A 42 year old man is sent in for CXR by his GP. He has a 5 day history of worsening cough, aches and chills.
click images to enlarge
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is a rounded opacity projected over the right hilum with some slight increased airspace shadowing in the right middle lobe. Rounded artifact over the left 6th posterior rib.
Lateral X-Ray demonstrates loculated fluid within the horizontal fissure and inflammatory changes in the middle lobe.
This is a localized parapneumonic effusion.
(Ignoring that this is nearly impossible to tap anyway) …small parapneumonic effusions do not necessarily need a tap – response to broad spectrum antibiotics and close vigilance to ensure the effusion does not get bigger is usually appropriate.