Today’s x-ray is from a 55-year old man. The film was taken in the operating room (“OR 3″). Notice anything interesting?
I’m totally floored by this recent comment to We Stand FIRM. It was posted in response to an op-ed debunking the myth of administrative savings under “single payer” systems of government heath care. Read it and weep:
the Canadian healthcare system is not the best in the world and certainly not perfect. however it is still rated superior to the system (or lack of a system) we have here in the US by the WHO. call it “socialist medicine” if you like, but like chairmen deng once said, “no matter it’s a white cat or a black cat, as long as it can catch mice, it’s a good cat.” lol.
the Canadian system is only at the 30th place in world ranking. how about looking at the other 29 better models? again, no single system in this world is absolutely perfect, but instead of picking faults (and i’m sure the canadians are going to have a grand time picking the faults of the american system, too), how about learning from their pros and cons and try to find the best system that works uniquely for the US? how about stop advertising your own personal beliefs and incentives, stop quoting our funding fathers who, though undoubtedly very wise in their time, could not possibly have foreseen the social condition and issues we are facing at present day? how about instead of dismissing new ideas regardless good or bad, try to focus on improving the efficiency of the government and fighting bureacracy, which is the primary reason why the many government programs didn’t work, not the initiative itself?
the theory that lasses-faire or free market mechanism will improve the US healthcare system (or the lack of a system) without external (government) interference – has this been proven anywhere by any means? a lot of americans focus so much on individual rights and benefits, which is based solely on their “beliefs” without any scientific or socioeconomic justification. they have very little regard to the well-being of the group, the society and the nation as a whole. and they think by defending the (implied) meaning of the constitution, they’re displaying such remarkable patiotism. honestly, i do not care what you believe, or what you think it right and morally acceptable. in fact, what i “believe” in completely irrelevant, too. what we should try to achieve, as a whole, is commonwealth and stability of our society, which will in turn benefit each and every individual within. what do you think is the priority of the government: defending YOUR personal ideals and beliefs, which is a lot of times the source of misinformaiton, conflicts, and chaos, or promoting the well-being of the society?
It would simply take too much time to comment on all that is wrong with that, so I invite you to pick your favorite bit of inanity to fisk in the comments.
This woman has a completely collapsed left lung. That’s why the left chest cavity is completely black. In contrast, the still-normal right lung shows the fine branching blood vessels emanating from the heart.
The white glob of tissue adjacent to the left side of her heart is her collapsed left lung plastered up against the left-sided heart border.
Here is a normal chest x-ray for comparison:
This is a severe case of spontaneous pneumothorax, much more severe than this one from three months ago.
The last I had heard, she was appropriately treated and doing well.
The slight difference in the height of the two sides of her diaphragm are within normal variation.
The apparent scoliosis of the spine is not real. Instead, I think folks are looking at the air-filled trachea (windpipe) which takes a slight normal curve to the right as it moves past the aorta. The trachea is slightly darker vertical stripe which then branches into the two separate “mainstem bronchi” — one for each lung.
Once again, here is the original image:
Here is a magnified view of the abnormality, at the front of the knee just below the patella (kneecap):
The patellar tendon is torn. It should be a smooth black stripe, as in the normal image:
The patellar tendon is normally very strong. In fact, you can feel how stout your own patellar tendon is by placing your finger just below your kneecap while your knee is extended, then gently bending your knee back and forth a few degrees (i.e., 2-3 inches).
Hence, patellar tendon ruptures are fairly rare sports injuries. Here’s more information.
Some of the other guesses were reasonable. However, I only gave one image (out of over 100), so many of the other structures of the knee were not included. For instance, the cruciate ligaments were not fully included on this one image and they happenened to be intact. But one would have required seeing the full data set to know one way or another. There probably was also some hemorrhage in the skin and fat just anterior to (in front of) the patellar tendon tear.
If you enjoy these semi-regular radiology case presentations, please let me know. My practice is very busy, so it’s easy for me to find and post interesting case examples to NoodleFood.
Today’s radiology case is another MRI study that came through my regular practice. I’ll post the ansewr tomorrow.
The patient is a 29-year old man who hurt his knee playing basketball, while jumping for a rebound. Here is the relevant MRI image. What’s wrong with this picture?
For comparison, here is an MRI image of a normal knee (from a different patient) and an anatomy diagram:
What’s your diagnosis? The answer will be posted tomorrow!
