CXR Case 105

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.

CXR CASE 105 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There is a left sided hydropneumothorax.
No obvious pleural or lung parenchymal disease.


CLINICAL CORRELATION

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.


CLINICAL PEARLS

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.


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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