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