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