Severe COPD and pectus excavatum

Case contributed by Dr Henry Knipe

Presentation

Increasing shortness of breath. On home oxygen.

Patient Data

Age: 45
Gender: Female
X-ray

The lungs are hyperexpanded. Obscuration of the right heart border. Prominent main pulmonary trunk, suggestive of pulmonary arterial hypertension. 

X-ray

5 years prior

Comparison with chest x-ray 5 years earlier demonstrates a pectus excavatum on the lateral projection. The lungs are also hyperexpanded, 

Case Discussion

Lung hyperinflation or hyperexpansion can be normal, especially in young patients who take a large breath in for an inspiratory chest radiograph or can reflect COPD. The latter is the cause in this case due to a history of heavy smoking and a clinical diagnosis. 

Pectus excavatum is a great mimicker of right middle lobe collapse or consolidation. The shift of the heart to the left and horizontally orientated ribs are good clues, and a lateral projection will confirm the diagnosis. 

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Case information

rID: 39471
Case created: 6th Sep 2015
Last edited: 7th Sep 2015
System: Chest
Inclusion in quiz mode: Included

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