This is from the radiology order sheet at my workplace:
FELL 10 DAYS AGO ON TILE FLOOR IN COSTA RICA AFTER A COATI (MAMMAL TYPE RACCOON) URINATED ON THE FLOOR — PATIENT HAVING PERSISTENT HEAD AND NECK PAIN
I’m sure someone enjoyed typing that in!
The January 11, 2009 Washington Examiner has quoted me in their editorial on the dangers of universal health care. Here is the opening:
Universal coverage? First, look at the disaster in Massachusetts
By Examiner Editorial — 1/11/09
To much fanfare from both right and left in 2006, Massachusetts became the first state in the nation to require all residents to buy health insurance. A new state health insurance clearinghouse was created, with taxpayers subsidizing those who couldn’t afford to buy coverage. Then Gov. Mitt Romney, a Republican, promised that “every uninsured citizen in Massachusetts will soon have affordable health insurance.” Yet just two years later, Romney’s much-heralded “solution” — touted by many as the model for a national program — has become an embarrassing flop.
Just a year after the universal coverage law passed, The New York Times reported, state insurers were already jacking up rates to twice the national average. According to Dr. Paul Hsieh, a physician and founding member of Freedom and Individual Rights in Medicine, 43 mandatory benefits — including those that many people did not want or need, such as in vitro fertilization — raised the costs of coverage for Massachusetts residents by as much as 56 percent, depending upon an individual’s income status. So much for “affordable” health care…
Their OpEd quoted extensively from my article in the Fall 2008 issue of The Objective Standard, “Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America”.
I’m deeply grateful to the Examiner for publicizing this issue and to Craig Biddle for encouraging me to write the original article.
Update: The OpEd also appeared in the San Francisco Examiner. So it may be getting a fairly wide circulation!
I’m pleased to report that the January 7, 2009 edition of the Christian Science Monitor has published my latest OpEd on health care entitled, “Universal healthcare and the waistline police”.
My theme is that adopting government-run universal healthcare will lead to a “nanny state on steroids” deeply antithetical to core American principles of individual freedom and responsibility.
Here is the opening:
Universal healthcare and the waistline police
Imagine a country where the government regularly checks the waistlines of citizens over age 40. Anyone deemed too fat would be required to undergo diet counseling. Those who fail to lose sufficient weight could face further “reeducation” and their communities subject to stiff fines.
Is this some nightmarish dystopia?
No, this is contemporary Japan.
The Japanese government argues that it must regulate citizens’ lifestyles because it is paying their health costs. This highlights one of the greatly underappreciated dangers of “universal healthcare.” Any government that attempts to guarantee healthcare must also control its costs. The inevitable next step will be to seek to control citizens’ health and their behavior. Hence, Americans should beware that if we adopt universal healthcare, we also risk creating a “nanny state on steroids” antithetical to core American principles…
(I would also like to extend my deepest thanks to Diana Hsieh, Ari Armstrong, and Brian Schwartz for their many helpful suggestions when proofreading earlier drafts of this piece.)
Update: My piece has also been picked up by Yahoo News – Opinion.
Today’s x-ray case was one I read a few days ago at our Invision offices. The patient is a 59-year old man who complained of chest pain after he fell while horseback riding.
(The weather in Colorado has been pretty mild lately, so people are still doing horseback riding despite the fact that it’s January. I went for a 4-mile run outside on New Year’s Day in shorts and a t-shirt.)
Here is the patient’s initial chest x-ray:
As usual, the patient’s left side is on the right side of the image (marked with a “L” in the upper corner) and his right side on on the image left — exactly as if he were facing the viewer in real life. The lungs are black. The heart is the white area in the middle.
So what’s the abnormality? (Hint: The abnormality is on the patient’s left side.) Keep scrolling down for the answer.
Here is a normal chest x-ray on a different 50-year old man for comparison:
Finally, we got a CT scan of the chest to better delineate the problem. Here is a matching reconstructed image lined up to correspond with the chest x-ray:
Based on this (and the other CT images), we made the diagnosis of a ruptured diaphragm on the left side.
The diaphragm normally separates the chest from the abdomen. Because his left hemi-diaphragm was torn, it allowed his stomach and a large part of his colon to slide upward into the chest cavity. This compressed most of his left lung and pushed his heart far out of position to the right side, in turn causing additional partial compression of the normal right lung.
Fortunately, the patient was still breathing well with just his partially functioning right lung. A small portion of his left lung was still inflated. But because the left hemi-diaphragm wasn’t working, very little air was moving in and out of the left lung.
The family practice doctor seeing this patient was just as surprised as we were. But she got him plugged in with a trauma surgeon right away, and the last I heard the patient was doing well.