A male in his 20s presents with haemoptysis
What does the X-Ray show?
TUBERCULOSIS
👨🏽💻This is a tricky case - there was a clear abnormality at the right hilum with consolidation in the right mid zone but the more subtle findings were:
▫️Consolidation extending behind the right heart shadow - remember to look behind the heart, the density should be roughly equal on both sides
▫️Well defined apical opacity - compare both apices and look between the ribs, here there was an opacity on the right
▫️Left lower rib erosion - follow all of the ribs! Sometimes a subtle rib erosion can be the only abnormality on the film
👨🏽💻These findings could represent either a primary lung cancer or TB - given the age of the patient TB is the most likely diagnosis here. The diagnosis was confirmed with positive sputum culture
👨🏽💻Sometimes TB can be more difficult to diagnose as all cultures come back as a false negative - if the sputum was negative here, the patient may have needed bronchoscopy or biopsy of a rib lesion to confirm the diagnosis
👨🏽💻In TB the aetiology of haemoptysis varies from patient to patient but possibilities for large volume haemoptysis include aneurysms/pesudoaneurysms of the pulmonary arteries (termed Rasmussen’s aneurysm when associated with a cavity) as well as the bronchial arteries as is the case here
🔻Hopefully you found this case useful - it serves as a good reminder to not get distracted by the obvious abnormality but always keep your review areas in mind!
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Негізгі бет Chest X-Ray breakdown: haemoptysis in a young male
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