CXR Case 116

A 63 year old man presents with productive cough, fever and breathlessness. He presents to the emergency department following two episodes of haemoptysis

click images to enlarge


Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

CXR Interpretation:
There is patchy airspace shadowing over the medial aspect right mid zone.
The hila structures are still visualized.
The remaining parenchyma and pleura are clear.

Lateral CXR Interpretation:
There is lobar consolidation of the right apical segment, lower lobe.


CLINICAL CORRELATION

This is lobar pneumonia.

Considering the description of ?haemoptysis – pneumococcal pneumonia is possible as this classically produces a ‘rusty brown‘ sputum which, in turn, classically is miss-labelled as haemoptysis.


CLINICAL PEARLS

Pneumococcal urinary antigen is strongly recommended in many community acquired pneumonia guidelines.
It is a simple, cheap investigation with good sensitivity with rapid processing time.

A positive pneumococcal urinary antigen in the appropriate clinical setting would support narrowing antibiotics to treat for Streptococcus pneumoniae.


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 |

One comment

  1. Looks like he has a cystic lung disease too?

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