5.18.20
Publication Date: 2020-05-18
6 images
Findings
Opposite lateral and VD radiographs of the thorax and abdomen are acquired by the emergency service.
Thorax: There is an unstructured interstitial coalescing to alveolar pattern throughout the entire right cranial, right middle, and right caudal lung lobes. On the VD view, there is a small region of suspect alveolar pattern of the left caudal lung lobe, superimposed with the cardiac silhouette. The remainder of the left lung lobes have a mild unstructured interstitial pattern. There is ill-defined increased soft tissue opacity and widening of the cranial mediastinum. There is generalized mild to moderate dilation of the esophagus which has a subjectively thickened wall at its caudal aspect on the left lateral view. On the right lateral view, there are fusiform shaped to ovoid gas opacities within the ventral pleural space. The cardiovascular structures are normal. There are multiple open physes, consistent with the reported patient's young age.
Abdomen: There is generalized mild decreased serosal detail throughout the abdomen. The stomach is moderately to markedly gas-distended. The small intestines are diffusely normal in diameter and contain mostly gas. The colon is mildly corrugated. The unobscured margins of kidneys and urinary bladder are normal. There are multiple open physes, consistent with the reported patient's young age.
Diagnosis
- The pulmonary pattern more severely affecting the right lung lobes likely represents caustic pneumonitis due to bleach aspiration/inhalation.
- The appearance of the cranial mediastinum may represent an incompletely regressed thymus (patient is estimated 8 months old).
- The gas dilation of the stomach is likely due to gastritis. Suspect colitis.
- The decreased serosal detail of the abdomen may be due to the patient's young age, however, peritoneal effusion cannot be ruled out.
Discussion
The patient was treated medically and was discharged.
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