Presentation
Shortness of breath and productive cough for several days.
Patient Data
The film is rotated to the right and underinspired.
No ECG monitoring. NG tube tip is too high and the tip is likely within the distal esophagus.
There is increased density in the apical and right upper zones with elevation of the horizontal fissure. Features here are of right upper lobe collapse.
The medial ends of the clavicles (blue) are clearly not equidistant from the midline denoted by the spinous processes (dashed yellow line). The trachea is displaced to the right, but the degree of displacement is consistent with the amount of rotation.
Case Discussion
Assessment of rotation is important when reviewing a chest x-ray. In this case, the tracheal position is secondary to rotation rather than being displaced by a pathological process.
The patient has right upper lobe collapse with reduced lung volume on the right and elevation of the horizontal fissure.
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