CXR Case 041

A 40 year old male presents with septic shock and reduced consciousness

click images to enlarge


Describe and interpret this AP and lateral CXR

CHEST X-RAY INTERPRETATION

CXR Interpretation:
There are multiple large areas of airspace opacification projecting over both lung fields.
* Areas of opacification project primarily over the lower and mid-zones, and completely obscure the heart border.
* The right base is more dense, suggesting possible pleural effusion, with fluid laterally and in the horizontal fissure.


Lateral CXR Interpretation:
T12 has diffusely and homogeneously increased density – an ‘ivory vertebra’ (this is actually visible on the PA – but we are easily distracted…).

This refers to a diffuse homogeneous increase in opacity of a vertebral body that otherwise retains its size and contours.

Multiple rounded patches of airspace opacification throughout the left lung field and fluid within the horizontal fissure.


CLINICAL CORRELATION

Methicillin-resistant Staphylococcus aureus was isolated from blood cultures 24 hours later.
Echocardiogram demonstrated tricuspid valve endocarditis.
The patient had recently had a PICC line in situ for chemotherapy treatment of lymphoma.


CLINICAL PEARLS

MRSA Pneumonia and bacteraemia has a high fatality rate.
If a patient with known MRSA bacteraemia is requiring inotropic support, mortality approaches 50%.


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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