Imaging Case of the Week 35

A 34 year old woman who is 3 days post-partum has presented with a sudden onset of central chest pain at 3 am. She has no previous medical illness. As part of investigations, a chest x-ray has been done and is as follows. What is seen on the x-ray? (It is very subtle)

Chest x-ray

Click to enlarge

Answer
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5 thoughts on “Imaging Case of the Week 35

  1. I will take a stab at it, since not many ppl being brave on this one 😉

    Nothing leaps out other than I think I see a para-trachael line on the right side and possibly opacity at the carina?

    Obviously the first thing that leapt into my mind was PE/amniotic embolism and PP cardiomyopathy based on the hx, but I cannot relate those to the findings I think I see – so, keenly waiting on the answer 🙂

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    • Just found answer – wow, nice catch!

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      • What answer did you find Chris? Please let me know 🙂

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    • Hi

      Thank you for your comments on the post.

      The very reason I chose this case was because it was such an unusual presentation. Chest x-ray findings in this case are subtle, but one should always be on the look-out for minute findings even in a largely normal looking x-ray.

      Patients with peripartum cardiomyopathy do not wake up on one fine morning with sudden chest pain; the common pattern of presentation is rather cardiac failure. Yes, they can present suddenly with APO but not with chest-pain.

      I do not think there is a right para-tracheal line. If you look closely, the CXR is slightly rotated which may be give off a false impression.

      This patient had a undiagnosed bicuspid aortic valve, a risk factor for AD, which unfortunately decided to play up in the post-partum period.

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