Presentation
Acute onset cough and breathlessness. Previously well.
Patient Data
Complete opacification of the right hemithorax with volume loss - the trachea is shifted to the right and the heart shadow is displaced to the right.
Case Discussion
This patient had aspirated some food and a subsequent CT demonstrated a grape completely occluding the right main bronchus.
Hemithorax white-out (differential) has several causes and the position of the trachea is pivotal to making an accurate diagnosis. In this case, as the trachea is pulled towards the opacified side, the differential diagnosis includes total lung collapse, pneumonectomy and pulmonary aplasia.
The patient had an a previously normal chest X ray and no past medical history so the diagnosis of total lung collapse was made. It is important to distinguish from a massive pleural effusion so that a chest drain is not placed into the collapsed lung.
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