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.

Starr A, Edwards ML. Mitral Replacement: Clinical Experience with a Ball-Valve Prosthesis. Ann Surg. 1961 Oct; 154(4): 726–740. [PMC1465984]


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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