SET T0018 -
Emergency Department / OPD.

Collapse with consolidation in the right upper lobe.

The clear evidence of collapse strongly suggests bronchial obstruction; carcinoma is probable.

( The other " shadowing " in both lungs is simply due to normal lung vessels ).

Initial impression: the heart appears enlarged and some interstitial shadowing in both lungs - possible left heart failure.

But - this is a small inspiration. Note which ribs (anteriorly) reach the left dome of the diaphragm. On this CXR it  is the 4th rib. A small inspiration can cause the lungs to appear abnormal. Abnormal in this context = crowding of normal vessels producing lung " shadowing ".

So, the CXR was repeated 5 minutes after the first CXR. See this repeat CXR (below) - the lungs are clear. The heart size is normal.

Be very careful: a small inspiration can produce misleading shadows.

What constitutes a satisfactory inspiration? We evaluated the PA chest radiographs on a series of normal patients aged 50 years and older. This enabled us to reinforce a " satisfactory inspiration " guideline, one that is well known to radiologists . . .

See : The Chest X-Ray : A Survival Guide : Pages 6 and 237

Right pneumothorax. Typical CXR features.

A little blunting of the right costophrenic angle is present; likely to be due to a small amount of pleural fluid (ie blood).

Extensive shadowing in the lower zone of the right lung.

• The right dome of the diaphragm is obscured.
• The right heart border is clearly defined; not obscured at all.
• Applying the Silhouette Sign principles this indicates that the shadowing (ie the consolidation) is situated solely in the lower lobe.

Note: it is very difficult to delineate the position of the right hilum on this CXR because of the extensive shadowing. But, the right hemithorax appears of smaller volume as compared with the left hemithorax. This raises the suggestion of some volume loss in the consolidated lower lobe. Volume loss is always a worrying feature (cf bronchial obstruction) and this presumed pneumonia will need to be evaluated / followed very carefully.