CXR Case 063

A 48 year old man presents with syncope on exertion. He admits to being breathless on and off for the last 2 years. He has never smoked and is HIV positive with a normal CD4 count.

CXR CASE 063 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

Lung fields are clear.
There are prominent, enlarged pulmonary arteries with pruning of peripheral blood vessels.
Heart size is normal.


CLINICAL CORRELATION

This is pulmonary hypertension.
HIV is an unusual cause of this, even in the absence of immune suppression.


CLINICAL PEARLS

In pulmonary hypertension syncope can occur due to a paradoxical fall in systemic blood pressure on exercise – cardiac output does not increase with exertion, which also leads to dyspnoea.


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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