José Vilar and Friends Case 5 (Update: Solution!)

Dear friends,

Today’s radiographs belong to a 37-year-old with fever and cough. Rule out pneumonia.

Ok friends, can I see some opinions about this case and what you would recommend?

Click here for the answer

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    Mar 2019
    DISCUSSION 9 Comments

    9 Responses to : José Vilar and Friends Case 5 (Update: Solution!)

    1. Mukhammadsaid says:

      Pneumonia lower lobe to the left. Hydrothorax left

    2. Flaumbart says:

      Clearly there is some ill-defined process in the left lower field. I don’t see any relevant pleural effusion. Also, I hardly see the left hemidiaphragm. Regarding the history I’d recommend an ultrasound and/or ce-ct to rule out an empyema.

    3. Shaimaa says:

      A pneumonic patch is seen involving the left lower lobe as it is silhoutting the left diaphragmatic copula
      Also the inferior lingula may be also involved

    4. Trinity says:

      Chest X ray PA view shows non homogeneous opacity in LLZ obliterating left cardiophrenic angle,lateral half of left hemidiaphragm with a few lucent areas within.No evidence of air bronchogram /air fluid level/ calcification seen Another homogeneous opacity is seen obliterating left costophrenic angle with superior meniscus margins-may represent pleural effusion. The fundic bubble appears irregular with a focal discontinuity of left hemidiaphragm…
      Left lateral X ray shows corresponding opacities in anterior, lateral and posterior basal segment of the left lower lobe with loss of spine lucent of lower dorsal vertebra.the left hemidiaphragm silhouette is also not well delineated . However posterior cp angle is not so dense for effusion.
      I would like to do USG chest to rule out effusion.
      Also is there history of trauma- diaphragm rupture?

    5. ELM says:

      There is a extrapulmonary pattern lesion in left lower lobe, with triangular shape and no clear definition of left hemidiafragm. The density is similar to muscle or fat.

      In the lateral view it seems that the opacities projected over left lower lobe have some intestinal/gastric pattern, so I’d suspect left diafragmatic herniation with abdominal content and less probably pleural lipomatosis.

      I’d recommend CT scan or esophagogram, but I’d try first with ultrasound to confirm if it’s fat or abdominal content.