CXR Case 137

70 year old lady presents with collapse at home. On arrival GCS 5, O2 sats 70% on 15 liters and shifting minimal air on auscultation. Respiratory arrest whilst in upright position – breathing returned on lying supine.

NIDDM with degenerative OA of knees on metformin and meloxicam

CXR CASE 137 CXR LITFL

Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

Small lung volumes and atelectasis in the right base.
No consolidation.
There is air under the right hemidiapragm and the liver appears displaced downwards.


CLINICAL CORRELATION

This lady had a perforated bowel with free air in the abdomen – causing a ‘floating liver‘.
This supine film does not give the more obvious air under the diaphragm picture [See CXR Case 141]
She had severe metabolic acidosis and inflammatory response and survived surgery.


CLINICAL PEARLS

This is not Chilaiditi sign – but does have a similar appearance – where colonic interposition above the superior border of the liver – a cause of pseudo-pneumoperitoneum.

Chilaiditi syndrome (Demetrius Chilaiditi 1883–1975) – is interposition of the colon over the liver associated with upper abdominal pain.


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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