SET T0009 -
ED and GP referral.

Abnormal.

Anterior dislocation of the head of the radius.

[ The displaced anterior fat pad indicates that an effusion is present. An effusion is not necessarily indicative of a bone injury - but provides a warning of the likelihood of a fracture or dislocation. In effect : anterior fat pad displacement = examine the radiographs very carefully ].

Are you familiar with the " Radio-capitellar line " ? This line will assist you when diagnosing a dislocation of the head of the radius.

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 101, and 104

The 3rd edition will be published in July 2014.

The appearances are normal.

No evidence of an effusion. The anterior fat pad is well shown - but is in its normal position (ie hard up against the cortex of the humerus).

Normal anterior humeral line.

Normal radio-capitellar line.

All of the ossification centres are in their normal anatomical positions. Yes, this includes the ossification centre for the lateral epicondyle.

The normal ossification centres . . .

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 98-100

Two appearances need to be explained.

1. Thickening of the horizontal fissure. This represents residual fluid (consequent on the LVF) lying within the pleural space that lies between the (two) layers of the visceral pleura that form the fissure. 
2. The opacity overlying the lower zone of the right lung has a well defined inferior border - but its superior border is absent / ill defined. This is the characteristic appearance of an encysted pleural effusion / collection. It will be situated on the anterior or posterior surface of the right lung. A lateral CXR would confirm this diagnosis.

See : The Chest X-Ray : A Survival Guide : Pages 82-85

Pneumonia.

The consolidation is situated in the right lower lobe.

The loss of the silhouette of the right dome of the diaphragm is the clincher - in terms of indicating the precise site (ie the lobe) involved by the pneumonic consolidation. Explanation: the lower lobe is full of pus, not air, so the interface is now water density to water density and the result is the loss of the silhouette of the dome of the diaphragm.

Note that the right margin of the heart is exquisitely defined despite the lower zone shadowing. This is because the air filled middle lobe is forming the lung-mediastinal border ( ie air against soft tissue ) at this precise site.

The Silhouette Sign . . .

See : The Chest X-Ray : A Survival Guide : Pages 45-50