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Image challenge
Curious CXR
  1. Graham Pluck1,
  2. Max Friedman1,
  3. Henrietta McGrath2
  1. 1 Emergency Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  2. 2 Radiology Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Graham Pluck, Emergency Department, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK; graham.pluck{at}cantab.net

Abstract

A 98-year-old man with 2 days of headache, nausea, malaise and unsteadiness was referred to the ED by his GP with a suspicion of an intracranial bleed. His medical history included atrial fibrillation (AF) (taking warfarin). Observations were SpO2 95% on air, RR24, HR88, BP210/104, GCS14, Temp 34.3. On examination he had bilateral creps and was sleepy but not confused. A septic screen was undertaken and intravenous ceftriaxone given. His CTH was essentially normal. His CXR is shown in figure 1.

Figure 1
Figure 1

Anteropsterior(AP) CXR at presentation.

Question What is the diagnosis?

  1. Acute collapse and consolidation secondary to pneumonia.

  2. Spontaneous haemothorax.

  3. Acute consolidation with underlying old TB.

  4. Traumatic lung contusions.

  • chest
  • geriatrics
  • infectious diseases
  • bacterial
  • pneumonia/infections
  • x-ray

https://doi.org/10.1136/emermed-2019-208453

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    Footnotes

    • Contributors GP wrote the manuscript. MF gained consent from the patient and reviewed the manuscript. HM reported the images and reviewed the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Patient consent for publication Obtained.