Presentation
Known case of bronchial asthma and COPD, comes with acute exacerbation.
Patient Data
Features of right upper lobe collapse (homogeneous density with elevated horizontal fissure)
Immediately CT was done to assess right upper lobe collapse, and then whole night, I was receiving calls on my representation / misrepresentation of images and CT-Chest X-RAY discordance.
Senile barrel chest deformity seen with marked AP expansion of lower thoracic cage. No upper lobe collapse is seen. Finding of upper lobe collapse on chest radiograph is being discarded as projectional artifact.
Case Discussion
In the night, I could only see the CT images, and snubbed it off as emphysematous lung with senile chest deformity. Then, the medicine resident on-duty made me repeated calls about chest x-ray, which showed obvious collapse. In morning, we repeated chest x-ray and CT both. Findings were same, presented here.
It was concluded that, it might be a projectional artifact due to deformed thoracic cage, and apical pleural thickening. In retrospect, if we see, some symmetrical upper lobe haze is also seen on left side.
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