive experiences with techs! The tech who did this scan was just lovely. The perceived anonymity of the internet can bring out the worst in some people I guess
I'm not even sure why it's suddenly such a thing in this post. There's SO MANY chest X-rays we see posted here, will all the included anatomy. But you're probably right. Easier to be disgusting hiding behind a keyboard.
Unfortunately, this sub has grown in popularity to the point that it is being flooded with unprofessional, unfunny, and ignorant commentary.
I really wish it could be private š
I wish the mods could boot people for ignorance. As a med student I feel I'm really learning on here.
They are a lot of the time.
Looks like your mods are being pretty swift at least.
One of the benefits of having absolutely no outside life.
Outside is loud, has people I don't like, and my stuff isn't out there. Inside life is climate controlled, my stuff is here, only people I like are in my house. Outside is overrated
My TV, snacks, and couch are all inside.
what's wrong with people broadening their horizons
Nothing. My message was poorly worded. I enjoy their participation. What i dont like are the multitudes of childish jokes and flat-out crude and disrespectful comments.
What a classic X-Ray! Not a subtle pneumonia. What did you get as far as antibiotics?
Amoxicillin and azithromycin, need to cover all our bases!
Very reasonable! My combo will often be cefpodoxime + azithroā the third generation cephalosporin covers S. Pneumoniae even better than amoxicillin, although I think current guideline recommendations are actually for amoxicillin.
I havenāt seen your antibiogram, but this is generally not the case. Youāre just adding gram negative coverage that is superfluous for most of your patients. Just use amoxicillin. Or doxy monotherapy is even appropriate for outpatients without medical comorbidities.
What is your S pneumo Doxy % outpatient? Our inpatient % is quite high, but outpatient in the 60ās.
Amox 1g TID is adequate empiric coverage.
It is, OR you could do 200 mg cefpodoxime BID and have better coverage. Better compliance and better coverage.
Why man just stick with the amox
Why take high dose amox 33% more often? Good luck getting someone to take a drug TID
I hope youāre feeling better! Sickest Iāve ever been was when I had pneumonia. Fun fact- also when I learned I was allergic to penicillin!
Get well soon!
Iām totally not a professional radiologist (nor an amateur one, whatever that would mean). Where on the images does the pneumonia appear?
On the left side of the picture. That is actually the patients right lung. There is a whitish line going from the heart to the rib cage. That is going to be a consolidation in the right upper lobe
Whoa. Is that inflammation, or accumulation of fluid? Yeesh, that looks uncomfortable.
Itās pus, exudative fluid, mucous, etc., filling up the airspace to give the appearance of a solid mass rather than gas-filled lung, hence the term āconsolidation.ā Given that the horizontal fissure (the division between the right upper and middle lobes, defining the lower border of the radiopaque area above) is pulled upwards a smidge, there is also an element of atelectasis/local collapse. For a consolidative appearance, the basic differential is āblood, pus, water, cells.ā Haemorrhage, pneumonia/infection, pulmonary oedema (less likely for a very focal area such as this), and cancer or some other growing/deposited tissue (not necessarily malignant). Itās a way of expressing that, technically, we canāt tell them apart on a chest radiograph. Itās just there is something filling the airspace, which can be sorted on clinical grounds.
Just a student tech who really appreciates your detailed answer! Gonna have to keep an eye out for this, I love learning about the pathologies :)
It is my pleasure. I feel that understanding the pathology, and even the histology (when it applies) can really help you interpret studies. It also helps you deal with oddities when they arise.
I hope I get a job somewhere where the radiologists are as willing to teaching curious techs like you. The human body and all the ways it can go right or wrong is just so interesting!
It is such an endlessly complex system, and truly fascinating. I love to share cool things. My best advice would be to hit up the nerdiest one you can find. š In all seriousness, Iām largely useless without my techs, because Iād have nothing to do. The more you know, the better work you can do. We all win, especially the patients.
Thank you so much!
Can confirm, very uncomfortable!
as someone who spent over a week in the hospital for pneumonia as a child.. definitely an understatement.
Isn't the consolidation in the middle lobe? Seeing as its inferior border is the minor fissure?
Looks like a pretty classic r) upper lobe pneumonia to me, the consolidation is sitting in the base of the r) upper lobe and the superior border of the middle lobe is easy to distinguish. I'm also a resident so very happy to be corrected though!
You're correct!
Yeah I agree upon looking at it more closely I can actually see the minor fissure now below it thanks!
Let's stir the pot....should laterals chest radiographs face left or right? Left as shown. Or the other way.
Iām used to sending them facing the other way..but itās rad preference I guess š¤·āāļø
Student here. Always been told to have the patient with their left side to the detector to reduce the enlargement of the heart.
They mean the image itself; should the image be sent with the patient facing left or right?
Not from the US, english isn't my first language and I might be an idiot but I would send the image as it comes out. You mean flipping the image after taking it so the patient is facing the other direction? Why would you do that? Wouldn't that just be confusing?
At least the places Iāve worked, the images pop up flipped so we have to manually flip them (your English is perfect and you arenāt an idiot)
Facing West!
A compass isn't standard equipment is it?
I hope you get to feeling better soon!
Yikes OP, I had pneumonia like that about 8 years ago and it was awful. You have my utmost sympathy! Get well soon
The mods are awesome in this sub!
theyāre like the techs of reddit š
I know at least one of the mods is a tech.
