today’s radiographs belong to a 34-year-old woman with moderate cough. Previous history of asthma.
What do you see?
1. Mucous plug
2. Segmental atelectasis
4. None of the above
Click here to see the answer
Findings: Pa chest radiograph shows a tubular opacity that seems to arise from the right hilum (A, arrow). The lateral chest (B) does not show any abnormality, which raises the possibility that the opacity in the PA view is spurious.
Careful inspection demonstrates that the opacity extends to the right apex and to the neck (C, red arrows). The appearance is typical of a superimposed pigtail.
Some of you described the slightly elevated minor fissure. It is an unfortunate coincidence, probably related to previous episodes of mucous plug in an asthmatic patient causing mild loss of volume of RUL.
Final diagnosis: Pigtail simulating pulmonary disease.
Congratulations to MK who was the only one to suggest the correct diagnosis.
Teaching point: You may think that I tricked you, but it was not my intention. This case is a reminder that apparent pulmonary opacities may be located in the pleura, chest wall or outside of the body.
To emphasize this point I am showing two more cases of braids simulating pulmonary disease, presented in earlier blogs.
CASE 1. 48-year-old woman with mild cough. PA radiograph shows an ill-defined opacity in the left lung, running from top to bottom (A, white arrows). The opacity extends towards the neck (A, red arrow), which suggests that it is external to the lung. Lateral view shows an elongated opacity in the back of the chest (B, arrows).
A photo of the patient (C) confirms that a long braid is the cause of the opacity. PA radiograph after lifting the braid demonstrates that the chest is normal (D).
CASE 2. 25-year-old man with braided hair simulating a RUL infiltrate (A, arrow). The opacity extends to the neck, giving away the diagnosis (A, red arrow). After raising the braid, the chest looks normal (B). Remember that men also wear their hair long nowadays.