CXR Case 083

A 79 year old lady is referred in by her GP with worsening cough and breathlessness

CXR CASE 083 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There is a right side pleural effusion and mediastinal shift to the right indication a right lower lobe collapse / volume loss.
There is a smaller left pleural effusion.

There is upper lobe diversion. No focal lung lesion, bones are normal


CLINICAL CORRELATION

There is likely at least dual pathology here – the right sided volume loss and likely collapse would suggest a possible malignant process, which may account for the ipsilateral pleural effusion.

However, the presence of a contralateral pleural effusion could indicate pulmonary oedema / decompensated heart failure, or less likely contralateral malignant pleural disease.

This lady needs a proper examination, followed by CT chest and an echo!


CLINICAL PEARLS

As opposed to CXR case 082, this lady probably does need a pleural aspiration on the right (after CT and bedside ultrasound) – heart failure usually produces bilateral symmetrical pleural effusions – in this case there is asymmetry and probably a lung lesion.


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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