Journal of the Canadian Association of Radiologists
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Case Reports
The importance of proximal and distal air bronchograms in the management of atelectasis.
Correlation of chest radiographic appearances with concurrent fibreoptic bronchoscopy in patients observed while in intensive care, and with lobar or multilobar atelectasis due to retained secretions, suggests that three levels of air bronchogram can be identified: Proximal: air is visible only to the level of the main bronchus, bronchus intermedius or lobar bronchi. Intermediate: air is visible down to the segmental bronchi. ⋯ Proximal or intermediate air bronchograms signify accumulation of secretions in central bronchi and indicate the need for fibreoptic bronchoscopy to aspirate secretions: a distal air bronchogram signifies peripheral bronchial obstruction thus precluding effective fibreoptic bronchoscopy; chest physiotherapy is then a more appropriate treatment. The proximal air bronchogram may change in extent or definition-sometimes rapidly; a receding or an increasingly poorly defined proximal air bronchogram are danger signals of centrally accumulating secretions which may lead to respiratory arrest.
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Anomalies of the inferior vena cava, azygous venous system and renal veins may take many forms. We report a patient with azygous continuation of a left-sided inferior vena cava with an associated retroaortic right renal vein. To our knowledge, this is the first such report.