Imaging Case of the Week 122

The following chest x-rays are from a 72 year old who has a history of COAD, who has presented with a fever, cough and dyspnoea. What can you infer from the x-rays?


Frontal CXRLateral CXR


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The frontal chest radiograph shows an opacity adjacent to the right heart border causing silhouetting and focal contour abnormality. The right hemidiaphragm appears slightly elevated and there is a degree of hyperinflation of the lung fields.

The lateral view shows a linear band-shaped opacity projected over the cardiac shadow. This appearance is classic for complete right middle lobe collapse.

Silhouette sign right heart borderRML collapse


In the presence of infective symptoms, the likely cause is a mucus plug. However, the possibility of an endobronchial lesion should be kept in mind and a CT chest may be needed if there is a failure of resolution of the chest x-ray finding after appropriate treatment.