Right lower lobe round pneumonia (hidden below the diaphragm)

Case contributed by Joshua Yap
Diagnosis certain

Presentation

Fevers and right upper quadrant pain.

Patient Data

Age: 3 years
Gender: Male

There is a round opacity within the base of the right lower lobe below the right hemidiaphragm. The abdominal structures are normal.

Subsequent chest x-ray again shows a round opacity within the base of the right lower lobe below the right hemidiaphragm. This is confirmed on the lateral projection where there is blunting of the right posterior costophrenic angle and loss of the "more black sign". There is also generalized peribronchial thickening consistent with inflammation. No pleural effusions.

Case Discussion

When reviewing chest and abdominal x-rays, it is important to check below the diaphragm for consolidation or masses that may hide within the lung bases. A lateral chest x-ray can be useful to look for loss of the "more black sign" in lower lobe pneumonia.

In this young patient with infective symptoms, the diagnosis is right lower lobe round pneumonia which typically occurs in this age group due to underdeveloped collateral airways.

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