CXR Case 113

A 23 year old man is referred to ICU with worsening fever, confusion and hypotension. He has a well healed mid-line sternotomy scar.

CXR CASE 113 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

Both lung fields have patchy airspace shadowing in the mid zones.
The heart size is likely to be enlarged; there are sternotomy wires in situ and surgical clips in the mediastinum and/or heart.
There is a left sided PICC line in situ.


CLINICAL CORRELATION

This man had a Tetralogy of Fallot repair 9 months previously.
Transesophageal echo demonstrated vegetations on the tricuspid valve.
Patchy pneumonia, presumably due to septic emboli. Methicillin sensitive Staphylococcus aureus was cultured from blood.


CLINICAL PEARLS

Most cases of infective endocarditis have some underlying structural heart disease.
Males are more commonly affected and the most common bacteria are Staphylococci and Streptococci.


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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