Quick Quiz Newsletter

Quick Quiz Newsletter
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Med-Challenger EM Career
Comprehensive Review and Assessment for Practicing
Emergency Physicians

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Issue: March 15, 2007
Case: Focal Densities, Infiltrates, and Atelectasis
Taken from Med-Challenger EM Career
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Question:
The x-rays shown in the images at right are from an elderly person with gradually worsening dyspnea, no fever, and an occasional dry cough. There has been an unwanted weight loss over the last several months. Upright PA (Image 1) and lateral views (Image 2) are presented. What's the density in the left chest?

pneumonia
pulmonary edema
left upper lobe atelectasis
pleural effusion

Answer:
C

Remediation:
Looking at the upright PA chest film, we are impressed with the asymmetric lucency of the right and left hemithoraces. The homogeneous appearance of this density makes one of two conditions likely: fluid or atelectasis. Looking carefully at the left chest, we notice that there is some sparing of the left base and in fact, if this were fluid, the diaphragm would not be seen in this upright projection. There is better aeration of the left base when compared to the left apex. This density is homogeneous, not patchy.

When looking at the lateral view, we can see the major fissure very nicely highlighted by the collapsed left upper lobe, which is the diagnosis here. Clear visibility of the major fissure is referred to as the "curtain sign."

About the Image(s):
Image 1: Obstructive Atelectasis of the Left Upper Lobe - PA CXR
There is a homogeneous density of the left hemithorax, which is more lucent in the base. The diaphragm is clearly visible.

Image 2: Obstructive Atelectasis of the Left Upper Lobe - Lateral View
The major fissure is clearly visible ("curtain sign"), with consolidation and collapse of the left upper lobe.

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