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
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
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