CXR Case 141

A 60 year old lady with COPD and bronchiectasis presents with severe abdominal pain and breathlessness.

RR 22, BP 102/62, P 110, SpO2 96% on air.

click images to enlarge


Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

CXR Interpretation:
There is air under both hemidiaphragms suggesting a perforated viscus.

Bilateral patchy shadowing and atelectasis in both lung bases.
Chronic bronchiectatic changes right base.


CLINICAL CORRELATION

This lady had a perforated large bowel from severe constipation.

She had a Hartmann procedure and survived.

Despite normoxia, her respiratory rate was raised when she presented due to severe metabolic acidaemia


CLINICAL PEARLS

This case emphasizes the importance of having an erect CXR in the context of severe abdominal pain – compare with Case 137


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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