Presentation
Confusion and hallucinations after having been recently diagnosed with metabolic encephalopathy secondary to pneumonia. Patient reports chest pain and shortness of breath. PMH includes T2DM, HTN, dyslipidemia, CABG x5 with pacemaker, essential tremors and Parkinson disease.
Patient Data
The trachea is midline.
Bilateral pleural effusions are noted, left greater than right. Left lower lung airspace opacification is noted adjacent to the pleural effusion.
The cardiomediastinal silhouette is unremarkable in size and contour. Intact median sternotomy wires and single lead left-sided pacemaker are also noted.
There is prominence of the interstitial markings. Bilateral hila are unremarkable.
There is also moderate osteoarthritis of the shoulders and acromioclavicular joints.
Case Discussion
Blunting of the costophrenic angles on this patient's chest x-ray is consistent with pleural effusions, which are clearly demonstrated on the lateral projection.
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