Left upper lobe pneumonia and pectus excavatum

Case contributed by Dr Andrew Dixon

Presentation

Cough and fever

Patient Data

Age: 35
Gender: Female

Chest x-ray

Modality: X-ray

PA film demonstrates opacification within the left mid to upper zones which partially obscures the left heart border consistent with left upper lobe consolidation, particularly involving the lingular segments. There is hazy opacity in the right lower zone medially and the right heart border is not visualised.  This could be misinterpreted as an additional right middle lobe consolidation, however this is in fact due to a pectus excavatum deformity, which is suggested by the orientation of the ribs and is confirmed on the lateral film. 

Chest x-ray

Modality: X-ray

Two weeks later

Follow-up imaging two weeks later shows resolution of the left upper lobe pneumonia, but persistence of the hazy opacity in the right lower zone medially which is related to pectus excavatum deformity.  

Case Discussion

This case demonstrates the typical appearance of pectus excavatum on frontal chest radiographs and how one might be tempted to incorrectly report right middle lobe pathology especially in the setting of respiratory tract symptoms. 

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Case Information

rID: 23146
Case created: 25th May 2013
Last edited: 15th Jan 2017
System: Chest
Inclusion in quiz mode: Included

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