CXR Case 038
A 38 year old female who has recently entered the country is referred by a GP with increasing cough, fevers and sweats.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is diffuse air space shadowing with volume loss in the right upper lobe with an area of lucency suggesting a cavity.
There is volume loss, air space shadowing in the left lower lobe and possibly a small pleural effusion.
*There is external artifact overlying the left lung apex and clavicle.
There is consolidation, a lung cavity and pleural effusion.
These features are most likely caused by infection and TB should be strongly considered.
*This lady had come from Eastern Europe and had multi drug resistant TB.
While PCR can provide a positive rapid answer, the gold standard for excluding TB is three separate acid fast bacilli cultures to be negative.
*Mycobacteria can take up to 35 days to culture.
*Genetic analysis can provide resistance patterns although this is not widely available as yet.
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