Imaging Case of the Week 144 Answer

Chest x-ray 1 is an AP film that is technically inadequate. Within the limits, there is a sub-total opacification of the left hemithorax. There is a bronchus cut-off sign on the left with a mediastinal shift to the left. This patient went on to have a CT of the chest which showed a mucus plug occluding the left main bronchus, resulting in near total collapse of the left lung.

Left lung collapseChest x-ray 2 is from a patient who has previously had a left pneumonectomy. There is mediastinal shift to the left and there are surgical clips visible around the left main bronchus.

Left pneumonectomy

Chest x-ray 3 is from a patient with massive left-sided pleural effusion. There is associated mild mediastinal shift to the right side.Pleural plaques are also visible in the right hemithorax. Based on case, cause and complications analysis, this is a case of severe left pleural effusion in a patient with asbestosis, which is likely complicated by mesothelioma.

Left pleural effusion

 

Causes of white out hemithorax:

  • With mediastinal shift towards the affected side – lung collapse, previous pneumonectomy
  • With no mediastinal shift – consolidation (will be associated with air bronchogram sign)
  • With mediastinal shift to the opposite side – massive pleural effusion

 

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