106Lu Tension Hydro/Hemothorax and Lung Cancer

Lung Cancer, Tension Hydro/Hemothorax,  and  Atelectasis

85-year-old female with a history of lung cancer, presents with a dyspnea and hypotension. CT scan shows a large right pleural effusion under pressure, suggestion of blood in the pleural cavity and mediastinal shift to the right. In addition, there is compression of the heart with back up of venous return due the pressure effect on the heart and vascular structures.

Lung Cancer, Tension Hydro/Hemothorax, and Atelectasis
85-year-old female with a history of lung cancer, presents with  dyspnea and hypotension. CXR shows “white out” of the right hemithorax with pressure effect characterised by narrowing of the distal trachea cardio-mediastinal shift and atelectasis in the left lower lobe. The lateral examination shows silhouetting of the right hemidiaphragm.
Ashley Davidoff MD TheCommonVein.net

Lung Cancer, Tension Hydro/Hemothorax, and Atelectasis
85-year-old female with a history of lung cancer, presents with a dyspnea and hypotension. Scout film prior to the CT scan shows “white out” of the right hemithorax (white asterisk) with pressure effect characterised by narrowing of the trachea (blue arrow) mediastinal shift yellow arrows) and herniation into the left chest characterised by a leftward shift of the azygo-esophageal junction line (white arrow).
Ashley Davidoff MD TheCommonVein.net

Lung Cancer, Tension Hydro/Hemothorax, and Atelectasis
85-year-old female with a history of lung cancer, presents with a dyspnea and hypotension. CT scan shows a large right pleural effusion under pressure, suggestion of blood in the pleural cavity (orange arrowheads e, f) and mediastinal shift to the right. In addition, there is compression of the heart with back up of venous return due the pressure effect on the heart and vascular structures. Among the structures showing compressive effects are the SVC (blue arrowhead, c) with venous distension on right sided upper limb veins (blue arrowhead a). There is also pressure effect on the trachea with narrowing (light blue arrow d) The effusion in the right pleural cavity with atelectatic lung herniates into the left hemithorax, (white asterisk c, e). There is a dense sediment in the pleural fluid (orange arrowheads, e and f) suggesting blood in the pleural cavity. The left atrium is compressed (red arrowhead, e, f), and the right atrium is compressed (maroon arrow f).
Ashley Davidoff MD TheCommonVein.net

Lung Cancer, Tension Hydrothorax, and Atelectasis
85-year-old female with a history of lung cancer, presents with a dyspnea and hypotension. Reconstruction of the CT scan in the coronal plane, shows a large right pleural effusion under pressure with herniation into the left chest (white asterisk e,and f) , with mediastinal shift to the left (yellow arrowhead b, c, d). In addition, there is compression of the heart with back up of venous return due the pressure effect on the heart and vascular structures. Among the structures showing venous distension are the SVC (blue arrowhead, c) right sided upper limb veins (blue arrowhead d) and the left upper pulmonary veins (red arrowhead, d and f). The density of the systemic venous abd arterial systems is similar, but vascular structures as noted by the green arrowhead in a could represent venous collaterals.
Ashley Davidoff MD TheCommonVein.net