Dear Friends,
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?
1. One
2. Two
3. Three
4. Four
Click here to see the answer
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.
Remember satisfaction of search!