CXR Case 120

A 54 year old man is admitted with worsening breathlessness and cough with pain in the right chest for 6 weeks.

CXR CASE 120 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

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.


CLINICAL CORRELATION

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.


CLINICAL PEARLS

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


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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