CXR: old school but always useful

Clinical Introduction An 80-year-old man with a medical history of hypertension, dyslipidaemia, coronary artery disease, alcohol consumption and atrial fibrillation, not anticoagulated, presented to the emergency department with sudden onset of pleuritic chest pain, dyspnoea and fever. Initial blood pressure was 165/93 mm Hg, with a heart rate of 100 beats/min, peripheral oxygen saturation of 91% (FiO2 21%) and an otherwise unremarkable physical examination. Electrocardiography showed sinus tachycardia, without other relevant changes. A CXR was performed (figure 1). Question Which diagnosis is most likely? Pneumonia. Acute pulmonary embolism. Adenocarcinoma of the lung. Loculated pleural effusion. Answer: B The radiological finding corresponds to a classic Hampton’s hump, consisting of a wedged-shaped, pleural-based opacification, representing pulmonary infarction distal to a pulmonary embolus (figure 2).1–3 This sign is rarely seen in clinical practice...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research