CXR Case 098
A 22 year old known IV drug user is found collapsed and admitted hypotensive with altered consciousness.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is left upper lobe consolidation with air bronchograms indicating pneumonia.
Linear shadows on the right lower lobe suggest atelectasis.
ETT and NGT in situ. The right subclavian line is incorrectly positioned.
CLINICAL CORRELATION
This pneumonia should be treated as an aspiration (as he is found collapsed and the history of drug use indicates this may have been for a prolonged time).
CLINICAL PEARLS
Tricuspid valve endocarditis should be considered although you would expect multiple pulmonary septic emboli rather than a focal lobar infection.
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 | ICIS Course ANZ
Is there also a L SC CVC that is heading cephalad?
Ha ha – good spot – yes, the right subclavian line could benefit from being repositioned.