CXR Case 034

A 54 yo man presents hypoxaemic with worsening of a long standing productive cough and low grade fever. He stopped smoking 20 years ago.

click images to enlarge


Describe and interpret this AP and Lateral CXR

CHEST X-RAY INTERPRETATION

CXR Interpretation:
This AP film has an irregular thin walled large cavity in the medial right mid zone.
The hilar vessels are visible suggesting it is situated either posteriorly or anteriorly .
There are coarse reticular markings in the right middle lobe and lingular lobes suggestive of bronchiectasis.

Lateral CXR Interpretation:
The lateral confirms the presence of a cavity in the right apical segment of the lower lobe. There is no fluid level.
The is some scattered surrounding airspace shadowing (consolidation)


CLINICAL CORRELATION

There is a single large cavity and evidence of chronic lung disease and the history suggests a more recent deterioration.
Relevant differentials include lung cancer (classically squamous cell) and infection.

A maturing pulmonary infarct from PE can cavitate.

*TB should be considered as mycobacterium are frequently found in this pattern of bronchiectasis.*


CLINICAL PEARLS

If there is a draining bronchus there won’t necessarily be a fluid level in an abscess caused by infection.


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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