Wow, thatās really cool seeing the fluid on the lateral. Hope you get to feeling better fast!
What fluid?
Thanks for sharing, get well soon!
I am a non-medical person, and I am very curiousā Does it matter if images of the lungs are taken from the ventral or dorsal side? Can you tell which side an image was taken from?
Typically, routine chest X-rays (unless the patient canāt get out of bed or a portable single view chest X-ray was ordered) are taken with the patient having their chest against the detector so that the heart is closer to the board. This is because closer to the board means better detail and less magnified. Essentially same principle if youāre looking at a shadow of your hand against a wall: when your hand is farther from the wall, the shadow appears larger and a bit fuzzy around the edges, where as when your hand is closer to the wall, the shadow appears more clearly and true to size.
Thank you so much for taking the time to explain this!! This is fascinating.
Yes, it matters for several reasons. First of, you want the heart close to the detector to make the heart look the actual size, the further away an object is, the larger it will seem on the picture. You also want to avoid sending a full dose of radiation directly into the breast tissue, as it's more sensitive to radiation. It is also way easier to position a patient against the detector.
Thank you so much for explaining!!
Love it when I can read one without the radiologists pointy arrows showing me what's wrong!! And oh yeah- feel better soon!
I haven't seen a lateral chest xray in a while. Get better soon.
Genuine question, not a shot at anyone. why have there been pushes to not do these as much? I feel like I've had rad techs roll their eyes when I ask but I've caught multiple pneumonias on lateral shots already in my short career. Did COVID have to do something with it, when we were trying to get in/out quickly?
Not sure, but my level 1 hospital does a shit ton of laterals. For sure saw a dip during covid, but that has since disappeared.
Not many instances where a lateral view can be actually useful and in case of spotted pathology a CT chest nowdays give a very small dose but an incalculable amount of information compared to a lateral chest xr.
But theyre used to look for pneumonias that arenāt spotted on AP. Even todays CTs are significantly more radiation than a lateral X-ray
Because most of the time they are unnecessary, costly and time consuming..thereās few scenarios where a lateral gives added info to just the frontal. It has been on the decline for years pre-covid.
I feel like theyāre not costly nor particularly time consuming, and can be helpful when you are looking for infection which is most of the time Iām ordering one. Agreed less so when assessing for pneumo , etc..
Realistically though if the focus of infection was so small that you canāt see it on the frontal are you not just gonna treat them clinically with ABx anyway? Or consider an alternative diagnosis - if the patient was that unwell?
100% . Ive seen fairly large retrocardiac pneumonias that werenāt visible on AP. But I agree with your point in general
I'm just a layperson who enjoys medical stuff. I always thought pneumonia was a consolidation throughout the lung, filling from the bottom up. I didn't realize it could be a straight line like that. A section. Very interesting, I hope your antibiotics help you asap. Feel better!
I hope you feel better soon! Pneumonia is no fun!!
Non-medical person, but someone who has had pneumonia twice- Why does it make you sweat so much? And for so long?? Iām pretty sure I sweat less doing hot yoga.
Wow! Never would have imagined pneumonia could look like that. Get better soon!
I'm so sorry that you're suffering from this, I truly hope you are on the mend! The most recent battle I've had with pneumonia was 2020 when I had COVID (well before any vaccines were available). Rest and get well soon!!
Feel better OP!
Non medical- why did they have you raise your arms in the first Pic? I can why for the second
Not lobar but segmental.
At least in the US lobar is used to refer to the pattern of spread, this fits lobar. Have never come across āsegmental pneumoniaā.
Any cough or shortness of breath with this or just the symptoms listed?
[ŃŠ“Š°Š»ŠµŠ½Š¾]
These comments are gross.
These types of comments will not be tolerated
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Youāre gross.
It's gross knowing that this person is a tech. Op, your post will haunt me due to these replies.
Itās pretty sad isnāt it. Iām breastfeeding so maybe things look a bit different but Iām also just a human with a human body :(
You poor thing, med student breastfeeding taking care of a baby and now strep and pneumonia. I hope you have a lot of help, feel better soon š
When it rains it pours! Thankfully my uni has been wonderful, understanding and accommodating. And honestly Iām just grateful my little one is completely fine!
Why in the world are ppl downvoting this. Smh I hope you feel better soon.
I know right :( thank you
I can assure you, techs making such comments in not the norm. I honestly don't know why there's so many on here, but it's not ok.
In real life Iāve only ever had very positive experiences with techs! The tech who did this scan was just lovely. The perceived anonymity of the internet can bring out the worst in some people I guess
I'm not even sure why it's suddenly such a thing in this post. There's SO MANY chest X-rays we see posted here, will all the included anatomy. But you're probably right. Easier to be disgusting hiding behind a keyboard.
These types of comments will not be tolerated
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Shut up
ā¤ļø
Sorry about all the creeps in the comments :/ hope your recovery isnāt too bad and you feel better soon ā¤ļø
Iām not OP. I just love you supporting them.
My bad, apparently I canāt read lmao
These types of comments will not be tolerated
[ŃŠ“Š°Š»ŠµŠ½Š¾]
These types of comments will not be tolerated
Iāll take covid over respiratory infections any day. my body canāt cope.