CXR Case 082

A 78 year old man presents with worsening dyspnoea.

CXR CASE 082 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There are bilateral moderate pleural effusions.
There is fluid in the horizontal fissure and upper lobe diversion.


CLINICAL CORRELATION

Common things are common: bilateral effusions are highly likely to be transudates from heart failure.

This man had a history of type II diabetes and NSTEMI with 2x coronary stents 4 years before presentation.


CLINICAL PEARLS

In the absence of any concerning aspects to the history (weight loss, malignancy, fevers) it would be reasonable not perform a diagnostic tap of the effusions.

Treat the cause (i.e. dry the patient out) and review.

Rarely, in the context of severe respiratory failure a therapeutic tap can improve the respiratory mechanics and oxygenation – but beware anti-platelet and novel oral anticoagulants!


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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