CXR Case 049

An 81 year old lady is admitted drowsy with type II respiratory failure

CXR CASE 049 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There is bilateral apical pleural calcification and upper lobe fibrosis, worse on the right.
Both hilar are elevated and there is volume loss on the right side, with deviation of the mediastinum and trachea to the right.


CLINICAL CORRELATION

This is old TB.
*The volume loss is from the fibrosis and also a right-sided phrenic nerve crush – both contributing to the ventilatory failure


CLINICAL PEARLS

A phrenic nerve crush was one of several pre-antibiotic era surgical procedures for TB.

Patients have a small ~2-3 cm scar above their clavicle and a high ipsilateral hemidiaphragm.

*With the recent advent of multi-resistant TB there has been a resurgence of interest in which ‘historical‘ surgical procedures might need to make a come back


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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