CXR Case 016
86 year old female presents with known bronchiectasis presents with shortness of breath and a worsening cough. She is more hypoxaemic than her normal baseline.
Presenting X-ray 
Repeat X-ray
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
Presenting CXR:
There is complete collapse of the left lower lobe (LLL) creating the sail sign behind the heart and volume loss in the left hemithorax.
There are age-related bony changes of the thoracic vertebral column and ribs
* The lung fields are overinflated, consistent with gas trapping from airways disease *
Presenting CXR:
The left lower lobe is now re-inflated
CLINICAL CORRELATION
Left lower lobe collapse has distinctive features, but may sometimes be missed on CXR.
* Features of left lower lobe collapse include: edge of collapsed lung creating a ‘double cardiac contour,’ loss of normal left hemidiaphragm outline*
A lateral CXR is useful in looking for left lower lobe collapse – a triangular outline representing the collapsed lung may be visible posteriorly.
In this case the patient was hydrated and had lots of chest physio – this is frequently enough to re-inflate collapsed lobes from retained secretions or sputum plugs.
CLINICAL PEARLS
Cardiomegaly may make it difficult to identify left lower lobe collapse.
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