CXR Case 081
You are asked to review this CXR by the ICU. CXR of a 28 year old male ‘ANCA positive’ with renal failure.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is patchy, diffuse airspace shadowing in both lung fields, worse on the left side.
There is a large tunneled subclavian IV access cannula in situ on the right.
No pneumothorax.
CLINICAL CORRELATION
This man had microscopic polyangiitis (MPA) with MPO-ANCA (old term: p-ANCA) positive staining
The vascath is for dialysis following acute renal failure. The infiltrates could represent some fluid overload, however, in the context of being ‘ANCA positive’, inflammatory infiltrates are likely. .
CLINICAL PEARLS
High dose corticosteroid therapy followed by cyclophosphamide or azathioprine, and more recently rituximab (with continued steroids), is indicated for MPA.
TOP 150 CXR SERIES
Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar | ICIS Course ANZ