Severe thoracic scoliosis

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Shortness of breath. COVID-19?

Patient Data

Age: 90 years
Gender: Female
x-ray

Severe thoracic scoliosis convex to the right.

Lungs clear.

Case Discussion

A simple radiograph I hear you comment.  Indeed yes, but this is included to outline a couple of learning points of interest.

The profound scoliosis is a meritable pathology in itself given the severity of the condition. But here are the points of interest;

a.  Don't let a striking finding distract one from potentially more serious/acute pathology.

b.  Be aware of how the typical anatomy you are used to is now altered and could lead to misinterpretation.

One might mistake the normal outline of the right breast in this case as consolidation or even a mass.

c. Don't be scared in your practice to report these radiographs (it's always easy to leave them and hope others might report them).  You will only ever improve if you take on these more challenging radiographs.

d.  Isn't it striking to see the whole of the heart!  It also allows one to appreciate how much spine is hidden behind the heart on a normal radiograph where hidden pathology may lie.

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