Learning the Chest Skiagram-Still a long way to go
Middle aged lady with cough shows- on PA chest ,a homogenous opacity in the left mid and lower zones with no significant air bronchogram or hilar prominence or CP angle blunting . There is silhouetting of the heart border with no mediastinal shift or retrocardiac extension of the opacity. Rib cage and rest of the lungs are clear. Soft tissues including the left breast shadow is symmetrical and normal. Lateral X-ray shows the localization to lingual location possibly superior and greater fissure appears pushed backwards by the lesion. It still shows no air bronchogram- diagnosis should read as superior lingual pneumonia. Usual organisms that have predilection to this region are oral commensals , and non tuberculous mycobacteria (particularly avium) and legionella. Case submitted by Dr MGK Murthy.
· Haemophilus influenza unlikely as no fissural fluid is noted
· Aspiration is les likely because of gravity nondependent position
· Neoplasm is less likely as there is more consolidation rather than collapse
· Pleural etiology is unlikely as the fissure or CP angle are not giving the hint and the lesion is not convex to the hilum if encysted
Learning the Chest Skiagram-Still a long way to go Reviewed by Sumer Sethi on Wednesday, October 19, 2011 Rating: