Imaging Case of the Week 44

The following chest x-rays are from an 11 year old presenting with fever and a cough. What can you see?

Chest x-ray PA view

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Chest x-ray lateral view

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The PA view shows the silhouette sign – the medial half of the left dome of the diaphragm is obscured by the consolidation process. There is left lower lobe pneumonia.

Left lower lobe consolidation

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On the lateral view, the spine sign is positive. There is a triangular opacity over the lower vertebral bodies. Normally, the lower thoracic vertebral bodies appear darker compared with the vertebrae in the mid and upper thorax. This is because of the increased soft tissue densities over the upper and mid thoracic vertebra.

Spine sign

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This child has pneumonia and should be treated with antibiotics.


2 thoughts on “Imaging Case of the Week 44

  1. i’d say classic LLL pneumonia – absent left hemi-d and shadowing seen on lateral inferiorly.
    also do you think there are bronchograms seen behind the heart?

    • There indeed is air bronchogram sign. Bit hard to appreciate because of the image resolution. Thanks for pointing out!

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