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CXR Case 109

An 83 year old man is admitted with a fall and confusion. He is hypoxaemic on air, requiring 2L of oxygen via nasal prongs.

CXR CASE 109 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There is subtle upper lobe diversion and bilateral small pleural effusions.
Lower zones bilaterally have possible patchy airspace opacification.
There is a single chamber pacemaker and a metallic mitral valve replacement.
Right shoulder prosthesis noted.


CLINICAL CORRELATION

The CXR is consistent with mild pulmonary oedema.

This man has a metallic Starr-Edwards MVR. This requires significant anticoagulation (normally INR 3-3.5) hence any confusion after a fall should lead to consideration / investigation for intracranial bleed.


CLINICAL PEARLS

The Starr-Edwards MVR is a ball-cage valve, the use of which was first reported in 1961; it has been highly successful and used globally.

The valve has sometimes been associated with a mild haemolytic anaemia. Catastrophic complications, such as cage rupture and embolism of the ball are, thankfully, very rare.


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

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