CXR Case 001

A 22 yo male presents with worsening chronic cough and breathlessness. He has been underweight since childhood.


click image to enlarge


Describe and interpret his CXR and CT scan

CHEST X-RAY INTERPRETATION

CXR AP
There is upper lobe predominant bronchial wall thickening with ring shadows and patches of consolidation.
There are features of mild airflow obstruction with flattened hemidiaphragms.
The features suggest cystic bronchiectasis and given the symmetrical upper lobe predominance and clinical features, cystic fibrosis (CF) is most likely.

CXR Lateral
This more clearly demonstrates the ring shadows and clear upper lobe predominance of the bronchiectasis.

CT Chest
CT demonstrates markedly dilated airways and thickened airway walls with sputum plugging on the right side.


CLINICAL CORRELATION

Cystic Fibrosis (CF) is a multi-system respiratory and metabolic disorder that requires specialist input.

Knowledge of prior sputum cultures is vital before starting antibiotics

Chronic low weight is likely due to malabsorbtion.


CLINICAL PEARLS

CF patients with abdominal pain and features of intestinal obstruction may have Distal Intestinal Obstructive Syndrome (DIOS) – and likely need a specialist CF team, not a surgeon!


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 |

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