A 38 yo presents with acute respiratory failure
what is wrong on the CXR?
Our patient had left lower lobe collapse which can be seen on cxr. It is of course much easier to see on the CT scan.
Some of the features which can be seen are:
A triangular opacity in the posterior aspect of the L lung referred to as the ‘sail sign’
A ‘double cardiac contour’
Depression of the L hilum
Loss of the L hemidiaphragm
Loss of the outline of the descending aorta
Treatment of a mucous plug which our patient had is chest physiotherapy, nebulized dornase alfa(DNase) and sometimes bronchoscopy. Our patient was admitted 11/11/16 and has been unable to be weaned off the ventilator. He had a trach placed 11/24 to help clear secretions. 11/25he became febrile and grew E. coli out of his secretions. He is again on antibiotics. Our patient had a previous gsw to the neck and may have had some difficulty moving his diaphragm because of that.
Teaching point: there is another sail sign; the thymic sail sign which occurs in children when a pneumomediastinum elevates the thymus and it appears in the R chest.
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3. Bejvan S, Godwin J 1996. Pneumomediastinum: old signs and new signs. AJR Am J Toentgenol 166(5) 1041-8.