CXR Case 040
A 64 year old male smoker presents to his GP with weight loss and a cough and is sent to ED.
The patient was put on 25mg of prednisolone for presumed polymyalgia rheumatica 6 weeks ago. He has type II diabetes.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is an air fluid level in a large cavity in the left upper zone with associated increased airspace shadowing and left hilar adenopathy.
There is increased lucency above the air fluid level with scanty lung markings suggesting this is either a large cavity or involving the pleural space.
The rest of the lung parenchyma and pleural spaces are normal.
CLINICAL CORRELATION
Malignancy and TB would be the most important diagnoses to consider.
* A CT scan and culture of sputum (including Acid Fast Bacilli) would be the next best steps.
CLINICAL PEARLS
Reactivation of old quiescent TB is rare but possible following immune suppression, particularly multiple factors such as age, diabetes and steroids.
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