Slide 1: Case 1 versus case 2. Questions. Number 1. Which lobe is abnormal? Number 2. Which patient has consolidation and which one has atelectasis?

Slide 2: Anatomy of the anteroposterior view of the right lung. Right upper lobe. Horizontal fissure. Right middle lobe. Major fissure. Right lower lobe. Answer to question number 1. The right upper lobe is abnormal in both chest x-rays. They are “too white”.

Slide 3: Answer to question 2. Case 1. The right upper lobe is “too white” and normal in size. The horizontal fissure is normally positioned. Case 1 is a consolidation due to pneumonia in this patient. Case 2. The right upper lobe is “too white” and too small. The horizontal fissure is elevated. Case 2 is atelectasis, due to a right upper lobe mucus plug in this patient.

Slide 4: Normal lung: inflated balloon– The lung, its lobes and even the alveoli are like balloons. A normal balloon is filled with black air. Consolidated lung: Water (or pus, blood etc.) balloon– if you remove the air and replace it with something else (blood, pus, edema, fluid etc.) that completely fills the alveoli, you get an opaque balloon with normal volume. This is consolidation. Atelectatic lung: deflated balloon– If you take the air out of a balloon and do not replace it with anything, you get an opaque balloon with decrease volume. This is atelectasis. I have a terrible confession to make. Sometimes, it’s hard to tell, especially on a portable chest x-ray, if the lung is atelectatic or consolidated. I have shown you the best case scenario!

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