Imaging Case of the Week 24

Your patient is an elderly man who has been brought in by his wife with a history of high fever, cough and mild confusion. You order a chest x-ray to see what is going on and the PA and lateral views are as follows. What can you see?

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It is an interesting chest x-ray. But what is the diagnosis and can you spot the radiological anatomy landmarks in the x-ray?

This is a classic chest x-ray showing right middle lobe consolidation:

  • There is a density in the right lung limited above by the horizontal (minor) fissure and medially obscuring the right heart border (Silhouette sign), indicating right middle lobe involvement.
  • On the lateral view, there is a triangular density ( between the minor and the oblique fissures) projecting over the heart shadow confirming its location in the right middle lobe.

There is an effusion clearly visible on the lateral view (lateral view is more sensitive in picking up the presence of an effusion).

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Click to enlarge

This patient has right middle lobe pneumonia and needs admission for intravenous antibiotics etc. It is important that he gets a follow up chest x-ray in a few weeks to ensure complete resolution.

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