A 71 year old man presents with sudden onset breathlessness.
Background history of slowly worsening dyspnoea and left sided chest ache over the last 6 weeks.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is a left sided hydropneumothorax.
No obvious pleural or lung parenchymal disease.
Secondary spontaneous pneumothorax is associated with known underlying lung disease.
This is at least strongly suspected in this case – a small pleural effusion (e.g. blunting of costophrenic angle, probably from heamothorax) is seen in ~20% of spontaneous pneumothoraces, but in this case there is too much fluid and this needs further investigation.
Pleural fluid cytology demonstrated adenocarcinoma from lung primary.
The tumour was on the periphery of the lung and had invaded the visceral pleura, causing the malignant pleural effusion and pneumothorax.