Presentation
Increasing breathlessness. Bibasal crepitations on examination. Background renal failure (amyloidosis) and mechanical aortic valve replacement (on NOAC).
Patient Data
Sternotomy wires. Aortic valve prosthesis.
Well defined 22 mm opacification in the right mid-zone, projecting over expected position of horizontal fissure.
Increased lung markings representing pulmonary edema.
Small bilateral pleural effusions with blunting of both costophrenic angles.
Heart size cannot be accurately assessed, but appears enlarged.
Bilateral glenohumeral joint degeneration.
Repeat CXR one month later demonstrated resolution of the pleural effusions and of the right midzone opacification. This is compatible with a pleural pseudotumor.
Case Discussion
Recognition of expected positions of lung fissures is important to consider when assessing solitary pulmonary nodules, especially in patients with established cardiac failure. Lateral radiographs can be useful to illustrate fluid within the fissures, particularly the horizontal fissure on the right.
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