Hemithorax whiteout and anterior shoulder dislocation

Case contributed by Dr Balint Botz

Presentation

Reduced oxygenation, high PCT and CRP levels, freshly placed CVC.

Patient Data

Age: 75
Gender: Female
X-ray

Mobile supine AP CXR (MICU)

Almost complete whiteout of the left hemithorax. The trachea retains a neutral position, suggesting a mixed pathology of atelectasis and pleural effusion. 

The homogeneously reduced transparency of the right hemithorax is likely due to effusion. The overlapping patchy airspace opacities are a result of both atelectasis and pneumonia considering the clinical picture. 

The CVC introduced through the right internal jugular vein is in a correct position corresponding to the SVC.

Several ribs on the right show signs of healed fractures. 

The left humeral head has dislocated anteriorly and inferiorly. 

Case Discussion

Considering the amount and extent of pathologies present in the image it is easy to fall victim to the satisfaction of search error and ignore the unexpected abnormality - the humeral head dislocation. Rigid adherence to a systematic search pattern is of great importance in such cases. 

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Case information

rID: 56743
Case created: 19th Nov 2017
Last edited: 9th Dec 2017
Inclusion in quiz mode: Included
Institution: University of Pécs

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