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.


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 |

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