0:01

This next case is a 32-year-old gentleman who comes into the ER after

0:06

a street party melee complaining of shortness of breath.

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There is a PA and a lateral view of the chest that were ordered.

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And so, again, in terms of looking at it

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in our systematic fashion, take a look at the lung.

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So the left lung is essentially clear.

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The right lung, there are no parenchymal opacities.

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There's no pneumothorax, no pleural effusion.

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We look at the mediastinum, the trachea is midline patent.

0:35

We see the initial takeoffs and those look fine.

0:40

When you take a look at the heart size, normal.

0:42

When we look at the hilar structures, again, they're normal in size.

0:46

What we do notice is this rounded opacity here in the right hilum.

0:50

Upon initial view, you may think that this is similar to one of the gown snaps.

0:55

However, it does have a different configuration.

0:57

You'll see that the gown snaps are oriented differently at different times.

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And so sometimes on a PA and lateral,

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you're going to get two different views of a single structure.

1:07

So it may be helpful to always look at your lateral view,

1:09

which will take a look at in a second, to really understand what this structure is.

1:13

But it's a little bit denser than the other snaps.

1:16

And when we look at the lateral view,

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what we can see is one, that it is actually not sitting external to the patient like

1:23

the snaps would be, but it's actually sitting inside the patient.

1:26

And this is not necessarily the configuration of a snap.

1:29

And this is a patient who actually inhaled a piece of a pen that was in his mouth

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and there was, during the melee, some aspiration that took place.

1:39

So in terms of going back to the frontal view,

1:42

again, this is located in the area of the right lower lobe airway,

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which is where we expect most commonly for aspiration events to take place

1:51

because of the orientation of the right lower lobe bronchus.

1:55

And again, we know that it's not external like some of these other structures are

1:58

because when we look at the lateral, it locates inside the lung.

2:03

And so, this is an example of a right lower lobe aspiration.