today I am presenting the PA chest radiograph of a 77-year-old man who came to the Emergency Room with severe dyspnea.
How many significant findings do you see?
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Findings: AP chest radiograph shows an opaque left hemithorax with displacement of the mediastinum towards the right. The splenic flexure of the colon is pushed downwards (A, arrow) a sign of left diaphragmatic inversion. The appearance of the chest is typical of a massive left pleural effusion. In addition, there are two nodular opacities in the right lung (A, red arrows). There is a lytic lesion of the left third rib (A, white arrow) and the anterior arch is missing (A, asterisk).
These findings are better seen in the cone down views (B-C, arrows). They are highly suggestive of widespread malignant disease.
The patient had a cardiac arrest in the ER and could not be reanimated. Autopsy demonstrated a gastric carcinoma with multiple metastases.
Final diagnosis: Metastases to the chest from carcinoma of the stomach
Congratulations to Rafał, who was the first to see the lytic lesion in the left third rib.
Teaching point: Although the main finding is very obvious (massive pleural effusion), detecting the nodules and the lytic lesion of the rib is the clue to the correct diagnosis of malignancy.
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