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Q scan
SELF ASSESSMENT: SHORT CASE PRESENTATIONS
373 She received several courses of treatment, including admission for intravenous antibiotics and physiotherapy. On examination she was noted to have decreased breath sounds in the left hemithorax. A chest radiograph (Fig. 1) and V/Q scan (Fig. 2) were performed. Questions 1) 2) 3) 4)
What are the abnormalities on this chest radiograph? What are the findings on the V/Q scan? Give a differential diagnosis for each of these findings. What other investigations would you perform?
doi: 10.1053/prrv.2000.0083, available online at http://www.idealibrary.com on
CASE 5: PRESENTATION Chest X-ray and V/Q scan Case 4.
Case 4.
Figure 1.
A girl was delivered by normal vaginal delivery at 38 weeks’ gestation. On antenatal ultrasound scanning at 20
Case 5.
Figure 1.
Case 5.
Figure 2.
Figure 2.
doi: 10.1053/prrv.2000.0082, available online at http://www.idealibrary.com on
CASE 4: PRESENTATION Chest X-ray and V/Q scan An 11-month-old girl was referred for investigation of chronic cough, episodic wheeze and vomiting. She was born at 37 weeks’ gestation by normal vaginal delivery, and had an uneventful neonatal course. She initially presented to her GP at 5 months of age with a sudden onset of shortness of breath. There were no preceding symptoms of cough or cold. A provisional diagnosis of bronchiolitis was made and she was treated with antibiotics, from which she developed diarrhoea and vomiting but no rash. Over the next few months she developed a persistent cough, worse when lying down or when eating, and had several episodes of wheezing and of vomiting solids.
© 2000 Harcourt Publishers Ltd
374
weeks’ gestation the heart was noted to lie in the right hemithorax, the stomach on the left side of the abdomen. An amniocentesis was performed and revealed a normal female karyotype. A repeat antenatal scan at 32 weeks showed polyhydramnios. Following birth the child was electively intubated, but attempts to pass an NG tube were unsuccessful. Oesophageal atresia was diagnosed. A chest radiograph was obtained (Fig. 1), and subsequently a V/Q scan was performed (Fig. 2).
SELF ASSESSMENT: SHORT CASE PRESENTATIONS
Questions 1) 2) 3) 4)
What does the chest radiograph show? What does the V/Q scan show? What is the most likely diagnosis? What associated anomalies may occur with this diagnosis? 5) What would be your differential diagnosis?
373 She received several courses of treatment, including admission for intravenous antibiotics and physiotherapy. On examination she was noted to have decreased breath sounds in the left hemithorax. A chest radiograph (Fig. 1) and V/Q scan (Fig. 2) were performed. Questions 1) 2) 3) 4)
What are the abnormalities on this chest radiograph? What are the findings on the V/Q scan? Give a differential diagnosis for each of these findings. What other investigations would you perform?
doi: 10.1053/prrv.2000.0083, available online at http://www.idealibrary.com on
CASE 5: PRESENTATION Chest X-ray and V/Q scan Case 4.
Case 4.
Figure 1.
A girl was delivered by normal vaginal delivery at 38 weeks’ gestation. On antenatal ultrasound scanning at 20
Case 5.
Figure 1.
Case 5.
Figure 2.
Figure 2.
doi: 10.1053/prrv.2000.0082, available online at http://www.idealibrary.com on
CASE 4: PRESENTATION Chest X-ray and V/Q scan An 11-month-old girl was referred for investigation of chronic cough, episodic wheeze and vomiting. She was born at 37 weeks’ gestation by normal vaginal delivery, and had an uneventful neonatal course. She initially presented to her GP at 5 months of age with a sudden onset of shortness of breath. There were no preceding symptoms of cough or cold. A provisional diagnosis of bronchiolitis was made and she was treated with antibiotics, from which she developed diarrhoea and vomiting but no rash. Over the next few months she developed a persistent cough, worse when lying down or when eating, and had several episodes of wheezing and of vomiting solids.
© 2000 Harcourt Publishers Ltd
374
weeks’ gestation the heart was noted to lie in the right hemithorax, the stomach on the left side of the abdomen. An amniocentesis was performed and revealed a normal female karyotype. A repeat antenatal scan at 32 weeks showed polyhydramnios. Following birth the child was electively intubated, but attempts to pass an NG tube were unsuccessful. Oesophageal atresia was diagnosed. A chest radiograph was obtained (Fig. 1), and subsequently a V/Q scan was performed (Fig. 2).
SELF ASSESSMENT: SHORT CASE PRESENTATIONS
Questions 1) 2) 3) 4)
What does the chest radiograph show? What does the V/Q scan show? What is the most likely diagnosis? What associated anomalies may occur with this diagnosis? 5) What would be your differential diagnosis?