Thursday, December 22, 2005

Radiology Thursday

This is a 78 year old man presenting to clinic for his one year f/u visit for his pulmonary disease. He looks well, is no respiratory distress and has no constitutional complaints. He does note increasing sputum. Vital signs are normal including 98% O2 sat on RA.

Aside from the obvious findings on his CXR - what underlying disease and series of events has led to the present picture? (CEOB hold your tongue and see if anyone else gets this):

4 comments - CLICK HERE to read & add your own!:

Jeff H said...

My guess is the patient had TB a long time ago, and was treated with induced pneumothorax/collapse of the left lung.

Arenberg said...

This looks like a prior thoracotomy, although I admit I cannot definitely see it, I believe there is a missing 6th rib indicating a thoracotomy, and maybe a prior pneumonectomy? There is an additional linear shadow over the right lower hemothorax that I cannot quite account for with this scenario. The suspense is killing me...

Baleeiro said...

In addition to the L collapse it seems to me that the gastric bubble is on the R. It looks like there is a situs inversus going on and the problem with the L lung might be related to poor clearance.

Mendez said...

Nice pick-up on the gastric bubble. The patient had Kartagener's (going along with the situs inversus) with a history of severe bronchiectasis on the left. He is s/p L. pneumonectomy a few years ago with decent improvement in his symptoms.