CXR Case 120

There are airspace infiltrates in the right upper lobe (posterior segment) and right lower lobe.
There is a right pleural effusion and diffuse pleural thickening with volume loss in the right hemithorax.
Left side of chest is normal.

This is likely to be an acute pneumonia, however pneumonia alone can not account for all the changes.
The pleural effusion could be parapneumonic but could also be related to the pleural thickening which may be malignant – this would account for the duration of pain, which is too long to be only infection.

Causes of unilateral pleural thickening include: primary or secondary pleural malignancy, old TB (can be calcified), old haemothorax (can be calcified), old empyema.