Click on the image for an enlarged view
Homogenous opacity with higher level towards the axilla on the left side is characteristic of a large pleural effusion on the left side. Tracheal and mediastinal shift to the right side is also evident. Pleural effusion can be either a transudate as in heart failure or exudate as in infections, inflammatory disorders or malignancy. Transudate is identified as a clear fluid with low protein and cell content. Exudate is straw coloured and has high protein and cell count. Hemorrhagic effusion is seen in …

Click on the image for an enlarged view
Left ventricular hypertrophy is manifest in this ECG as tall R waves in lateral leads (leads I, aVl, V5 and V6). S wave in V1 is 2.5 mV and R wave in V6 is 2.2 mV, with a total of 4.7 mV, which is well beyond the 3.5 mV cut off for diagnosis of left ventricular hypertrophy by voltage criteria. Voltage criteria for left ventricular hypertrophy is more sensitive, but less specific. Voltage may be enhanced in thin chest wall as in children. …

Click on the image for an enlarged view
Baseline is irregular and lead V1 shows coarse fibrillary waves suggestive of atrial fibrillation. But the unusual feature about this ECG is the grouped beating, which is unusual in atrial fibrillation. The QRS complexes appear to be in a bigeminal rhythm. Since a long rhythm strip is not available, we cant be sure about the group beating. Here all the beats are having a narrow QRS complex. If it was one narrow and one wide, it could have been called a ventricular ectopic …

Click on the image for an enlarged view
Left bundle branch block is characterised by a wide QRS, which is 120 msec or more. The left precordial leads V5 and V6 will show a tall RR’ or M shaped QRS complex. A QS complex with a notch or W shaped QRS may be seen in right precordial leads V1 and V2. A small initial r wave may be seen in these leads. Secondary ST segment and T wave changes are seen associated, in the form of a discordant ST – T. …