The Xray given above was taken in a 37 year old patient who presented with acute colicky abdominal pain. Spot the diagnosis! How many air fluid levels are normally seen? Which are the normal sites where air fluid levels are seen?
The X-ray shows multiple air fluid levels. This finding combined with the history of colicky abdominal pain points towards the diagnosis of acute obstruction of small bowel. The obstruction may be due to adhesion, hernia, neoplasm, foreign body etc. Studies have shown that a normal person has on average 4 air fluid …

An 41 year-old male presented to the emergency department with the sudden onset of severe epigastric pain. He had a history of heart burn and dyspeptic symptoms for past 10 years. On physical exam, he had a temperature of 101.4°F, a pulse of 118 and a blood pressure of 128/72. Abdomen was tender with board like rigidity. An X-ray was taken to confirm the diagnosis.
What is the diagnosis revealed in the X-ray given above? What are the other conditions that can produce this sign?
 Answer:
X-ray shows gas under diaphragm – pneumoperitoneum. From …

Barium swallow – Right anterior oblique view chest x-ray – showing normal indentations of oesophagus
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The normal indentations of the esophagus seen in a right anterior oblique view during barium swallow are made by (from above downwards):

Aortic arch – 22.5 cm from incisor teeth
Left bronchus – 27.5 cm from incisor teeth
Left atrium

Clinical importance:

In olden days, when echocardiography was not available, this was used to detect left atrial enlargement in cases of mitral stenosis
When left atrium is enlarged, it may compress on the esophagus and cause dysphagia – …

Obliteration of spleen outline
Obliteration of psoas shadow
Intendation of gastric air bubble on the left side
Some of the left lower ribs may be fractured
Elevation of left hemidiaphragm
Increased free fluid in between air filled intestinal coils

Kerley B lines are short horizontal white lines seen in chest X-ray produced by distended interlobular septa. Features: Short – about 1-2 cm long. Seen close to the pleura and perpendicular to it
Individual lines are parallel to each other. Usually seen at the lung bases near costophrenic angles in postero-anterior view radiographs / at the substernal region in lateral radiographs.

X-ray chest posteroanterior view showing homogenous haziness in left lung – upper and mid zones. Elevation of left dome of diaphragm – due to volume loss secondary to bronchus obstruction / diaphragmatic palsy secondary to phrenic nerve involvement. Mediastinal shift to left side. Hyperinflated right lung.

Spondylotic changes to look for in lateral view radiograph of neck are Osteophytes, Disc space narrowing, Loss of cervical lordosis, Uncovertebral joint hypertrophy, Apophyseal joint osteoarthritis and Decreased vertebral canal diameter

Scoliosis with hyperinflated lungs
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Scoliosis is a deformity of the spine which is characterised by lateral curvature of the spine in upright position in the coronal plane
Problems due to scoliosis:

Cosmetic
Deranged force and load transmission through spine
Impairment of functioning of vital organs like heart and lungs
Difficult to treat

Types of scoliosis:

Structural

Fixed curvature
Non flexible
Does not get corrected by side bending

Non structural

Flexible curvature
Gets corrected by side bending

Mechanism of non structural scoliosis

Compensatory – to compensate for leg length deformities / fixed flexion deformities of hip
Sciatic – due to inflammation …

Right side Hilar Lymphadenopathy
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Causes of hilar lymphadenopathy:

Infections (eg: Tuberculosis)
Granulomatous diseases (eg: Sarcoidosis, Wegener’s granulomatosis)
Neoplasms (eg: Bronchogenic carcinoma)

Massive pleural effusion – left side
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X-ray chest anteroposterior view showing massive pleural effusion on left side and mediastinal shift to right
Patient presented with symptoms of dyspnoea, cough and fever for 1 week duration
On examination, breath sounds were absent on left side with stony dullness on percussion
Patient’s spouse was an active case of tuberculosis, hence tuberculous pleural effusion was suspected