Pleural Abnormality Mind Map.jpg

Unlike most other clinical mind maps, this clinical mind map is based upon an abnormal lab/image finding, as opposed to a patient symptom. A clinician can encounter this as an incidental finding in the absence of any additional clinical data or accompanying history/physical exam data may be present, such as shortness of breath, or cough. An abnormal chest X-Ray with pulmonary pathology can have too much black (air) or too much white (solid) on the image, and this clinical mind map is based upon this finding. For the purpose of reviewing pathologies within pulmonary systems, X-Ray abnormalities outside of lung/pleura are not discussed here. Probable diagnoses include abnormalities which give rise to too much black or too much white on the image.

Urgent/emergent situations include the absence of lung markings which represent serious pathologies, such as lung collapse, large lung mass, and large effusion. If history and/or physical exam related data is available, then vital signs and the patient’s appearance can be reviewed to determine whether an urgent/emergent situation is present.

Weighing and removing anchor bias involves reviewing further details of the image (costophrenic angles, consolidation, and cardiac silhouette) and gathering further data (reviewing the patient’s history, physical exam, labs and additional tests). A working and then final diagnosis can be achieved fairly quickly in this patient presentation.

Helpful mnemonics to remember differentials in cases when there is too much white (solid/fluid) or loss of lung markings are 3Ps and MICA.