Right sided pneumonia

Case contributed by Dr Wayland Wang

Presentation

Flu like symptoms and right pleuritic chest pain.

Patient Data

Age: 40
Gender: Male
X-ray

Presentation chest x-ray

Heart size is within normal limits. Parahilar soft tissue density , mass vs lymphadenopathy. Widespread airspace opacity throughout the right lung. Prominent interstitial opacity throughout the right lung. Small right pleural effusion.

Conclusion: The appearances suggest right parahilar mass or lymphadenopathy with possible lymphatic obstruction.

X-ray

Chest x-ray a day later

There is extensive left sided mixed alveolar and interstitial opacification, progressed since yesterday. Appearance favours significant pneumonia. Right hilar soft tissue density is less well defined on today's study.
X-ray

X-ray 2 months later, after treatment

The heart size, mediastinal contours and pulmonary vascular pattern are normal. The lungs and pleural spaces are clear. There is no evidence of a pulmonary mass, infiltrates or pneumothorax.

Case Discussion

Often the initial imaging of a patient's illness can be quite non-specific, with a broad differential that includes malignant and non-malignant conditions. In many cases the evolution of the underlying process is as important as the findings at each point in time, as in this case where the initial imaging was suggestive of a hilar mass but subsequent imaging showed rapid progression to a diffuse consolidative process. The complete resolution after treatment is in keeping with an infective process.

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Case information

rID: 50759
Case created: 20th Jan 2017
Last edited: 21st Jan 2017
System: Chest
Inclusion in quiz mode: Included

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